The secondary importance of primary health care in South Cameroon

Primary health care in a multi-level perspective: towards a research agenda

The authors propose to view primary health care (PHC) from a multi-level perspective. Studying how PHC is conceived and implemented at different levels of social organization (e.g. in international agencies, national governments, regional centres of health care and local communities) will reveal which interests may be competing in the planning and execution of what broadly and conveniently is called 'PHC'. Mapping out these conflicting views and interests will contribute towards a better understanding of how PHC works or why it does not work and provide suggestions for a more effective and equitable PHC. Five themes are proposed for a multi-level research approach: (1) vertical versus horizontal organization of PHC: (2) the role of medical personnel in PHC; (3) the distribution of pharmaceuticals; (4) the integration of traditional medicine in PHC; and (5) family planning.

Concepts of illness and the utilization of health-care services in a rural Malian village

This paper discusses the concepts of illness and the utilization of alternative medical resources in a rural Malian village, including self-care and the services of cosmopolitan medicine, folk medicine and Islamic medicine. The main concepts of causation are described. Special emphasis is given to the explanatory models for the illnesses mara and nyènkènè bilènkè (red urine). The study presents a hierarchy of classification and analyses the determinants associated with pluralistic medical behavior. Case studies are used to illustrate how the villagers cope with severe illnesses. Finally, it is argued that indigenous illness concepts should be taken into consideration in the design of health-care projects. The research for this paper was conducted in the district of Baguineda, Republic of Mali.