From free health care to pricing in subsaharian Africa : rise and fall of the project "health for all"[De la gratuité à la tarification des soins en Afrique subsaharienne : grandeur et décadence de l'objectif "santé pour tous"]

The idea o f the "health for all", that consists in insure to each the free access to health care and the equality on treating, has been found enough rapidly taken in defect by the catastrophic economic situation of countries of Africa to the South o f the Sahara. Faced with the impossibility to promote a free health policy for all, local governments and international organisations, such the WHO and the UNICEF, have proposed to make pay users for cares that they receive and to decentralize management of public health system so as to create the favorable environment to a market of health. This reform of health system in Subsaharan Africa, called the Bamako Initiative, is going to tempt to solve inefficiency and iniquity problems of free health care but is going to knock in the same time to the persistence of recurrent question that has not been solved.