Recession and economic adjustment policies have led to massive resource shortages in government health systems in many less developed countries in Africa. There is growing evidence that the IMF- and World Bank-sponsored adjustment programmes are responsible for negative effects on the health of the poor in these countries. Calls for a New International Economic Order and 'adjustment' in the industrialized countries have been ignored and the resource flow from the poor to the rich countries continues. UNICEF is currently promoting ‘Adjustment with a human face’ as a means of alleviating poverty and minimizing the negative impact of adjustment on the poor. In the health sector, this approach concentrates on the GOBI-FFF strategy and the supply of essential drugs to primary level health services. UNICEF is also in the process of launching the ‘Bamako Initiative’ which aims, by introducing drug/treatment charges and setting-up revolving drug funds at community level, to finance drg costs, the operational costs of the MCH programme and the salaries of community health workers at primary level. Quite apart from the debatable long-term impact of the health strategy being advocated, the Bamako Initiative poses serious questions related to equity and the implementation of fee systems which must be answered.