Paying for health care instead of buying drugs; an experience from western Mali

This paper gives an overview of what happened when a flat fee cost recovery system for pre-school children was introduced in a rural town hospital in western Mail: the preceding analysis, the implementation of the new scheme, the results and the problems. The most probable explanations for the problems are discussed. It is concluded that, in order to be successful and to attain its objectives, an initiative of this kind - in this environment - requires very careful preparation and commitment, management-wise as well as socially, in order to achieve a sufficient level of common understanding and consensus.