Inequity in the Bamako Initiative programme--implications for the treatment of malaria in south-east Nigeria.

An exploratory study was carried out to examine the utilization of malaria treatment services in the Bamako Initiative (BI), the exemption practices and the cost recovery of user-fees for treatment of malaria in south-east Nigeria. Structured questionnaires were used from 1594 households to collect socio-economic and demographic information, the utilization of health care services and experience with user fee exemption. Historical data on malaria utilization rates from 1991 to 2000 were obtained from health centres. In addition, financial information was collected on the annual BI revenue. Health centres for malaria experienced a drop in outpatient attendance when the programme started which later rose again. The more affluent population, as assessed by household belongings and education, used the health centres more often than the poorer population, were more aware of exemptions and benefited from exemptions more than the poorer and lesser educated populations. The sale of anti-malaria drugs was a large proportion of the costs recovered. BI appears to have increased malaria care utilization but has also raised some equity issues. It seems that richer households benefited more than poorer households.