[Toward strengthening the health politics in Africa: the military health system and its contribution to health policy in Senegal]. / Pour le renforcement des politiques de santé en Afrique: le cas de la contribution de l'armée à l'effort en matière de santé au Sénégal.

Since the following days of independences, the Senegalese army mission has mainly consisted in defending the national territory integrity and in ensuring the protection of the populations and their goods. In the public health system, thanks to the quality of its human resources the army intervenes specifically at every level of the health care structure. The mission assigned to the Senegalese army health unit is therefore multidimensional. In 2001, the operational budget of the army health services is estimated at 177 millions CFA F (265500 euros), its medical consumption at 212 millions CFA F (323 000 Euros) and its health expenditure at 385 millions CFA F (585 000 euros). The army supports the government health policies in different ways: on the one hand, availability of the ministry of health staff, on the other hand, the direct involvement in health care and the implementation of the national and international health programmes.

[Cost of tetanus toxoid injection using a jet-injector (Imule) in collective immunization in Senegal: comparison with injection using a syringe and resterilizable needle]. / Coût de l'injection d'anatoxine tétanique par injecteur sans aiguille(Imule) lors dúne vaccination collective au Sénégal: comparaison avec l'injection par seringues et aiguilles restérilisables.

Needle-less jet injectors were developed by the US army after World War II. Their principal use, however, has been in the administration of lyophilized vaccines from multidose vials to at-risk populations in developing countries. In 1983, a hepatitis B epidemic occurred among customers of a beauty clinic in California (USA) following the use of jet-injectors, demonstrating a clear risk of cross-contamination associated with this technique. As a result, the WHO and Unicef stopped recommending jet-injectors for collective immunizations in developing countries. To eliminate the risk of contamination, Pasteur Mérieux Sérums et Vaccins (now Aventis Pasteur) developed, in 1990, jet-injectors for use with single-use vaccine cartridges. These injectors were tested for tetanus toxoid, DTP, influenza, hepatitis A and typhoid Vi vaccination. The immunogenic reaction was as strong and the injection as well tolerated as for injections using a standard needle and syringe. The additional cost of the Imule technique was evaluated in a district-wide (127,000 inhabitants) tetanus toxoid immunization program at Velingara, Senegal in 1993. The total cost was estimated to be 1.51 FF (76 F CSA, 0.32 US dollars) for one dose of tetanus vaccine given by needle and syringe and 2.41 FF (121 F CSA, 0.56 US dollars) for one dose given by Imule. Thus, the additional cost of injection by ImuleTM was 0.90 FF (45 F CSA, 0.21 US dollars). The cost of cross infection in sub-Saharan Africa has been estimated to be 2.37 FF (118 F CSA, 0.55 US dollars) per injection if injection practices are not supervised. Therefore, the Imule technique may be considered to be cost-effective. However, the technique is still not completely reliable, as shown by the total breakdown of four jet injectors during this vaccination session. Lyophilized vaccines have also not been tested in the field. Vaccinators prefer Imule, training is easy and immunization can be carried out on a day-to-day basis with no vaccine wastage. Imule is not yet in mass production, which would reduce costs. In the face of the ever-increasing risk of cross-contamination during vaccination sessions in sub-Saharan Africa, the Imule technique deserves considerable attention.

[Evaluation of vaccination policies. The case of measles]. / L'évaluation des politiques de vaccination. Le cas de la rougeole.

Any immunization policy involves a given vaccination coverage rate and a related cost of implementation. Moreover, for each vaccination coverage rate, there are associated costs for treating residual morbidity and its human and social consequences. Thus, an overall cost can be determined for each coverage rate, and an optimal policy can be defined. This approach is illustrated in the paper by examining the costs and advantages of a measles vaccination program for France. We first calculate the various costs of the present situation (in which vaccination coverage is close to 0%), and then simulate the cost of total eradication of measles (vaccination coverage = 100%). The results show that the latter policy is to be preferred from every point of view.

[Public and private hospital care--an economic approach (author's transl)]. / Hospitalisation publique et hospitalisation privée: une approche économique de leur appréciation.

In an investigation involving over 1,000 patients, the LEGOS group (Univ. de Dauphine) has studied the two sectors which co-exist in the French hospital service--the public sector and the private profit--making sector. This paper gives the economic results of the investigation. The private clinics function in a commercial framework and define a privileged area of treatment related to the "cost" of the medical activities which occur in this sector. The public hospital aims at satisfying certain needs, in particular those associated with emergencies, and economic considerations are only considered in the last resort. These conclusions are drawn from observations on medically defined situations treated in the two sectors and on medical activities occurring in them.