The Bamako Initiative was designed as a strategy for strengthening primary health care. One of the most controversial elements of this initiative has been the prominent role given to community financing through user fees. User fees are a fragile financing tool that requires careful design and implementation. The impact of fees, particularly in relation to equity, needs to be properly monitored and evaluated. To ignore these lessons will only widen the gap between the winners and losers in health care.
Wiseman, V. Reflections on the impact of the Bamako Initiative and the role of user fees [Editorial]. Tropical Doctor (2005) 35 (4) 193-194. [DOI: 10.1258/004947505774938639]