Health Insurance Coverage for Refugees in Cameroon: Feasibility and Perspectives for Inclusive Access

By Iskandar Patrick Abadoma Mounpou, Solange Dabou, Odette Kibu

Executive summary

Cameroon hosts more than 430,000 refugees and asylum seekers, most of whom live in remote regions with limited access to health services. Refugees face persistent barriers to care, including financial constraints, unstable legal status, mobility, and a health system heavily reliant on out-of-pocket payments. These vulnerabilities heighten the risk of delayed care and catastrophic health expenditures.

This brief examines the feasibility of creating a refugee-inclusive health insurance mechanism. Despite structural constraints, international experience shows that refugee coverage is achievable when financing, legal frameworks, and partnerships are well-designed. Three pathways are particularly relevant for Cameroon: progressive integration into national schemes with subsidies, dedicated humanitarian insurance, and public-private partnerships (PPPs) to expand service availability in underserved areas.

Short-term priorities include establishing a legal basis for enrolment and piloting subsidized schemes. In the long term, investments in district-level facilities and digital systems would strengthen continuity of care and support national UHC goals.

Background

In Cameroon, as in many African countries, the integration of refugees into national health systems remains a major challenge. Globally, the burden related to displaced persons is on the rise and the plight of refugees whose numbers neighbor around 36 million worldwide one gets more dire. Around 71% of these refugees are hosted in low and middle-income countries, most of them in Sub-Saharan Africa. Cameroon alone hosts approximately 431,530 refugees and asylum seekers in 2025. 67% of these refugees originate mainly from the Central African Republic (located in East, North and Adamawa regions), 29% from Nigeria (Far North), and the remaining 4% are settled in urban centres such as Yaoundé and Douala, where most of health services are located.

Beyond the country’s limited national coverage, the core issue is the persistent non-inclusion of refugees; their inclusion aligns with international commitments, leverages dedicated donor funding, and strengthens health services in host regions. mechanisms. This makes refugee coverage a strategic point for accelerating system improvements and testing prepayment mechanisms that can later support the national UHC agenda. Aiming for health coverage for refugees should not be considered contradictory to national health priorities. The objective is therefore not to place this goal above the national agenda, but to integrate it as a complementary component of these national priorities.

The health system in Cameroon is already under strain, with multiple challenges including limited resources and workforce, insufficient medications, out of payment policies and poor governance. While the World Health Organization (WHO) estimates that less than 50% of Africa’s population has access to essential health coverage, in Cameroon only 40% of inhabitants live within five kilometres of a health facility. This situation exacerbates the exclusion of refugees, who face a triple vulnerability:

• Exposure to precarious living conditions
• Constant mobility, sometimes driven by the risk of attacks to which certain host camps are exposed or by the lack of resources necessary for sustainable survival, forces many refugees to move from one place to another in search of some degree of stability.
• Exposure to various disease conditions and risks including infectious diseases (malaria or cholera); maternal and child health risks (lack of prenatal, postnatal care or unsafe deliveries, increasing maternal mortality; stunting among children), mental health issues (trauma cause by violence), chronic diseases (e.g. HIV/AIDS resulting from prevalent unsafe sex, communal use of personal tools), conflict-related injuriesand others.

These system-wide limitations become even more pronounced when viewed through the lens of refugee populations, who face a unique combination of structural and socio-economic vulnerabilities. Refugees in Cameroon struggle to obtain healthcare due to service shortage in their settlement areas. Most existing healthcare services are concentrated in urban areas, while refugees reside mainly in remote, rural border regions. They also face financial barriers due to the lack of stable income, and a health system that relies heavily on out-of-pocket payments (representing 71.8% of total expenditure). This reduces the ability to afford consultations, medications or hospitalization. Since exposed to economic vulnerability and a high risk of catastrophic health expenditures, they are forced to choose between seeking healthcare or addressing other needs, since their revenue is limited. In this context, the establishment of a health care coverage scheme, like insurance for refugees, is urgent to protect and insure equitable access to health services.

Such a scheme will carry notable advantages in terms of social cohesion, reduced health costs, and enhanced international credibility. Ensuring equitable access to healthcare for refugees in Cameroon requires innovative solutions and robust partnerships between governments, insurers, and humanitarian actors, and is necessary to meet international commitments to universal health coverage within global development goals (SDG 3). The remaining sections of this document further highlight difficulties faced by refugees to access health insurance and propose mechanisms for establishing such system. Despite the clear need for a protection mechanism, several systemic and population-specific barriers continue to hinder refugee inclusion in existing or emerging health insurance schemes.

Factors leading to the non-inclusion of refugees from Health Insurance Schemes

Structural factors related to the health system

The structural fragility of Cameroon’s health system is largely tied to constrained access to care. Health financing remains heavily dependent on direct household payments, which account for nearly 70% of health services. In a context of low individual incomes and high treatment costs, this situation deepens inequalities and creates significant financial vulnerability, forcing the poorest to forego care. These pressures have intensified since nearly 12.5% freeze on UNCHR funding reduced the availability of essential and life-saving services for displaced populations. Refugees are even more affected, as their unstable incomes, heightened exposure to health risks (poor sanitation, communicable diseases), and high treatment costs further limit their access, while shrinking humanitarian resources weaken the support systems they rely on.

Beyond financial constraints, Cameroon’s health infrastructure remains limited, with a system that is under-capacitated. In 2022, the country had only 0.135 physicians per 1,000 inhabitants (far below the global average of 1.7 per 1,000), a low hospital density (0.71 hospitals per 100,000 inhabitants), and just 26.5 hospital beds per 10,000 inhabitants. Under such conditions, even if insurance were introduced, its utility would remain dependent on the availability of health services. These services are concentrated in urban areas, while rural and border regions—where most refugees reside—are largely marginalised.  In this context, integrating refugees into insurance schemes appears secondary, reinforcing their exclusion.

While weaknesses in the broader health system create a difficult environment for insurance expansion, refugees also face additional challenges linked directly to their legal and socio-economic conditions.

Refugee-specific factors

Refugee-specific obstacles are linked to their legal status, constant mobility, unstable living conditions, financial barriers, and insufficient access to healthcare.

Regarding legal status and recognition by the host state, refugees are covered under the 1951 Convention and its 1967 Protocol. In practice, however, and particularly in Cameroon, many refugees lack legal documentation and face administrative difficulties. Without official papers, formal enrolment in insurance schemes is impossible, depriving them of essential social rights.

Added to this is the constant mobility and instability of refugee living conditions. Camps, often located near conflict zones, are frequently subject to attacks, forcing refugees to abandon them for safer areas. Overcrowded living conditions also generate internal conflicts and expose refugees to severe health crises due to the lack of inadequate water, sanitation and healthcare infrastructure. These realities complicate the establishment of durable and adapted insurance mechanisms and reinforce the reluctance of health providers to take on additional risks.

Finally, financial barriers and the absence of stable income are among the main constraints to refugee integration into health insurance schemes. Most refugees live in precarious economic conditions, with no income-generating activities to support subscription to any insurance policy. Even reduced premiums would remain unaffordable. At the same time, Cameroon’s limited resources restrict the possibility of national subsidies.

Despite these structural and population-specific obstacles, international experience shows that refugee-inclusive health insurance is feasible when financing arrangements, legal frameworks, and partnerships are well-designed. Several country models offer practical lessons that can inform Cameroon’s approach.

Feasibility and pathways for refugee health insurance implementation

The establishment of a health insurance scheme for refugees in Cameroon remains feasible despite resource constraints. Its success, however, depends on addressing key financing questions: who bears the cost of contributions when refugees are known to be financially vulnerable, and how can a sustainable scheme be guaranteed for populations that are permanently mobile and expected to eventually leave the territory.

Drawing inspiration from experiences in Rwanda, Lebanon, Uganda, Ghana, and Jordan, three models emerge from international practice:

• Progressive integration into national schemes: refugees are included in existing systems, with access to the same benefit packages and networks. Financing adjustments such as subsidies, exemptions, and cofunding are required, based on mixed arrangementsaligned with the host country’s health financing structure.
• Dedicated humanitarian insurance:funded by international agencies such as the UNHCR and NGOs operating in crisis or limited-access zones. The success and sustainability of this approach nonetheless depend on links to national funding pools.
• Public-private partnerships(PPPs): combining public subsidies, reduced premiums, and donor co-funding. This involves pooling resources from governments, donors, and insurers, establishing contracts with private providers, and offering targeted subsidies for premiums.

These approaches represent viable options for implementing refugee health insurance, each offering specific benefits.

Building on these findings, the following recommendations outline the concrete steps required to establish an inclusive and financially viable health insurance mechanism for refugees.

Key recommendations

Short-term

• Establish a legal framework within national health insurance schemes that supports refugee inclusion. This involves responsibility of stakeholders (Ministry of Public Health, Ministry of Justice and NGOs like UNHCR) by providing technical assistance for drafting and supporting legal harmonization.
• Implement targeted subsidies, premium exemptions, and PPPs to cover refugee contributions using the pilot regions (East, Far North and North).

Medium-term

• Promote refugee integration into the labour market to generate income necessary for insurance premiums.
• Strengthen public-private partnerships by contracting private facilities in underserved regions, negotiating reduced tariffs and quality-of-care standards, expanding service availability in border districts.

Long-term

• Invest in health facilities, particularly local ones, and develop agreements for the care of insured refugees by upgrading infrastructure, staffing and essential medicines; strengthening referral systems and emergency transport; and improving data systems for monitoring insured refugees.

Conclusion

Establishing a health insurance scheme for refugees in Cameroon is both necessary and feasible, despite the structural fragilities of the national health system. Refugees face intersecting legal, financial, geographic and health-related vulnerabilities, that limit their access to essential services and expose them to catastrophic expenditures. Integrating them into an insurance mechanism would not only enhance equity and financial protection for refugees, but also generate benefits for host communities by strengthening service delivery and reducing pressure on overstretched local systems. Targeted interventions are justified by Cameroon’s international commitments and the availability of donor financing dedicated to displaced populations.

Achieving this objective requires a solid legal framework within national health insurance schemes to formalize refugee inclusion; introduction of targeted subsidies, premium exemptions, and PPPs to cover refugee contributions; the promotion of refugee integration in the labour market to support long-term contribution capacity. Investment in health facilities, particularly local ones, and digital identity systems, is essential for care continuity and enrolment security, as refugee-inclusive insurance model can serve as a catalyst for Cameroon’s broader health insurance rollout.