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Fifty-three districts have been identifted to cover the entire country. Five CMs have so far been upgraded (Bogandd, Diapaga, Nouna, Tougan and Zabrć) with the construction of a surgical unit, three of them under the IDA-supported first health project (FHP) which is scheduled to conclude in June 1994. An additional nine CMs are being upgraded (Boulsa, Boromo, Kongoussi, Houndd, Dićbougou, Kossodo, Orodara, Paul VI, and Pissy) under the FHP and are expected to be completed by mid-1994.

2.12 The oriyate health sector is expanding. A recent survey indicated that there were 140 private doctors' offices or clinics in the country, mainly in Ouagadougou and Bobo-Dioulasso. Traditional practitioners exist in virtually every viliage and town in Burkina Faso. The Govemment occasionally sponsors training activities to upgrade the knowledge and practices of these practitioners. In addition, the Directorate of Pharmaceutical Services (DSPH) bas an office dealing with the identification and promotion of effective traditional pharmacopoeia. Based upon data from only one province, it is estimated that about 60% of out-of-pocket expenses on health care are spent on traditional medicine (para. 2.14).

2.13 The pharmaceutical sector is divided into a growing private sector and a stagnant and inefficient public sector. These two sectors are responsible for all phases of drug distribution. Pharmaceutical production is characterized by:    0) production of perfusion Solutions by the

Młdicaments du Faso (MEDIFA) laboratories which were established with the cooperation of Italy; 00 production of lOOtng chloroąuine tablets, 500 mg paracetamol tablets, and 500 mg units of acetyl salicylic acid at the Research Institute of Natural Substances (U. Parma/IRSN) which was established through the cooperation of the Belgian govemment and with assistance from the United Nctions Office of Industrial Development; and (iii) production of pharmaceutical alcohol by the mixed Capital company Sociśtć de Production d'Alcool (SOPAL) located in Banfora. Bulk distribution is guaranteed by: 0) SONAPHARM (Sociśtć Nationale d'Approvisłonnement Pharmaceutiąue) a mixed Capital company which bas undergone privatization during which the Goverament's holding was reduced from 51% to 5%; (ii) COPHADIS (Coopłrative Pharmaceutiąue de Distribution), an entirely private wholesaler which began operations in early February 1994; (iii) ABOREX Burkina a private wholesaler which has recently obtained its operations permit; and (iv) la CAMEG (Centrale d'Approvisionnement en Mćdicaments essentials Ginźriąues) which was created in 1992 to ensure the supply of essential, generic drugs to public health centers and private non-profit health centers according to the recommendations of the Bamako Initiative. Retail distribution of pharmaceutical products takes place through two main channels: 0) free distribution at the public health centers constituting a minimum supply level of emergency medicines in order to assure emergency health care; and 00 distribution to 60 paying pharmaceutical offlcines most of which are located in the urban zones (36 in Ouagadougou and 13 in Bobo-Dioulasso). The remaining gap is morę or less fdled by 460 pharmaceutical outiets which are not managed by pharmacists, and which have received legislative exemption in order to improve drug availability in the rural zones. There is a total of 176 private outiets and 284 community/village-owned outiets in Burkina Faso. The majority of these outiets operate under a cost-recovery system and the funds received from the sale of drugs are used for the resupply of drugs and to cover other village priority needs. Drugs from donors and NGOs represent a non-negligible, but unquantifiable, share of the total supply.