Measuring time utilization in rural health centres.

OBJECTIVES: During the recent re-design of the primary health care system in Cameroon a time-motion study was undertaken to determine how health workers at rural health centres use their time before redefining their roles. METHODS: The study developed a simple, effective and inexpensive tool which uses the activity sampling technique, and was applied to 20 health centres with a total of 19,080 observations being made of 64 health workers who represented all grades of worker in the government health services. RESULTS: The study developed a clear picture of how health centre staff apportion their time, and how the division of labour and tasks is carried out in a rural health centre. It found that only 27% of health workers' time is currently being spent on productive, health-related activities, and of this time, the largest proportion is spent on curative, clinical work. Less than 1% of health workers' time is spent on preventive and outreach activities. DISCUSSION: This study has developed a simple and inexpensive tool which can be used in any health facility to determine how health-related activities are carried out. This is an important step if changes in the delivery structure are to be made, because it establishes the discrepancy between expected and actual behaviour, and provides an important baseline for the evaluation of the effectiveness of any changes that are introduced within the system.

Recovery of recurrent health service costs through provincial health funds in Cameroon.

This article describes the Provincial Health Funds pioneered in two Provinces of Cameroon. These funds are non-profit associations and financed by the community through drug fees and--to a lesser extent--through fees for services. The financial objective of the Funds is the full coverage of both the costs of the drug supply and the recurrent non-salary costs of the entire public health services in the province. In addition the funds are channels for community participation in the management and improvement of health services. Following a discussion of the institutional and legal framework, the paper examines the cost recovery targets and the mark-up necessary to achieve them. Comparison is made with mark-up and prices of private for-profit pharmacies. In its third year of operation, the Fund currently covers 62% of recurrent health service costs, up from 22% in the first year. With increasing number of health centers joining the fund full coverage of recurrent costs is projected to occur at the earliest in year four of operations. The authors argue that the appropriate role of donor assistance is not only to finance investment but also to subsidize recurrent costs, until the fund has reached its optimal anticipated size, thus realizing economies of scale. While the final word on sustainability can only be said years after the funds have reached their final size, the consistent trend towards full cost recovery is encouraging.

[Peritoneal tuberculosis. Apropos of 5 cases of acute abdomen recently operated at the Central Hospital of Yaoundé]. / Tuberculose péritonéale. A propos de 5 cas d'abdomen aigus récents opérés à l'hôpital central de Yaoundé.

Tuberculosis has become a rare disease in developed countries. However, this is not the same in Third World countries where the prevalence rate is 20 to 50 times greater. The abdominal forms are relatively rare, but should also be looked for, because surgery, which would show the affection of more than one organ, permits the revelations of tuberculous granulomas, and also permits a more specific treatment of these patients.

[Upper digestive system hemorrhages in Cameroon (apropos of 172 cases examined via endoscopy)]. / Les hémorragies digestives hautes au Cameroun (à propos de 172 cas explorés par endoscopie).

172 cases of upper gastrointestinal bleeding were explored endoscopically from 01 March 1987 to 15 May 1989 in 3 centers in Cameroon. The patients comprised 124 men and 48 women with an average age of 39.64 years. Haematemesis with resultant melena constituted the most frequent presentation (42.36%) while haematemesis and melena was the unique presentation in 37.22% and 17.91% of cases respectively. The aetiologic factors encountered were: duodenal ulcers (33.64%), acute gastric bleeding (22.08%) gastric ulcer (13.44%), ruptured gastroesophageal varices (13.92%). Predisposing factors included the ingestion of gastric irritant medication, spices and alcohol. The authors review the literature and in its light, discuss the epidemiology and aetiology of gastrointestinal bleeding in Cameroon.

[The role of exclusion gastrectomy in gastroduodenal pathology]. / Place de la gastrectomie pour exclusion dans la pathologie gastroduodénale.

Following a gastrectomy for exclusion performed 13 years ago with an excellent result at the time of an ulcerous recurrence after vagotomy, the authors have extended that indication to the "large stenosis" characterized by a huge gastric bag down to the pelvis minor including a plentiful stasis liquid, and by presenting some non-reversible sclerotic lesions. The results obtained have confirmed the merits of such technics of which the indications have been clearly expressed. The technic consists of not dissecting the ulcer, but to do stitches on the 2 cm stump, its mucous membrane having been resected, of the pyloric antrum. So stump complications are eliminated as well as biliary-pancreatic risks. The authors' experience is based on 54 case reports (6 females and 48 males) with a follow-up of an average of more than 7 years. 13 patients underwent in November 1987 an endoscopic control. Gastrectomy for exclusion with resection of the mucous membrane of the pyloric antrum appears to the authors as a permissible indication in treating "large African stenosis" as well as stenotic recurrence following a "Dragstedt" operation.

[Impact of the African year of vaccination on vaccine coverage in Cameroon]. / Impact des journées africaines de vaccination sur la couverture vaccinale au Cameroun.

The efficiency of the African Year of Immunization has been studied in Cameroon by the evaluation of the nationwide coverage thanks to two cluster sample surveys carried out in rural and urban areas. The results are compared to those of previous surveys.

[Anal fistula: value of the fistulectomy technic combined with endoanal suture using chromium catgut. Reflections apropos of 25 cases]. / Fistules anales: intérêts de la technique de la fistulectomie associée à la suture endo-anale au catgut chromé. Réflexions sur 25 cas.

Results of treatment of 25 cases of anal fistula demonstrate that these lesions can be treated by combined fistulectomy and endoanal suture whatever their anatomic type, if the technique is carried out patiently and strictly. It ensures successful relief in 100% of cases of fistula treated by first intention. Satisfactory results were obtained after recovery surgery in 3 of 5 cases (60%) the 2 patients failing to respond having been treated by Arnous' method. Its advantage is total conservation of anal sphincter, avoiding postoperative sphincteric complications and other local sequelae.

[Ambulatory surgical treatment of uncomplicated inguinal hernia with minimal local anesthesia]. / Traitement chirurgical ambulatoire des hernies de l'aine non compliquées avec anesthésie locale à minima.

At a time when scientific progress is to the forefront in the field of anesthesia, by the increased knowledge and use of anesthetic drugs and their antidotes, and by the increasing sophistication of anesthetic and intensive care apparatuses, it could appear absurd to wish to make local anesthesia in treatment of uncomplicated inguinal hernia a commonplace procedure. However, confronted with the usual risks of general anesthesia and the minimal incidence of accidents after local injection of 2% xylocaine, the authors have developed a technique of infiltration of certain key-zones to ensure maximum effectiveness of 4 to 6 cc of the compound. Results are reported of the use of the method in 100 ambulatory patients, age range 15 to 70 years, of both sexes. A full discussion on the procedure adopted follows a brief summary of the anatomy and nerve supply of the inguinal region.