By Odette D. Kibu, Bruna Djeunang, Evrard Kepgang, Regina Sinsa, Constantine Asahngwa, Wilfred Ngwa, Ngo V. Ngo, Solange Dabou, Ronald M. Gobina
Introduction
In Cameroon, unequal access to quality health care services at an affordable cost to all strata of society remains a major challenge to government. The high poverty rates in Cameroon, with over 35% of the Cameroonian population below the poverty line, significantly hinders access to healthcare for a vast portion of Cameroonians using out-of-pocket payments. In addition, less than 2% of the Cameroonian population benefit from any health insurance coverage which exposes many people especially the poor to the risk of catastrophic health expenditures in times of sickness. In effect, many households have plunged into acute poverty as a result of heavy healthcare spending for their family members. Uptake of health insurance schemes in Cameroon, in general however, is considerably low with the consequent high out-of-pocket payment for healthcare services over 70%. Can Cameroon attain Universal Health Coverage with such a huge financial burden on the health care users? What should be done to increase subscription to health insurance? It is with these questions in mind that this paper seeks to recommend measures that can increase subscription to health insurance.
Health care expenditure on poverty
Healthcare costs continue to rise, from US $7.83 trillion in health expenditure in 2013 to a projected US $18.28 trillion by 2040 [1]. The high cost of healthcare prevents 1.3 billion people worldwide from accessing necessary, quality and timely care [2]. In 2017, the WHO and the World Bank released a joint report revealing that at least half of the world’s population still lacks access to basic health services. Furthermore, more than 800 million individuals throughout the world still spend more than 10% of their household budget on healthcare, and about 100 million people are pushed into extreme poverty each year as a result of excessive out-of-pocket medical costs [3].
Health insurance is underutilized in Cameroon
A very insignificant proportion of the population (2%) are subscribed to a health insurance scheme and this is mostly made up of persons in the formal sector and those residing in the urban areas. A large proportion of the Cameroon’s labour market is informal residing mostly in the rural settings than in the urban areas where access the insurance providers is limited.
The Cameroon social health protection system operates on 2 levels: the government civil servants’ scheme and the National Social Insurance Fund, NSIF, (Caisse Nationale de Prévoyance Sociale, CNPS) for workers covered by the labour code [4]. The NSIF is compulsory for workers and civil servants but not compulsory for those in the informal sector. This already establishes a barrier as most of the active work force is informal. Other social health protection initiatives include the creation of community-based health insurance (CBHI) organizations which has taken root in several rural communities. It is worth nothing CBHI help to reduce out of pocket expenditure and increase access to healthcare services in the rural settings and informal settings.
According to a 2019 WHO report, access to health coverage in Cameroon in 2017 was 45.5%. Universal Health Coverage (UHC) is an undeniable program to increase access to healthcare. It is closely linked to Sustainable Development Goal (SDG) target 3.8, which aims to achieve UHC through focusing on health service coverage and expenditure [5]. To successfully implement UHC, healthcare finance needs to be properly executed to reduce catastrophic health expenditure on the citizens. This is not the case in Cameroon as households contribute 70% of the healthcare budget from out of pocket.
Subscription rate to health insurance is hindered by many factors in Cameroon
According to the research we carried on the barriers to health insurance subscription in Cameroon [6], we found that lack of trust, limited finance to subscribe, inadequate knowledge, long and complex bureaucratic procedures for reimbursement, reliance on self-medications and on traditional medicines were some of the reasons mentioned. Some Cameroonians think that health insurance is a concept that can only be implemented in high-income countries. Both CBHI and private health insurance providers have expressed the lack of support from government to enhance their activities. WHO reports that CBHI are joined by people with few health needs on a voluntary basis, and there is usually little or no subsidization for poor and other vulnerable groups [7].
Despite the challenges, CBHI is effective in Rwanda [8] because of the partnership between the community and health care providers that is built-up on the benefits of the CBHI schemes, a multi-level leadership developed in the country to provide support to the adaptation, and extension of the schemes. Political leaders at the central level, with the Presidency inclusive, called for the mobilization of all actors to support the implementation of CBHI schemes throughout Rwanda.
It is therefore necessary to put in place measures to break existing barriers and increase access to health insurance, access to health care and attain the goals of UHC and SDG number 3.
Proposed policy recommendations for increase in health insurance subscription
- The key to success, especially in Cameroon’s rural areas and informal sector, is getting people to recognize the significance of a CBHI system. Its implementation has proven effective in other countries in Africa with similar, geographic, socioeconomic structure as Cameroon.
- Government should play an active role in supporting and subsidizing the operation of both private and community insurance providers.
- Government should support the creation of CBHI in rural settings
Conclusion
Health care is fundamental right. However, its access has been hindered due to the huge financial burden. Cameroon spends a very small portion of its budget on health care thereby shifting the health care spending to households. Subsidizing health care services and breaking barriers to health insurance subscription are indispensable in improving access to health care.
References
- Dieleman JL, Templin T, Sadat N, Reidy P, Chapin A, Foreman K, Haakenstad A, Evans T, Murray CJ, Kurowski C. National spending on health by source for 184 countries between 2013 and 2040. The Lancet. 2016 Jun 18;387(10037):2521-35.
- The world health report: health systems financing: the path to universal coverage. https://iris.who.int/handle/10665/44371?locale-attribute=ru&ref=based.inc
- WHO. Book order. http://apps.who.int/bookorders
- https://www.cnps.cm/index.php/fr/a-
- UHC 2023. https://www.uhc2030.org/blog-news-
- Kibu OD, Kepgang E, Sinsai R, Conner A, Asahngwa C, Ngwa W, Ngo NV, Fobellah NN, Muenyi CS, Zalamea NN, Gobina RM, Foretia DA. Barriers and Motivations for Health Insurance Subscription Among Health-Care Users in Cameroon. J Surg Res. 2024 Jan;293:158-167. doi: 10.1016/j.jss.2023.09.010. Epub 2023 Sep 27. PMID: 37774593.
- WHO. Community-based health insurance, 2020. https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020 .
- Schneider P, Diop F. Community-based health insurance in Rwanda. Health financing for poor people—Resource mobilization and risk sharing, Washington DC: World Bank. 2004:251-74.
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