Self-financing and self-management of basic health services.

In Zaïre's Kasongo health district an effort is being made by the community to reduce costs and increase income for the health centres. Decisions on improvements in the running of the centres are partly based on analyses of their utilization.

Cesarean sections for maternal indications in Kasongo (Zaire).

Cesarean section rates in a rural area in Eastern Zaire are described. Indications are stringent and section is essentially performed on maternal indications. In the urban area cesarean section was performed for 1.1% of the expected births over a 9-year period, but only for 0.3% of expected births in the rural area, indicating a major problem in access to the district hospital. Section rates are compared with those reported for other settings.

PIP: In developed countries, cesarean section incidences are well documented. In developing countries cesareans are not widely performed or documented. This study focuses on rural Kasongo in eastern Zaire and documents the incidence of cesarean sections in rural vs. urban areas. Kasongo has 1 typical rural African hospital and a network of health centers. An analysis of the literature yielded data on section rates in other than rural settings. These rates are subject to selection bias and unclear definition of "maternal indication." Rural vs. urban section rates in Kasongo from 1976-84 fluctuate greatly with the lowest rates always in the rural sector (0.3%-1.1% of expected births). These discrepancies may be due to untrained medical personnel, lack of supplies, lack of access to facilities, a high section mortality rate, or a combination of these factors.

[The flexibility of an integrated health service in the campaign against Trypanosoma brucei gambiense trypanosomiasis]. / Réflexions sur la flexibilité d'un service de santé integré dans la lutte contre la trypanosomiase à Trypanosoma brucei gambiense.

The difficulties encountered by the vertical control programme of the gambiense human african trypanosomiasis in various countries, and the achievements of the primary health care policies on the other hand, justify the consideration of an alternative operational management model for this disease. The alternative model presented here is the integrated model. The authors define the concept of integration, discuss its justifications and describe the operational model. Integration is not a goal in itself and could be completed by a vertical approach of the problem in function of the local situations. Integration appears both as a rational response from the health care service to the needs of the population and as a research instrument aiming at answering more adequately the sleeping sickness problem.

Comprehensive can be effective: the influence of coverage with a health centre network on the hospitalisation patterns in the rural area of Kasongo, Zaire.

This study analyses routine data from Kasongo, Zaire in order to assess the influence of coverage with a network of health centres delivering primary care on hospitalisation patterns. Admission rates are 2.1 times higher for non-covered than for covered areas. For non-justified hospitalisations (false positives) distance decay is marked both in covered and non-covered areas, but at consistently lower levels in covered areas. For justified hospitalisations (true positives), hospitalisation rates are markedly lower in covered than in non-covered areas if one considers areas with reasonable (less than 40-50 km) access to the hospital. In more remote areas the relationship is inversed, and populations from non-covered areas do not use the hospital at all, whilst some people from covered areas do reach the hospital. Reduction of hospitalisation rates is for diseases for which standardised technical solutions of known efficacy are available at the health centres. Hospitalisation rates for the diseases usually targetted by selective PHC programmes are reduced by 86% in the covered areas as compared to the non-covered areas. Reduction in hospitalisation rates for those diseases accounts for 29% of the total coverage-related reduction.