Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...

THE ISSUE OF ESSENTIAL DRUGS
From its creation in 1962, and until 1983, the PPM was responsible for
importing and distributing drugs to the public. The hospital sector and
public services network were supplied by the central pharmacy of the
National Health Directorate. The private sector was confined to a single
pharmaceutical dispensary in Bamako.
In 1984, following pharmaceutical reform, the PPM appointed itself
to import and distribute drugs to hospitals and public services, effectively
establishing a monopoly.
In 1985 and 1986, laws liberalizing the health professions and
pharmaceuticals raised questions about this monopoly. But in 1987, the
PPM moved in the opposite direction, signing a comanagement agreement
with China that formalized the monopoly. The question came up again in
agreements governing the structural adjustment of public enterprises. These
agreements, concluded with the Bretton Woods Institutions, called for the
PPM to be restructured and to cease from distributing drugs in favour of the
private sector before December 1989. Negotiations with the World Bank to
implement the new health sector policy put an end to the PPM monopoly,
though it was still accorded a major role in importing and distributing
essential drugs. The decision undercut a part of the Bamako Initiative
conceptual framework defined in August 1989: the PPM had been expected
to import and distribute essential drugs to the benefit of public and
community structures. 27
In other words, the PPM’s contract with the government required it
to import and distribute essential generic drugs. 28 Signing the contract was a
condition of the World Bank loan. But now the PPM had to reduce the
number of its personnel from 650 to 200, give up nearly all of its
dispensaries to the private sector, stop importing brand-name specialty
drugs in place of essential generic drugs, and compete with new private
importers of drugs (rapidly put in place with credit assistance from French
drug exporters). The PPM retained its commercial nature but lost all its
27 Brunet-Jailly J (1990) La Pharmacie Populaire du Mali dans le contexte de l’Initiative de
Bamako. 137p. Bamako: Institut National de Recherche en Santé Publique - UNICEF.
28 Ministère de la Santé, de la Solidarité et des Personnes Agées (1992) Contrat plan Etat -
Pharmacie Populaire du Mali. Bamko: Ministère de la Santé, de la Solidarité et des
Personnes Agées.
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