By Brian Nolan

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Thus before country experiences can be assessed, it is necessary to determine whether countries are implementing Bamako-type programs or cost recovery programs with a broader thrust. To complicate matters, some countries are implementing Bamako-type schemes within broader cost recovery programs, and others are implementing various aspects of each. The important point to remember throughout this discussion, then, is that in practice cost recovery in health can take many forms. Not all countries are following a single model, nor are they simply implementing either the standard or the Bamako model.

Medium" spenders include Burundi, Cameroon, the Gambia, Ghana, Kenya, Liberia, Malawi, Mali, Niger, Rwanda, Senegal, Togo, and Zambia. Source: World Bank (1993a), table 2, 130. allocation would do nothing to improve the availability of basic health care. If the objective is to bring about the greatest possible reduction in the burden of disease, the success of cost recovery has to be judged in terms of its impact on the resources available for cost-effective basic health services (as well as on the utilization of these services).

Although some recent studies (notably Gertler and van der Gaag 1990) suggest that the unresponsiveness of demand to price was overstated in early econometric analyses, this does not in any way detract from the importance of quality. Even with a significant negative price effect, if the revenue from user fees is used to improve the service provided, there can well be an increase in demand when fees are imposed or increased, owing to the positive impact of improved quality. Econometric studies that have attempted to capture the influence of quality on demand have had great difficulty identifying the appropriate indicators of quality.

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