Improving access to essential drugs for rural communities in Nigeria: the Bamako initiative re-visited.

One of the major indices of the performance of the primary healthcare delivery remains improved access to essential drugs. The Bamako Initiative (BI) was introduced by WHO/UNICEF in the late 1980's to improve access to essential drugs for the most vulnerable in the society and thus improve the health outcomes. However, almost 20 years post-inception, the outcomes and/or impact of the BI on the health indices of many implementing African countries remains varied, with not so significant improvement in health status being registered in a majority of countries. A review of literature suggests that the poor outcomes may be attributable to issues more fundamental than just the absence of adequate funding. Although the current Nigeria Drug Policy (NDP) clearly enunciates and provides policy direction for the core objective of the Bamako Initiative (BI), which is "EQUITABLE ACCESS TO ESSENTIAL DRUGS at the community level", it appears the implementation guidelines may not have drawn on the NDP policy guidelines to provide an adequate framework/tools to ensure efficient realization of the core objectives of the BI. This paper appraises the implementation of the BI in Nigeria within the context of the NDP. It reviews the current status of the BI in the country and attempts to proffer solutions for improvement and/or functionality. The paper seeks:1. To provoke thoughts and direct attention to an aspect of Public Health Pharmacy, which had been hitherto neglected by Pharmacists and Programme Planners.2. To get pharmacists more involved in ensuring the efficiency and safety of drug supply at the community level.3. To engender more research by pharmacists and stakeholders for improved outcomes in this service area.