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relate essentially to emergency programs supported by special financing; and the latter can be regarded, considering the present htalth situation of the country as a whole and their geographical location, as luxury or at the very least premature programs. Finally, account is not taken of vertical programs because, since they are in fact favored by certain donors and certain public health administrators, financing for them is always assured, when the political authorities so desire, by external aid, without regard either to their efficacy or to the impact they can have on the organization and operation of the horizontal services.

The following table shows the orders of magnitude of the parameters than can be used, at the various levels of the health pyramid; it also specifies the origin of the information used.

This table prompts the following comments.

Regarding service utilization rates, those given for the cercle towns do indeed relate to the latter (and not to the entire cerc2e), whereas those given for the _arrondissements_ relate only to the peripheral _arrondiss.ment_ (the central _arrondissements_ being by definition those of the cercle capital); the Bamako district is treated separately. It was necessary to use these definitions because of the low attraction radius of th. health units: it has been shown that the service utilization rate falls to a negligible value (less than one contact per 100 inhabitants in a year) when the distance to the _cercle_ health center exceeds 15 km (cf. (581). While the choice of these definitions can hamper comparison between the figures used by us and those published in other studies, we felt it to be clearly preferable. Moreover, the extreme diversity in service utilization rates noted at all levels of the health system is due to many factors. These range from interregional differences in access to care and in the att-itudes of the population to it to no less important differences between health units in the reputation, skills and attitude of the-health personnel. This dispersion is obviously a source of extreme difficulty when it comes to introducing a particular value for this parameter into the model.

Self-medication and private prescribing are of considerable importance which must be reflected as well as possible in our estimates. Unfortunately, this phenomenon, which many people prefer to ignore about, can be measured only indirectly. It is certainly known that, at Niono, 20S of dispensary customers present prescriptions that have not been issued in a health unit and 65 of customers purchase without prescription ([651 p. 77). Similarly, at Bamako, self-medication represents 481 of purchases, and prescriptions written by "anonymous" prescribers (people probably incapable of obtaining a qualification to prescribe) 132 ([671 p. 22). But to be able to estimate the value of drugs supplied in this way at each of the health-pyramid levels defined by us, we had to combine data on PPM turnover and data from the survey of total private consumption.

Thus, we had to obtain from the PPM an estimate of the turnover of the pharmaceutical depots for the first half of 1986. This estimate uses the amount of the discounts granted by the dispensaries to the depot managers and the rate of these discounts (in principle, 151 or 101, depending on the seniority of the depots) to calculate the value of the sales effected in this way. Although approximate, this estimate shows that sales by the depots are