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2.37    In linę with its objective of improving the supply and minimizing the cost of essential drugs, the MSASF has taken a number of initiatives during 1992-1993. It has: (i) revised the pharmaceutical legislation to facilitate the importation of essential generic drugs; (ii) established an initial list of abom 60 essential drugs (ED) to be imported exclusively in generic form, which is presently in the process of being expanded to a list of 120 EDs; (iii) created an essential drug purchasing agency, the Centrale d'approvisionnement des mśdicaments essentiels gćnćriąues (CAMEG), modeled on the one established under a Bank/UNICEF-supported project in Benin; (iv) given the authorization to donors and donor-supported projects to import directly the drugs included on the Essential Drug List, in generic form; and (v) approved legislation that would allow peripheral health facilities (CMAs and CSPS) to retain the ftinds they collect from the sale of drugs and provision of medical services in order to establish revolving fonds for essential generic drugs.

2.38    To lessen the impact of the recent CFA devaluatlon on the popuiation, the Govemment of Burkina Faso has planned the following steps: (i) accelerating the implementation of a community management system for the primary and secondary level (CSPS and CMAs) health centers; (ii) establishing fixed prices for a national list of essential drugs for all public service health centers; (iii) accelerating training relating to generic drugs for drug prescribers; and (iv) informing the populadon about generic drugs. Under a special action program, the Goverament has agreed as a condition to the IDA Economic Recovery Credit to ftnance a one-time initial stock of essential drugs (US$3 million) for the CSPS and CMAs of the districts that do not yet have in place a fonctioning cost recovery system. This stock will provide the initial Capital for commencing cost-recovery under a revolving fund scheme. Training for key Staff within primary and secondary level health centers would focus on health services management with special attention to drug management, establishment of an accounting system, and organization of essential generic drug distribution. The Govemment has agreed as a condition to the IDA Economic Recovery Credit to finance this training component (US$1.8 million) and UNICEF will act as the implementing agency.

2.39    Within the framework of this national pharmaceutical policy which inter alia promotes the availability of inexpensive essential drugs in cooperation with the private sector, the Goverament intends to take the following actions: (i) abolish the ad valorem margins on drugs; (ii) authorize pharmacists to substitute generic drugs for name-brand, specialty drugs; and (iii) authorize pharmacists who already own a pharmacy to open one or morę additional pharmacies.

2.40 Nutrition. Malnutrition is a serious problem (para 2.5) and lack of integration of nutrition activities into the PHC system has been identified as a weakness under a study of the sector undertaken in 1991 (Ouddraogo Andrź, Analyse de la situation: Secteur de la Nutrition) The Govemment's commitment to controlling the problem has increased substantially in the past few years. The "National Action Plan for Child Survival, Protection, and Development in Burkina Faso," adopted in 1992, specifies the following targets for the year 2000: (i) reduce by 5096 moderate and severe malnutrition in children under five; Cu) virtually eliminate iodine deficiency disorders; (iii) virtua!ly eliminate vitamin A deficiency and its consequecces, including blindness. The MSASF participated in the Montreal global policy conference "Ending Hidden Hunger" in 1991, which specifically addressed micronutrient deficiencies. The Govemment prepared a national program on nutrition which was presented at the International Conference on Nutrition in Romę, in December 1992; a large proportion of this document was devoted to micronutrients.

2.41 Endemic Parasitic Diseases. The Govemment's strategy to secure sustained control of onchocerciasis and trypanosomiasis is based on its Devolution Plan, which was first prepared in