The geography of the Northwest Province in Cameroon is mountainous with altitudes ranging from 1200 to about 5500 feet, covering land from low-lying tropical forest to high savanna grasslands. The roads that exist are of laterite, making travel during the rainy season very difficult. During the dry season, from mid-November until late March, the Province is dry and dusty. The Health Board of the CBC is in Kumba, 60km from Bamenda, the Provincial capital. All IHCs are within three days drive on unpaved roads from Bamenda. The primary languages spoken in the health centres are English and Pidgin English. In Etoug-Ebe and Nyamboya, French is also spoken. Figure 1 uses a map of the Northwest Province with the locations of the IHCs and hospitals to illustrate the study area.

Figure 1. Study area

Health centres and hospitals n = 14

CBC health facilities vary greatly in their capacity to recognize, diagnose and treat different illnesses. Considering that the location, number of patients seen on a daily basis, number of personnel, extent of personnel education and training, and disease patterns may partly explain the discrepancy in prescription patterns, it is important to note the differences from clinic to clinic. In particular, some clinics have an on-site doctor or at the very least, a regular doctor's visit. Other facilities have less highly trained personnel and less frequent doctor supervision. Some facilities are very busy in comparison to others, seeing over 100 patients a day, others less than 30. Furthermore, some clinics have extensive diagnostic capabilities, such as laboratory tests and ultrasound. The tables in Appendix 1 describe in detail the characteristics of the hospitals and IHCs.