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In Togo Congo and Zaire which have experienced periods of political instability BI health centers have demonstrated relative resistance to the instability-- as long as drug supply was maintained services continued to be provided. These countries are now accelerating BI to rehabilitate their peripheral health systems. With the increasing adoption of BI or similar health system reform strategies in Africa there is an increasing need for empirical evidence of their impact on sustainability of PHC in the ``flagship countries. This series of articles attempts to: (i) clarify the sustainability concept and provide an operational definition of sustainability; (ii) summarize the operational strategies and enabling conditions for sustainability implemented in Benin and Guinea; and (iii) analyze the effectiveness efficiency financial viability and equity achieved between 1988 and 1993 by going to scale with the BI in Benin and Guinea. (excerpt)
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