7 learning). In addition, the level of staff providing survices to patients was recorded to allow differentiation in physicians and nurses services cost. Among inpatients, time and motion studies conducted over one week provided the basis for extrapolating an average amount of medical attention for subsequent periods.

A separate survey form was used for drugs, diagnostic tests and surgery. Where drugs were ordered, prescribed, given to the patients (to take at home) or applied to the patient, the drug and the hospital's source (e.g., PROMESE, private sources, SESPAS, etc.) were recorded. Who paid for the drugs and who applied them to inpatients and emergency patients were included to allow costing of donated drugs. Subsequent follow-up and matching with registries--set up bv the project at all sources of drugs (subsidized sale of drugs at Botica Popular; pharmacy in the hospital) and all diagnostic test sites--provided information on whether the hospital filled prescriptions, or followed orders properly or at all.

Twenty-three surgical operations were surveyed, with an attemp_ to gain at least two wound, appendicitis, cataract, hysterectomy and hernia operations so that some rough average for operations in general, and specific kinds of procedures in particular, could be costed out. The level and function of personnel in the operating room were recorded along with the use of equipment, instruments, consumables, drugs and pharmaceutical products.

A registry to capture patient flow on the wards was included in the survey to allow calculation of occupancy rates. Registries in the first aid and immunization rooms captured patients using only those services and the time use of nurses, and a registry of social workers summed the number of daily patient visits.

**Collection of Prices.** No price information existed in the hospital prior to the study. Price information for drugs and consumables -he hospital received from the central government and for goods the hospital purchased outside the facility at wholesale and retail outlets was collected directly from the soui.e. Inventories of stocks were usually available. How much the government paid for those products, and the unit cost of items obtained in bulk, were obtained from the multiple sources of goods.

Unit prices of all potential inputs (hospital official stock and actual usage varied) were obtained from all sources. For example, all drug prices for different concentrations and presentations (liquid, tablet etc.) from the various sources used by the hospital (PROMESE, the drug procurement parastatal; SESPAS; Office of the President; private distributors; and private pharmacies) were collected. The unit cost of each lab, x-ray, pathology and special test was calculated using the appropriate fraction of technicians' time, consumables, reagents and any other inputs.

Prices were obtained from: sear.,ing PROMESE records for what was paid for different products, reviewing SESPAS financial records, studying receipts in the hospital's accounts, interviews with pharmaceutical companies and their distributors, interviews with medical equipment distributors, interviews with distributors of special items such as oxygen, and private pharmacists. In all, prices for 154 consumable items and 1002 drugs were obtained.