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C. Health Sector Flnai

2.14    No comprehensive analysis of private health expenditures has so far been undertaken in

Burkina Faso. Studies carried out as part of the cost recovery pilot operation undertaken under the FHP in the province of Boulgou show that, on average, individuals in the study area spent about CFAF 2,800 (US$10 at the pre-devaluation ratę of US$1 =270 CFAF) per year on health care. Of this, about CFAF 1,000 (about US$3.70) was for modern treatment and drugs, the rest for traditional medicine. Extrapolation from these studies to the national level suggests that totai private expenditures for health might be as high as CFAF 25 billion (US$93 million). That is morę than twice the total national health budget (CFAF 9.9 billion or US$37 million in 1992). Public sector expenditure sources include the central budget (60%) and foreign aid (40%). NGOs provided about CFAF 1.3 billion (US$4.8 million) to the health sector in 1991.

2.15    Imports of drugs have increased considerably in the past few years, growing from about CFAF 3 billion in 1986 to CFAF 9 billion in 1991, equivalent to 1.6% of the GDP. The private sector accounts for the bulk of drag purchases as goverament purchases have stagnated around CFAF 200 million (just over 2% of total drag imports) in the past few years due to budgetary constraints. To the generał public, this situation has meant significant increases in the cost of health care, growing inaccessibility of drugs, as most drugs handled by the private sector are brand names which on average are about six times the cost of their generic equivalents (para. 2.25), and a concomitant declining confidence in public health facilities. As a result of the recent devaluation of the CFA firanc, Burkina Faso cannot continue to spend the same US dollar amount to import drugs. Furthermore, the private sector cannot remain viable by maintaining a policy of importing expensive, specialty drugs which are becoming increasingly inaccessible to a large pordon of the population. In order to ensure its survival, the private sector must move into the generic drag market, and the Government needs to take measures to ease the introduction of an active generic drag market by adopting a national pharmaceutical policy conducive to such a market in cooperation with the representatives of the private sector.

2.16    Public spending within the MSASF (not including aid-financed projects) rosę modestly as a share of total Government budgetary expenditures from less than 7% in the mid-1980s to around 8% in the early 1990s. However, spending on critical commodities, such as drugs, medical supplies, and in-patient feeding, has stagnated in the last three years. Lack of growth in nominał public expenditures for drugs is a particular cause for concern given inflation rates of 7-11 % per annum in international drag prices-a situation which will be exacerbated by the recent devaluation of the CFA franc.

2.17 Investment spending by the MSASF has varied considerably from year to year, approaching nearly CFAF 200 million per annum in budgetary expenditurcs and CFAF 4 billion per annum in aid-financed spending sińce 1987. These amounts represent 1-4% of total public investment spending and 3-10% of foreign aid disbursements, respectively. Recent survey results indicate that 68% of 1991 aid disbursements in the health sector was investment, of which 29% financed technical assistance, and the remainder was Split evenly between facilities constructionyrehabilitation and eąuipment purchases.    Seventeen percent covered operating

expenditures-mostly goods and services-including 3% for drugs and 5% for medical supplies. Ninę percent of aid disbursements supported training activities, and another 3% funded locally hired personnel.

2.18 Burkina Faso has past experience in cost-recovery in some of its health facilities. In the 1970s, fees were introduced in hospitals, urban maternities and medical centers for consultations,