that were already approved by the 1989 Executive Board have shown substantial progress. In Benin, the implementation of Bamako Initiative strategies in the context of the national EPI/PHC programme effectively started in February 1988 in 44 communes spread across the country. In these communes, the number of monthly curative attendances nearly tripled between 1987 and 1989. In addition, pre- natal consultations nearly doubled, the number of deliveries by trained attend- ants increased by 50 per cent in the same period, and the percentage of fully vaccinated children tripled. Forty ol" the most essential drugs were used at an average cost of US$0.50 per treatment, yielding, on the average, USSL5Q per patient. This margin permitted over 40 centres to recover their local operating costs. Studies carried out in six parts of the country on the impact of this system on equity are presently being analysed. During the first half of 1989 these strategics were adopted as national health policy and extended to a total of 300 of Benin's 400 health centres. Guinea started implementing Bamako Initiative strategics in one third of its 300 health centres in 1988. The monitoring of the first 33 centres in mid-1989 showed results very similar to Benin—mainly a strong increase in utilization of curative and MCH services and an average drug cost of US$0.50 per treatment with an average charge to the patient of USS0.80. The proportion of local operating costs and drug costs recovered was 90 per cent on the average. The expansion of the programme to another 70 health Centres is planned for early 1990, Sierra Leone has a three-yearplan to strengthen individual PHC components in three localities, and Nigeria is focusing on community-level activities which complement support in the areas of essential drugs and health systems, from the World Bank, USAro and other donors. Kenya is expected to move from the
**Analysis**
The text appears to be discussing the implementation of a health program, specifically the Bamako Initiative, in several African countries. The program aims to improve access to healthcare services and essential medicines, and its success is measured by increases in utilization of services, improved health outcomes, and financial sustainability. The text highlights the program's impact on equity, cost-effectiveness, and recovery of operating costs.

**Category**
Health