2.1 Structure of the health system in Cameroon

According to statistics, people living in low-income countries are much more likely to die from a communicable disease than from a non-communicable disease. Despite the worldwide decline, six of the highest 10 causes of death in low-income countries are communicable diseases. Malaria, tuberculosis and HIV/AIDS all remain in the top 10, but all have seen significant declines thanks to international donors who are fighting against their increase. The largest decline among the top 10 causes of death in this group is HIV/AIDS, with 59% fewer deaths in 2019 compared to 2000, or 161,000 and 395,000 respectively (4).

In Cameroon, the Ministry of Public Health is responsible for developing the health policy and ensuring the implementation of these health policies in the country. Although this ministry has achieved a lot for the past decades, weaknesses could still be seen in aspects such as child mortality rates which could be noticeable with mortality rate of 74.8 deaths per 1,000 live births in 2019, when compared with other African countries like Ghana and Rwanda, where there has been a little bit of Health improvement. (5)

The health system in Cameroon comprises of three sub-sectors:

- The sub-public sector consists of public hospitals and the health structures under the care of other ministerial departments (Ministry of Defense, Ministry of Labor, Employment and Social Welfare, Ministry of National Education).

- The sub-private non-profit sector are the hospitals and health structures under religious denominations (Catholic, Baptist, and Presbyterian churches), associations and various non-governmental organizations and not-for-profit organizations.

- The sub-sector of traditional medicine which is an important part of the system should not be ignored. It should be noted that herbal medicines also play an important role in the health sector in most African countries and Cameroon in particular. (5)

The health system in Cameroon is also structured in three levels, with each having administrative, sanitary formation and structures and dialogue structures.  

 (I) Central level. Central Services of the Ministry Public Health: These services coordinate, regulate and develop ideas, methods and policies within the field of health.

(II) Intermediate level: These structures are depicted overall by the reference hospitals, University teaching hospitals, regional hospitals, and agencies under their control.  These structures are also depicted and assimilated by the regional hospitals. This intermediate   structure has other units such as. Structures of CENAME: These structures are units depicted by the CAPP (Center Pharmaceutical provide provincial) and therefore, are the pharmacies within the general hospitals and its headquarters, structure of care and others.

(III) Peripheral level:

These are body Structures depicted by the district health services, they implement the national programs. Have other structures within it such as, structures of care which is represented by the district hospitals, medical centers and district health centers, Structures of SYNAME depicted by the pharmacies for health coaching courses of the previous levels, further as non-public pharmacies

 
Graph A: A Cameroons Case over a three years’ period https://apps.who.int/nha/database/ViewData/Indicators/en  (4)
Graph A: Cameroons health expenditure over a three years’ period in million current US$

2.1.1 NGOs and other organizations.

 Quite a good external financing source exists in SSA, looking at the case of public enterprises it should be noted that some have their own health facilities and those without owned facilities use private for-profit facilities for their workers. The public social insurance, National Social Insurance Fund (NSIF) abbreviated as (CNPS) in French renders good services, but unfortunately does not yet include health coverage to it insured but covers claims responsibility in areas of, accidents at work, family benefit, invalidity, old-age, and death. Other companies have internal schemes which, like in some African countries, are obligatory- but in most cases they are voluntary. (7)

All in all, the sub-sector of private health providers, who complement and often compete with government suppliers, consist of non-profit religious missions and NGOs, for-profit providers, private clinics, pharmacies, drug retailers, and traditional healers. The bulk of non-profit facilities are operated by the Catholic and Protestant Health Services, who formerly operate about 179 facilities, Religious missions and NGOs finance a small part of their activities from donations in the form of staff, drugs, and equipment from their denominations.

Mutual health also plays an important role in sub-Saharan Africa, which treats quite a variety of diseases and offers outstanding services such as free X-ray, generic drugs, Surgery coverage of birth among others, provided at integrated health centers, religious and in public hospitals. This system requires an annual contribution of 15,000FCFA covering 75% of the hospital cost to a maximum 290,000FCFA for 4 persons. (8)   

2.1.2 Household expenditure on health in Cameroon

 Looking at the SSC and their economy, it could be said that most of the masses rely on agriculture to earn a livelihood. Putting Cameroon at the forefront of discussion, the majority of its inhabitants are below the National Poverty Level (NPL). Matched with unstable economic and political crises present in this country, it is evident that the household’s income has really reduced as many of the inhabitants have abandoned their Regions affected, hence leaving behind their primary sources of income to seek refuge in the francophone regions. This is a clear indication that this population is going through tougher times to finance their health bills, therefore a huge amount of out-of-pocket payment (OOP).

This low rate of financial security and medical attention - in time of need - leads us to the majority of the population, who are under NPL, leaving from “hand-to-mouth” and having higher chances of getting sick. Most of these people go through various processes in order to finance their bills. These include, personal savings from jobs done or from little economic activities such as farming and petty trading. A good number take loans from micro financial institutions (MFIs) or from “njangi” houses with very little interest rates (10FCFA per 1000 FCFA) others borrow from family members, friends and neighbors to finance their health bills. Still, other important sources include contributions from family members and close relatives which is mostly based on the principle of reciprocity in the sense of give-and-take which is mostly practiced in Africa in large and extended family circles (9).

https://apps.who.int/nha/database/ViewData/Indicators/en

Table A: Tabular presentation of Cameroon's Health schemes in Million current US$.

The above statistics shows that the household has been spending so far enormous when it comes to health, OOP. (4)

3. Health Expenditure Compared with other African countries

Methods used, panel knowledge, from the institute for health Metrix and Analysis, on domestic government health expenditure in forty-six countries in sub- Saharan Africa from 1995 to 2015. A regression model was used to examine the factors affecting government health disbursal, and urologist decomposition was used to assign the factors' contributions to the explained variance in government health finance disbursal.  (10)

Results: Although the expansion rate in government health finance payment in this geographical area has been positive overall, there are still major variations across subgroups. Between 1995 and 2015, government health finance payment in the geographical region grew by six.7% (95% uncertainty intervals [UI]: six.2% to 7.0%) every year, whereas in the Southern continent it grew by solely four.5% (UI: 4.5% to 4.5%) every year. Further-more, per-person government health (11), national income and additionally the share of government mercantilism were completely associated with government health mercantilism. The results from the decomposition, however, showed that individual country characteristics created up the simplest proportion of the explained variation in government health mercantilism across desert African countries. These findings highlight that a country’s policy choices are very important to determine how vibrant the health sector is. (12)

https://apps.who.int/nha/database/ViewData/Indicators/en  

Table B: comparison of health expenditure between Cameroon and Gabon

4. Looking at Covid-19 and its impact in Cameroon.

COVID-19 which originated from the Wuhan city of China in December 2019 was announced as a pandemic by the WHO on March 11, 2020, it affected the world globally with Cameroon included (14). In Cameroon, the first COVID-19 case was recorded on March 6th, 2020, on a French national which alerted the nation to intensify measures toward fighting the Virus.  (15). Some underdeveloped countries have been able to respond to this Pandemic positively while the developed countries have been fighting without end to come out of the Pandemic. (16). Reasons accountable for this could be related to higher rate of intensity of the Virus in developed nations which even led to the exhaustion of emergency facilities. This COVID-19 exposed the global inequality in the health sectors and has triggered the need for government and non-state health practitioners to work together towards finding solutions in combating Pandemic. It has also created the need for a unique global transformation of the health system to preempt any future pandemics

Concerning Cameroon`s population, with an estimated prevalence rate below 6%.  (17), the vulnerable population has been really affected by this Pandemic beginning with very limited testing centers for COVID-19, which is coupled with the crisis in some of the regions making it difficult for some of the population in the suburb areas to move to test centers. Looking at bigger towns, challenges ranged from having access to clean water to washing their hands which is part of the preventive measure to stop the spread. To this effect, shopping for water to comply with measures is burdensome as the populations of these areas are mostly living below the minimum wage level. These preventive measures and more were already rooted in the minds of the population due to the Ebola crisis of 2014 which gave the population a pre-knowledge on handwashing and sanitization methods in times of crisis like this.  (18),

Effects of the COVID-19 could also be seen in areas of mental health due to social distancing associated with distance learning. This lack of peer contact promotes stress factors in the educational system coupled with the fact that most could not get the necessary facilities needed for distance learning. Hence much family and parental support was needed towards moving Freely during this Pandemic, thus family life has also noticed a change in routine as parents are expected to spend more time with children to help, guide and orientate them. (19). On the other hand, the country received a lot of aid in terms of finance and non-financial which went a long way to calm down the tension in the country and also gave room for activities to get back on track.

The lockdown in Cameroon which went operational from the 18^th of March 2020 affected economic activities especially the transport sector. It experienced a closure of borders. However, some of the restrictions were quickly removed. Bars and restaurants could be open from 6pm. Schools witnessed a pause in activities like the FENASSCO games and other important activities which brought social gathering together.  (20). This population and governments which were already overwhelmed with problems affecting the –the Anglophone crisis, Bokhara attacks, climates change issues and others- could not really maintain the lockdown for a longer period of time.

The reaction of the population to this Pandemic shows quicker measures being taken by the older persons to adhere to preventive measures as they are well informed on the higher risk of being infected with this Virus and the consequences associated with it. Also men have been seen as respecting less social distancing due to carrier reasons and the need in providing for their families.  (15).

Countries affected have been greatly organized. For example, India has widely switched its purchase method to online shopping as the lockdown period was relatively longer with higher infection. Plastic waste recyclability has also increased as many measures were being taken to keep cities and villages clean. (21)

The slowdown in economic activities due to social distancing. Looking at Cameroon with a population mostly surviving from their daily earnings. Implementing lockdown was really a dilemma to most of the urban population.