CAMEROON
There’s strong and high-level political will to deliver UHC in Cameroon, aided by multi-sectoral collaboration. But health expenditure needs to rise if the country is to realise its vision.
Cameroon’s commitment to UHC was reflected in a 2017 declaration by the President, which underlined the country’s determination to strengthen its health system. A national Technical Working Group on UHC (GTN-CSU) has also been established.
Working closely with the Ministry of Health, the GTN-CSU has adopted a multisectoral and intersectoral approach to address the various obstacles to UHC reforms, including developing a roadmap for moving forward. The country has also established various financing mechanism to advance UHC, including performance-based financing (PBF) and a voucher system for pregnant women, called Chèque Santé. Moreover, a long-standing public interest group, called Regional Funds for Health Promotion, located in each region of the country, enables easier and better access to quality medicines for health facilities, as well as community-based health promotion initiatives.
Nevertheless, health expenditure remains insufficient to achieve Cameron’s UHC objectives, a difficulty that is compounded relatively inefficient public financial management in the health sector. In addition, existing health financing mechanisms such as PBF, Cheque Santé and free treatment for malaria (and, soon, HIV) could produce better outcomes with greater harmonization and coordination.
UHC Indicators
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UHC service coverage index: 45.9%
Physicians per 1,000 population: 0.1
Catastrophic expenditure: 10.8%
L4UHC Support
In L4UHC
2019 – present
Type of Support
- L4UHC Modules
- Collective Action Initiatives
- National coach
- Ministère de la Santé
- Ministère du Travail et de la Sécurité Sociale
- North West Regional Fund for Health Promotion
- Service du Premier Ministre
- Collectivité Territoriale Décentralisée
- Ministère de l’Action Sociale
- Ministère des Finances
- Société Civile: ONG Association de Lutte contre les Violences faites aux femmes + plateforme ONG pour la santé/CSU
- Instance de Coordination Nationale
- Programme National de Lutte Contre le Paludisme
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German Development Cooperation
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World Health Organization
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World Bank
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US Agency for International Development
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The Global Fund
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African Development Bank
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Gavi, the Vaccine Alliance
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United Nations International Children’s Emergency Fund
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French Development Agency
- Aminata Tou (GIZ)
Ongoing Collective Action Initiatives
Among the 7 challenges identified by the National Coordination for UHC for achieving the UHC goals in 2023, 4 were chosen to accelerate the achievement of results, from a perspective of teamwork and coalition between the stakeholders concerned, including beyond the MoH. Hence the launch of three Collective Action Initiatives (CAI) on May 17, 2023.
Objectives
1. Disburse 50% of resources for UHC
Challenges:
How to make UHC Phase I a tangible reality through the effective provision of the resources mobilized for its implementation, knowing that (i) there are a lot of cash flow tensions at the level of the Public Treasury due to the significant demand from other administrations; (ii) there is no fluid collaboration framework to ensure commitments are made on time; and (iii) there is very little communication between the MoF Treasury, the MoH Finance department (DRFP) and the Specialized Paymaster service to ensure effective payment.
Achievements:
- Agreement between the DRFP and the Financial Control to accelerate the commitment of resources: within 30 days vs several months previously.
- Agreement with the Treasury Committee for the disbursement of 500 million FCFA per week.
- Establishment of an information sharing framework between the Treasury Committee, the DRFP and specialized Paymaster service.
Results:
10.6 billion FCFA were disbursed under focus area 1/.
2. Enroll 40% of Phase 1 UHC target (1.3m people)
Challenges:
How to mobilize and gain support from the target populations of the UHC Phase I, knowing that (i) there is poor coordination of training mechanisms for personnel engaged at the level of the different enlistment structures; (ii) there is weak support from the targets of the UHC Phase I due to lack of information, fear or reluctance; and (iii) there are many delays in the process of acquiring equipment and operationalizing enrollment posts.
Achievements:
- Harmonization of training content and approaches and pooling of enrollment materials between regions.
- Several consultation meetings between the UHC Coordination (CTN-CSU) and the coalition of UHC CSOs, to raise awareness among the population.
- Several meetings between the CTN-CSU, the Ministry of Social Affairs and the Ministry of Social Security, to facilitate the enrollment of vulnerable groups and members of mutual health insurance.
Result:
1.1 million people enrolled under focus area 2/.
3. Reduce out-of-stock days by 50%
Challenges:
How to ensure the effective and permanent availability of inputs within health facilities in a context of (i) weak communication between stakeholders (purchasing center and programs) on input needs; (ii) cumbersome procurement procedures for the acquisition and distribution of inputs; and (iii) progressive erosion of TFP confidence due to non-payment by the State of counterpart funds.
Achievements:
- Determination of the stock status of tracer inputs in collaboration with the malaria, tuberculosis, HIV and vaccination programs.
- Completion of acquisitions through TFP financing, covering needs for the entire year 2023, except malaria.
- Redeployment of surplus malaria inputs from 2 regions to the 8 others in the country following stronger collaboration.
Result:
Average number of days of stock out of UHC tracer inputs reduced from 15.8 to 6.35 days under focus area 3/.
Completed Collective Action Initiatives
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Objectives
Raise awareness amongst central and regional stakeholders of the UHC strategy and its implementation, starting with the elimination of HIV/AIDS user fees for People Living with HIV/AIDS ( PLHAs)
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Results
- Created sub-thematic UHC groups
- Validated and adopted the strategic development frameworks for UHC and started awareness-raising activities in 8 regions.
Prepare contractual frameworks for the implementation of UHC
- Created a special commission for UHC partnership contracts, with the decree for this signed by the Prime Minister;
- Established a multi-sectoral contract analysis commission.
- Signed a public-private partnership (PPP) contract for the implementation of UHC in Cameroon.
Timeline
Regional module in Morocco with Cameroon and Chad
Module
Regional module in Tunisia with Burkina Faso, Cameroon, Chad and Niger
Module
Virtual regional module with Burkina Faso, Cameroon, Niger and Senegal
Virtual Module
Regional module in Tunis, Tunisia, with Burkina Faso, Cameroon, Niger and Senegal
Module
Regional module in Rabat, Morocco, with Burkina Faso, Cameroon, Niger and Senegal
Module