Developing a Sustainable Economy in Cameroon

13 - Public Provision of Health Care in Cameroon: Policy Choices and Options

13 Public Provision of Health Care in Cameroon: Policy Choices and Options Ntembe Augustine Ntembe Introduction and Background Cameroon made considerable progress in its social and economic development over the three decades following independence in 1960. The government embarked on a policy aimed at providing total coverage of the population in all aspects of health care in a progressive manner. These aspects of health included preventive and curative care and health education. The phenomenal growth in health care institutions during this period was reflected in the significant improvement in the health outcomes of the population. However, during the previous decade, health indicators deteriorated dramatically. Infant mortality rate estimated at 65 based on the 1991 Demographic and Health Survey (DHS) increased to about 77 per thousand in the 1998 DHS. Maternal mortality stagnated during most of the 1990s at 430 per 100 000 live births but remained relatively high. During recent years, some of the indicators have recorded progress although these remain inadequate in relation to the millennium development goals. The general decline in health indicators highlights significant problems in the health care delivery system, which include inefficiencies in the allocation of public resources across facilities and regions in addition to a poorly functioning referral system. The deterioration in health indicators has been further exacerbated by a rise in the spread of the HIV/AIDS epidemic. HIV prevalence in Cameroon is estimated at 5.5 per cent. In the absence of any existing therapeutic cure or vaccine for the infection, the disease constitutes a serious threat to the socio-economic development of the country. The rise in government expenditure committed to the fight against the pandemic is likely to strain expenditures for other programmes in the near future if major steps are not taken to reduce the spread in transmission of the disease. The public sector is the most important provider of health services in Cameroon and has relied on general revenues for financing these services. The revenues are in turn generated through direct and indirect taxes, and budgetary deficits supported 260 Developing a Sustainable Economy in Cameroon by domestic and foreign borrowing. Budgetary shortfalls during the period of economic decline forced the government to make painful choices in regard to the financing and provision of health services. Cost recovery was thus introduced as a mechanism of raising additional revenue for quality improvement and freeing public resources that could be reallocated to cost-effective services. While the introduction of cost recovery was expected to raise funds for the health sector, it could not replace government’s role in the financing of health care. Although this role is essential in promoting efficiency and equity, public funds are skewed towards highlevel tertiary services at the expense of cost-effective services. Given the important role of government in health care provision, it is of primary importance to investigate changes in public expenditure on the health sector over time and how it affected health care, to determine whether the government should continue to invest in the sector and the type of interventions on which to spend public money. Equally of first importance is the need to know what local communities and the private sector are expected to contribute to the shortfalls in public health financing. This is in part determined by the influence of prices paid for the use of health care services and household incomes on the demand for health care. This study sets out to address these issues. Based on empirical findings, a number of recommendations are presented on how policies and programmes can be made more effective in improving health outcomes, thus reducing mortality especially among mothers and infants. The main purpose of this chapter is to analyse household responses to the introduction of user fees into government health facilities and to determine whether or not government should provide health services, and if it should to determine the type of services that should be provided. To achieve these objectives, we shall first estimate the effects of prices or cost of health care on utilization and then determine the effects of government intervention on health outcomes particularly infant and maternal mortalities. Later on, we establish a link between health outcomes and interventions relevant to the health sector and particularly verify if public money is more effectively spent on cost-effective services than on curative services. The Institutional and Health Policy Framework Besides being a major provider of health services the Government of Cameroon defines health policy and also manages the health system. The...