This study summarizes the findings ofthree assessments of Central Medical Store (CMS) reform andperformance in Francophone Africa. The study aims todocument and characterize the organizational reform of theCMSs and the impact of the reform on CMS management andperformance in Cameroon, Burkina and Senegal. It seeksfurther to assess the extent to which increased autonomybrought about by such 'marketizing' reforms hashad an impact on intermediate CMS results, service quality,product quality, and access to medicines. The findingsindicate that organizational reform did contribute towardsimproving operational performance which, in turn, influencedservice quality, product quality, and access to CMS-suppliedmedicine in these countries. However, improvements in theseareas were premised not simply on increased autonomy, but ona whole variety of drivers, both internal and external to aCMS. These include a strong regulatory framework, theconventions, laws, regulations, and administrative acts thatincrease the flexibility of some decision making rights,whilst constraining others, with an emphasis on socialobligations, accountability, and transparency, as well asexternal factors, such as technical assistance, governmentsubsidies, and relevant external policies, institutions andregulations. The paper ends by proposing a framework thatcould be used both for the design as well as for theanalysis of marketizing reforms in CMSs and other publicsector commodity supply entities in developing countries.The framework is sufficiently general that, with somemodifications, it could also be applied usefully to thedesign and analysis of such reform in other public sectorinstitutions delivering social services.
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