Interventions for Non-Communicable Diseases

By Kelly Makougoum, Dr. Wilfred Ngwa, Dr. Asahngwa Constantine, Dr. Odette Dzemo Kibu, Dr. Ronald Gobina, Dr. Nkengafack Fobellah, Dr. Denis Foretia (Download pdf version)

Interventions for Non-Communicable Diseases: Role of Strategic Health Purchasing in Cameroon

The burden of non-communicable diseases in low and middle-income countries has been on the rise this last decade. Despite the health financing strategies in place in Cameroon, there is an urgent need to develop better financial protection policies addressing non-communicable diseases (NCDs) as they count for more than 31% of the mortality rate in Cameroon and present a greater opportunity cost if left unaddressed. 

Strategic health financing could be a way to improve the quality of health services and foster the efficiency of the financial risk protection mechanisms in Cameroon, but there are some limits as NCDs are concerned. Therefore, this policy brief analyses the role of the strategic health purchasing system in improving interventions against NCDs in Cameroon. 

Introduction

The burden of non-communicable diseases (NCDs) in low and middle-income countries has known a considerable increase since 2015, accounting for more than two-thirds of mortality, and in the next decade, it will be the most killer by 2040 in developing countries (1). As countries set priorities and design benefit packages, particularly in low and middle-income countries(LMICs), where the problem of NCDs is confronted with communicable diseases and limited access to primary health care, there may be an inherent desire to prioritize communicable diseases (2) (3).

The emergence of new infectious disease like COVID-19 has been shown in several LMICs (including Cameroon) to have diverted the intentions of policymakers to pool funding that address communicable diseases with immediate actions in contrast to NCDs, which rather has a greater burden on the population’s economic and health outcomes (4).

Furthermore, the rate of increase of NCDs in Cameroon’s population has become alarming, with more than 50% of adults exposed to its consequences which have a huge impact on their Disability Adjusted Life Years (DALY) (5), increasing the gap in the financial protection provision for patients suffering from NCDs in Cameroon (6) (7). Subsequently, strategic health care financing could be one of the most important factors to be used to reduce the burden of NCDs and help attain the Sustainable Development Goal (SDGs) in Cameroon.

Following this, policymakers in LMICs like Cameroon have developed the health financing system through strategic health financing purchasing to limit the challenges faced by health financial purchasers in funding health care (8).

Strategic health purchasing refers to the allocation of pooled resources to providers in order to deliver healthcare goods and services to the covered population, in accordance with the defined benefit package, based on active evidence-based engagements in defining the service mix, volume, and selecting the provider-mix in order to maximize societal goals (4). Therefore, this policy brief analyses the role of the strategic health purchasing system in improving interventions against NCDs in Cameroon.

I. The Burden of NCD and Cost of Interventions in Cameroon

In Cameroon, NCDs are responsible for 31% of mortality and a significant prevalence of hypertension (21.6%) and diabetes mellitus (6.5%). Furthermore, decision-makers remain more focused on policies for the control of infectious diseases compared with policies for the prevention of NCDs (10). Although there is a general misperception that NCDs are too costly to address, in reality, they are too costly not to address for several reasons.

First, according to studies, the economic burden of some NCDs potentially exceeds the costs of their prevention and treatment (8). For example, providing 50% coverage of chronic hypertension management for medium to high-risk patients costs 500 Dollars, but the benefits outcomes will be 11,410 Dollars annually (8). Secondly, as the mortality burden is concerned, investing in some cost-effective interventions can reduce the proportion of immature deaths due to NCDs by 8.1 million between 2018 and 2030 in developing countries.

Thirdly, globally with respect to cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health burden, the macroeconomic simulations suggest a cumulative output loss of US$ 47 trillion over the next two decades. This loss represents enough money to eradicate two-dollar-a-day poverty among the 2.5 billion people in that state for more than half a century (9).

II. Strategic Health Purchasing as Solution to Improve the Cost-Effective Interventions Against NCDs in Cameroon

Strategic health purchasing is relatively recent in Cameroon’s health financing mechanism (4).  Its role is to improve the quality of health services and foster the efficiency of financial risk protection (10)(11). There are four main actors concerned in SHP; the Government, the citizens, the Purchaser, and healthcare providers (4).

There are different health purchasers, including the Cameroon National Health Insurance (NHI), Performance-based financing (PBF), voucher system, private health insurance companies, and Mutual health organizations (MHO). They developed mechanisms to allocate pooled funding to health providers through free/subsidized health policies, risk-sharing mechanisms, results-based financing, and government budget support.

These strategic health purchasing schemes do not include NCDs in their benefits packages in Cameroon (4). Several reasons explain this gap; first, the insurance schemes in low- and medium-maturity schemes in LICs/LMICs suffer from sustainability challenges (12). Furthermore, the absence of a regulatory and policy framework to align the benefits amongst the five SHP scheme render inequalities in addressing diseases and in the target population; for example, there is more than two scheme that tackles maternal health, but none of them tackle NCDs.

Second, strategic health purchasing schemes have insufficient benefit packages that manage patients affected with NCDs in Cameroon. There are public treatment centers that provide subsidized treatment for diabetic and cancer patients, but these centers are insufficient compared to the demand for health care for these diseases are concerned (4). Third, the insurance schemes are not well developed in Cameroon, and the budgetary feasibility depends greatly on the political and managerial intent of policymakers, so it does not mean that the payer will definitely assign resources (12).

In addition, there is an asymmetry of information between the patient and the purchaser, thus low-benefit utilization of SHP schemes. Lastly, there is very limited autonomy to health purchasers, and providers as their benefits packages and health care services are guided by the government, thus influencing their decisions mainly in the public health insurance scheme.

In conclusion, the agenda for health financing against NCDs in Cameroon is still lagging and present an emergency for policymakers. To attain this goal, strategic engagement of health purchasers and better health sector reforms must be carried out using country-specific strategies involving innovation engagements to fill the gaps discussed in this policy brief.

Key Recommendations

• Increase studies that analyze the impact of Strategic Health Purchasing on NCDs management in Cameroon: Strategic Health Purchasing is relatively new in Cameroon, and the benefits packaging must be based on evidence-based analyses, and also the scope of the review available does not address NCDs in particular.
• Adopt health sector reform initiatives that enhance financial protection: Health policymakers must consider where the gaps appear in NCDs financing compared to infectious diseases; there is the need to reduce inequalities in the access to healthcare in LMICs like Cameroon. During COVID-19, providing high health coverage and financial protection have appeared to be of basic importance as the pandemic has caused a financial crisis and worsened the impact of out-of-pocket payments in Cameroon
• The government must involve innovative partnerships with the private sector to expand access to health purchasers: Working in innovative partnerships with the private sector will be critical for countries to expand strategic health purchases.
• There should be increased and equal access to health care services for the targeted populations related to NCDs.