By Dr. Odette KIBU & Constantine Asahngwa, Ph.D (Download pdf version)
Private Health Insurance Service Providers in Cameroon: Current Status and Organizational Framework
In Cameroon, access to quality healthcare services for all members of the public is hampered by several factors, such as poverty, high cost of care, and out-of-pocket payment policies.  This disproportionate health service delivery architecture projects the health system as discriminatory and raises concerns about equity and social justice.  Cameroon finances its healthcare through multiple sources, strategies, programs, and various schemes, including health insurance. 
There are three main types of health insurance schemes in Cameroon: National Health insurance (NHI), community-based health insurance (CBHI), and private health insurance (PHI).  The role of health insurance schemes in providing protection against catastrophic health expenditures and in enhancing the drive toward universal health coverage (UHC) has been the subject of discussion in several health financing debates. However, the role of PHI, though a major player in the health insurance landscape and its potential to advance the drive toward UHC in Cameroon, seems to have received little attention from scholars.
Based on a review of the literature, this paper is an attempt to highlight the PHI sector as one of the main actors in healthcare financing in Cameroon. As the first in a series of upcoming investigations, we begin by looking at the current status. Specifically, we uncover their growth, actors, organizational framework, services, and beneficiaries.
Rise of Private Health Insurance Service Provisioning
The rise of PHI actors is not unconnected with the emergence, growth, and development of the private sector in Cameroon. Government recognized the strategic role this sector could play in economic development and nation, building the signing of laws that allowed individuals and groups to create businesses, enterprises, and companies that could enhance economic growth and development.  It is against the backdrop of this open-door policy that several businesses came into being, including insurance companies and banks.
In the domain of health, the private sector has been a key government partner in the provision of healthcare services to the Cameroonian population.  It is common to find health facilities, such as hospitals, clinics, health centres, pharmacies, and other health services, belonging to the private sector. Through the promotion of public-private partnerships (PPP), some private institutions have been involved in financing healthcare through the provision of health insurance services to the population. 
Private Health Insurance Service Providers
In Cameroon, like many other African countries, private health insurance service providers are mostly private banks and insurance companies.  Although the main motive for the creation of banks is to save money and provide loans to customers, some banks also provide health insurance services to their customers and members of the public.  However, not all banks offer health insurance services, and for those who are involved, their health insurance policies differ.
While it is optional for some banks, it is mandatory for others, and the deductions come directly from the client’s account. Private banks are owned by individuals or a group of people who own shares.  Most banks are located in urban areas where most of the large-scale businesses are located, like in the cities of Douala and Yaoundé. However, banks are also located in all the regional capitals and some divisional headquarters. But those located in rural areas do not offer health insurance services because the majority of the population in these localities are poor and cannot afford premiums. 
Currently, the exact number of banks offering health insurance services in Cameroon is not known, given that studies in this sector are rare. Banks that offer health insurance services to clients do so basically to make a profit. 
Like banks, insurance companies are owned by individuals or groups of individuals (who own shares). Their main goal is to make a profit. They provide general insurance services to the public, such as life insurance, accidents, personal property, and health.  They are mostly located in urban settings. The exact number of private health insurance companies operating in Cameroon remains unclear due to a lack of credible empirical data. Looking at these providers, it can be inferred that their motives and locations are similar, while they may have varied operational principles, as will be seen in the next section. 
Most first-class banks and insurance companies have similar administrative and management structures. Each type of institution has a top-level management body that oversees the smooth functioning of the institution. The executive body has a secretariat headed by a General Manager or a Director.
There are different service heads in relation to the various services offered to the public. With this type of organizational arrangement, the manager is accountable to the Board of Administrators, a watchdog body which oversees the effective functioning of the institution. Both types of institutions usually operate in a decentralized structure, with their main offices located in major cities like Douala and Yaoundé, having multiple branches in these cities and in other regions of the country. 
Health Insurance Services Provided to Clients
Banks and insurance companies use various approaches to offer health insurance services to the public. In the case of banks, clients who have opened an account with the bank are introduced to the insurance service, among other options. For those who choose the health insurance service option, a subscription form is provided, which the client fills out and declares the current state of his/her health. Some questions are asked to know if the client has contracted certain illnesses for the past three or six months or one year.
These are mainly non-communicable diseases, like diabetes and hypertension. These diseases are given special attention because they are excluded from the benefits package offered by the bank. In the case of Ecobank, an annual subscription fee of 26,000frs (called Eco-Sante) is deducted from the client’s account after subscription. The subscription fee covers a range of diseases, like malaria and typhoid. 
With regards to insurance companies, they have contracts with particular health service providers, which could be public or private. The client subscribes to the scheme and pays their annual premiums for a specific benefits package. Like in banks, terminal diseases are excluded from the benefits package. Only less complicated and less expensive diseases are included in the benefits package. However, registration and annual subscription fees are costly and unaffordable for many. 
Insurance companies also work in partnership with other public and private establishments to provide health insurance to staff and students, as is the case with educational establishments. They sign a contract with the establishment and a health service provider, typically a hospital. In times of sickness, the student has to seek care from the contracted health facility, and the cost of care is fully or partially covered by the insurance company. In most cases, coverage is partial, with the insurance company providing either half or a quarter of the cost. 
Private insurance companies also provide health insurance to travellers coming in and moving out of the country. This is a key travel requirement from many visa-issuing authorities. Travellers get in contact with an authorized insurance company and pay for their health insurance. The amount varies with the duration of the trip. Once the trip is over, the engagement ends. 
Beneficiaries of Private Health Insurance Services
Those who benefit from the services of private health insurance companies are those who are financially viable and reside in urban settings.  Those who can purchase premiums from insurance companies on an annual basis are not usually many. [21, ] The exact number of Cameroonians who benefit from the services of private health insurance institutions is hard to come by due to a lack of empirical evidence. This estimate cannot be deduced from banks that have made subscriptions mandatory for their clients because subscriptions do not automatically guarantee benefits if the client has not been ill.
The actual beneficiaries are those who get financial support from a bank or insurance company when they become sick after a subscription. Since insurance service providers operate on the principles of financial resource mobilization and risk sharing, people are likely to purchase premiums for more than five years without receiving any financial support from their subscribers.
The Way Forward
Private health insurance service providers are a key player in health care financing in Cameroon. However, this sector seems to be totally absent in the evidence base on health insurance in Cameroon from an empirical standpoint. Therefore, some action is needed.
First off, high-quality and largescale empirical studies are needed to uncover various elements relating to private health insurance service provisioning. Specifically, studies are needed to unveil the number of private health insurance service providers, the services provided, the benefits package, their quality of services, the impact on access to quality health care services and sustainability.
Private health insurance service providers constitute part of the health financing ecosystem in Cameroon. Their role may be pivotal in accelerating the agenda to offer universal health coverage in Cameroon. Consequently, there is a need to set up an agenda with strategic priorities to explore this sector of healthcare financing in Cameroon.
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