CHAPTER FOUR
4.2 POPULATION OF THE STUDY
The questions were both closed and open-end, with closed questions forming the majority of the questions. The
"Likert-style" format formed the basis of most of the closed questions. The "Likert-style" scale helps to develop more valid measure.
Finally, the questionnaire was originally written in English. Considering the bilingual nature of Cameroon, which is French-dominated, the questionnaire was translated into French (Appendix 1b). This was to accommodate the French- speaking medical professionals. The translation from English to French was done by translators at the Ministry of Public Health, Yaounde, Cameroon.
4.1.1.3 Informal meetings and observation
Informal meetings and observation were conducted to seek more information and to obtain personal views on the problem. The researcher had informal meetings with directors, general supervisors, nurses, doctors, librarians and also the patients of the hospitals. She observed the actual state of health information and the application of ICTs in the hospitals during the distribution and collection of the questionnaires. This gave the researcher an opportunity to gather information that would otherwise have been impossible to obtain.
4.2.2 Sampling of government Hospitals
In Cameroon, government hospitals, health areas and centres are arranged hierarchically in seven levels. Levels one to four are hospitals, five and six are health areas and centres and level seven is the Mobile Health Service (MHS). At the time the study was done, the MHS was not yet operational in the country as it was introduced in the new organisation chart of the Ministry of Public Health in September 2002 (MoPH 2002).
Each level is different from the other in management and administration, the amount of financial support received from the State and so are the types of ICTs infrastructure available. Therefore, concentrating on asingle level government hospital will not provide a broader picture. Thus, there was a need to survey hospitals in each of the four levels.
Table 4.1: List of hospitals and their levels in Yaounde centre
Category Types of Hospitals Number
Level 1 Yaounde Teaching Hospitals, General Hospital 2
Level 2 Yaounde Central or Provincial Hospital, Jamot Hospital 2 Level 3 Military Hospital, National Social Insurance Hospiral (CNPS) 2 Level 4 District Hospitals: Biyem-Assi, Cite Verte, Djoungolo, Efoulan and 5
Nkolndongo.
From the table above, Yaounde has 11 government hospitals from level one to four.
4.2.2.1 Reasons for selecting hospitals
From the 11 government hospitals as indicated above, the following criteria were considered in selecting the hospitals for the survey:
• Personal exploration and discussion with individuals in the MoPH.
• The size of the hospital, that is hospitals of the first three levels are very large in size and have many divisions, as well as medical specialists who, in turn, may reflect the ICT experiences; the number of ICTs equipment possessed by these hospitals
• The proximity of the hospitals to the researcher's base.
Thus, six government hospitals from the total of eleven were selected. See Table 4.2 below.
Table 4.2: List of hospitals in the survey
Level Names of Hospitals Number
Level 1 Yaounde Teaching Hospital and Yaounde General Hospital 2
Level 2 Yaounde Central Hospital 1
Level 3 Yaounde Military Hospital 1
Level 4 Biyem-Assi and Cite Verte District Hospitals 2
Total 6
4.2.3 Sampling of Medical professionals (doctors and nurses)
The medical doctors and nurses are directly involved in the provision of quality care, promotional, preventive and curative health services, with the resources at their disposal, including the knowledge and skills acquired. These professionals were the units of population in the six hospitals except in the Military Hospital where only doctors were allowed to participate in the survey. According to the Director of this Hospital, there was low usage and knowledge of ICTs in the hospital and ICTs were mostly used by medical doctors.
A list of medical doctors was obtained from the office of the National Association of Medical Doctors in Cameroon.
This list was considered appropriate because according to the code of medical ethics, all medical doctors trained in Cameroon and/or abroad are supposed to register with this Association before practising medicine in the country (Ngufor 1999). It was later realised that there are doctors who practice and are not registered with the Association.
Therefore, this list was inadequate since it was not up-to-date.
The researcher contacted the "Surveillant Generale" or General Supervisor of each of the hospitals aimed at obtaining an up-to-date list of medical professionals in each hospital. From discussions with the General Supervisors of the General Hospital, Teaching Hospital and Central Hospital it was found that obtaining a reliable list of medical professionals in these hospitals was impossible, because it does not exist. To the General Supervisors, this was attributed to:
• The complex manner in which the health sector is administered, see (Section 2.4.2).
• Medical doctors hold more than one post of responsibility. For example, a medical doctor is appointed as director in one hospital and also the chief medical officer of the gynaecological unit in another hospital. Or the delegate of provincial health is also the director of the provincial hospital and the chief medical officer of one of the units in the provincial hospital.
• The time of the research was when student doctors were on internships in the government hospitals in Yaounde. That is, they move from one hospital to another.
Considering the time constraints of the researcher and the necessity of the research, it was absolutely important for the researcher to have a "workable" population for the survey. The last resort was to use what was available (Kerlinger 1986:120). In this case, the lists of doctors and nurses on duty in each hospital during September and October were used.
Table 4.3 gives abreakdown of the number of medical professionals in each of the hospitals. There was atotal of 325 medical professionals (175 medical doctors and 150 nurses) listed. They were divided as follows: General Hospital 120, Teaching Hospital 90 and Central Hospital 30. The Military Hospital and the two District Hospitals (Biyem-Assi and Cite Verte) are smaller in size and so was the number of medical doctors and nurses. The Military Hospital had only 25 doctors and the two district hospitals 20; five nurse and five doctors from each. With this population, the researcher went ahead and distributed questionnaires to all (doctors and nurses) who were available. See table 4.3 below.
Table 4.3: Distribution of questionnaires to the different hospitals
No. Name of Hospitals No. of questionnaires No. of questionnaires to Total
to Doctors Nurses
1 Yaounde General Hospital 70 50 120
2 Yaounde Teaching Hospital 40 50 90
3 Yaounde Central Hospital 30 40 70
4 Yaounde Military Hospital 25 / 25
5 Biyem-Assi District Hospital 5 5 10
6 Cite Verte District Hospital 5 5 10
Total 175 (52.3%) 150(44.7%) 325
4.2.4 Reasons for choosing Yaounde
Yaounde is the political and administrative capital of Cameroon. The town has all the government ministries and their ministers. It is also the place where all government policies are created and implemented. In 1972, Yaounde became important due to it administrative structures and the city further received asubstantial boost under the unitary structure that brought about increased bureaucratic centralisation. DeLancey and Mokeba (1990:208) opine that, due to the
unitary structure of government, it is very common to see civil servants from all over the country making apilgrimage to Yaounde to follow up the progression of documents in the various ministries.
Yaounde is one of the cities with all the six operational levels of hospital. Therefore, in terms of feasibility and accessibility, and taking into consideration the duration of the study and the financial constraints involved, the researcher found Yaounde the most suitable location to conduct the survey.