Reaching Universal Health Coverage by 2035: Is Cameroon on Track?

Integrating HIV/AIDS services into financial protection systems to increase sustainability of the HIV/AIDS response

Begun in 2014, the Sustainable Financing Initiative (SFI) was dedicated to mobilizing domestic resources for the HIV response. Among its three programmatic pillars was a focus on ensuring financial protection for people living with HIV (PLHIV). SFI's activities were founded on a strong understanding of and alignment with partner government priorities, as well as costing and actuarial analyses, which allowed for the development of context-specific approaches for improving financial protection for PLHIV. SFI implemented financial protection activities in a total of nine countries; the five countries with the most substantial investments are discussed in this paper. In Vietnam, SFI's support helped the country to integrate almost all outpatient HIV treatment facilities into the public health system, attain enrollment of 90% of PLHIV into Social Health Insurance (SHI), and increase domestic funding for HIV through SHI. In Cambodia, SFI supported the development of a guiding framework for integration of HIV/AIDS services into the existing health system; key achievements included a policy change that expanded eligibility for the country's Health Equity Fund, allowing all PLHIV to access free health services. In the Dominican Republic, SFI support led to the inclusion of antiretroviral drugs in the family health insurance benefit package, increased enrollment of PLHIV in health insurance, and expanded care options through non-governmental organizations. In Nigeria, SFI's support helped to enroll more than 600,000 people and empanel 216 health facilities into the Lagos State Health Insurance Scheme. In Cameroon, SFI support helped the government achieve stepwise progress on key building blocks of its planned new universal health coverage system; SFI contributed to the development of a consolidated package of services, standardized care and service protocols, and accreditation criteria. SFI's investments in financial protection demonstrated that with strong political will; long-term engagement with partner governments; and focused technical assistance for advocacy, policy reform, and implementation support, HIV services can be successfully integrated into financial protection systems. Such integration can promote increased, long-term domestic financing for HIV while also protecting PLHIV from financial risk.

Do deferred emergency payment programmes increase use of injury care services in Cameroon? A trauma registry analysis

BACKGROUND

Injured patients in Cameroon face high out-of-pocket costs and care discrepancies based on ability to pay. Per government declaration, all Cameroonian hospitals instituted emergency payment deferral (EPD) programmes to mitigate financial barriers to emergency care. Doctors or nurses decide on patients' eligibility for the EPD programme. However, the impact of EPD on care patterns is unclear.

METHODS

The Cameroon Trauma Registry (CTR) is a prospective, multisite trauma registry collecting injured patient data from four hospitals in Cameroon. Using CTR data from March 2020 to February 2022, we analysed associations between patient participation in EPD programmes and healthcare interventions using univariate analysis and multivariate logistic regression.

RESULTS

Of 5287 CTR patients, 58% (n=3081) were emergency payment deferral recipients (EPDR). A greater proportion of EPDR lived in urban residences (89% EPDR vs 87% non-EPDR, p=0.003). EPDR more often presented with a 'serious' or more severe estimated injury severity (70% EPDR vs 59% non-EPDR, p<0.001). Compared with non-recipients, a smaller proportion of EPD recipients, a smaller proportion of EPDR underwent recommended X-rays (48% EPDR vs 51% non-EPDR, p<0.001). However, greater percentages of EPDR received a recommended ultrasound (3% vs 1%, p<0.001) or CT scan (14% EDPR vs 10% non-EDPR, p<0.001). EPDR more often did not receive radiological tests due to inability to pay (12% vs 4%, p<0.001). Moreover, 10% of EPDR did not undergo recommended surgery due to cost while 6% of non-EPDR did not undergo recommended surgery due to cost (p<0.001). Multivariate logistic regression controlling for injury severity and other demographics indicates that EPDR were less likely to undergo surgery (adjusted OR=0.63, p=0.001).

CONCLUSION

Payment deferral programmes were associated with increased use of some imaging tests, but did not fully address the downstream financial barriers that impede health equity in Cameroon.

Integrating political prioritisation into national surgical planning: a scoping review of surgical, obstetric and anaesthesia care in Cameroon

BACKGROUND

Surgical diseases contribute substantially to death and disability in Cameroon. Strategic planning for surgical, obstetric and anaesthesia (SOA) care in low-income and middle-income countries (LMICs) requires consideration of the policy environment in addition to the issue severity. We aimed at the current landscape of SOA care in Cameroon, incorporating a framework for political prioritisation.

METHODS

A scoping review of published and grey literature was performed. Literature specific to Cameroon, published between 2010 and 2020 and written in either English or French, was included. Abstracts and full texts were screened for discussion of SOA policy context, care and delivery conditions, and issue characteristics. Data extraction and analysis were performed using the Shiffman and Smith framework for political prioritisation accounting for actors, ideas, political context and issue characteristics.

RESULTS

121 articles were included. By specialty, 83 articles were specific to surgery, 45 to obstetrics and 6 to anaesthesia. Policy environment was discussed by 20% (n=25) articles; 30% (n=37) discussed actor power; 22% (n=27) discussed ideas in SOA care and 93% discussed issue characteristics. Core challenges to political prioritisation of SOA care in Cameroon are limited actor support, a lack of consensus definitions, gaps in capacity and a need for systematic data collection on surgical diseases. Policy opportunities include leveraging existing multilateral partnerships to unify SOA actors, conducting national assessments of SOA care capacity, formalisation of task shifting to build capacity, defining essential SOA procedures, including surgical care in future health coverage, and defining and including SOA benchmarks in strategic planning.

CONCLUSIONS

Integrating a framework for political prioritisation into a situational analysis of SOA care is critical to understanding an LMIC's policy context and actors, in addition to issue severity. Such an approach can serve as a baseline for analysis in evidence-informed policy-making for SOA care, even in the absence of centralised, country-wide data.

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

Introduction

the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies.

Methods

we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis.

Results

we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder.

Conclusion

most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.

Serum Biomarker Concentrations upon Admission in Acute Traumatic Brain Injury: Associations with TBI Severity, Toxoplasma gondii Infection, and Outcome in a Referral Hospital Setting in Cameroon

Despite the available literature on traumatic brain injury (TBI) biomarkers elsewhere, data are limited or non-existent in sub-Saharan Africa (SSA). The aim of the study was to analyse associations in acute TBI between the admission serum biomarker concentrations and TBI severity, CT-scan findings, and outcome, as well as to explore the influence of concurrent Toxoplasma gondii infection. The concentrations of serum biomarkers (GFAP, NFL Tau, UCH-L1, and S100B) were measured and Toxoplasma gondii were detected in the samples obtained <24 h post injury. GOSE was used to evaluate the 6-month outcome. All of the biomarker levels increased with the severity of TBI, but this increase was significant only for NFL (p = 0.01). The GFAP values significantly increased (p = 0.026) in those with an unfavourable outcome. The Tau levels were higher in those who died (p = 0.017). GFAP and NFL were sensitive to CT-scan pathology (p values of 0.004 and 0.002, respectively). The S100B levels were higher (p < 0.001) in TBI patients seropositive to Toxoplasma gondii. In conclusion, NFL was found to be sensitive to TBI severity, while NFL and GFAP were predictive of CT intracranial abnormalities. Increased levels of GFAP and Tau were associated with poorer outcomes 6 months after TBI, and the S100B levels were significantly affected by concurrent T. gondii infection in TBI patients compared with the seronegative patients.

Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study

Traumatic brain injury (TBI) is a huge public health challenge worldwide. Epidemiological monitoring is important to inform healthcare policy. We aimed at determining the prevalence, outcome, and causes of TBI in Cameroon by conducting a 5-year retrospective study in three referral trauma centers. Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were recorded. Comparisons between two categorical variables were done using Pearson's chi-square test or Fisher's exact test. A total of 6248 cases of TBI were identified of 18,151 trauma cases, yielding a prevalence of 34%. The number of TBI cases increased across the years (915 in 2016, 1406 in 2020). Demographic data and causes of TBI were available for 6248 subjects and detailed data on clinical characteristics on 2178 subjects. Median age was 30.0 (24.0, 41.0) years. Males were more affected (80%). Road traffic incidents (RTIs; 75%) was the main cause of TBI, with professional bike riders being more affected (17%). Computed tomography (CT) imaging was performed in 67.7% of cases. Of the 597 (27.4%) cases who did not undergo neuroimaging, 311 (52.1%) did not have neuroimaging performed because of financial constraints, among which 7% were severe TBI cases. A total of 341 (19.6%) patients were discharged against medical advice, of which 83% had financial limitations. Mortality was 10.3% (225 of 2178) in the overall population, but disproportionately high in patients with severe TBI (55%) compared to those in high-income settings (27%). TBI occurrence is high in Cameroon, and RTIs are the main causes. Disparities in care provision were identified as attributable to financial constraints regarding CT scanning and continuation of care. The data presented can inform preventive interventions to improve care provision and transport policies. Implementation of a universal health insurance may be expected to improve hospital care and reduce the adverse effects of TBI among Cameroonians.

Using Twitter to Understand the Effects of the Cameroon Anglophone Crisis on Social Determinants of Health

Insufficient opportunities to collect data on public health exist in armed conflict regions. Increased use of social media during war and conflict has allowed for data collection in situations where information is usually difficult to obtain. In this study, Twitter, a public social media platform, was used as a source of data and information to gain insight into how the Cameroon Anglophone Crisis impacts public health in the population. Our findings revealed that Twitter was being used to share information and call for action. Analysis of tweets revealed 8 distinct themes, which illustrated the impact of the crisis on the social determinants of health: neglect from government related to the social determinants of health; education; loss of employment; increased poverty; housing and homelessness; social exclusion and oppression; women and gender inequality; and health services. This study provides insight into the significant impact on public health in Cameroon caused by the Anglophone Crisis, and demonstrates the potential benefits of social media for gathering information about public health in crisis situations.

Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months

The COVID-19 pandemic reached Cameroon in March, 2020. The aim of this study was to unveil the consequences of this pandemic on hospitalizations and on mortality in a pediatric hospital. Methods: A descriptive and retrospective cross-sectional study was carried out using hospitalization and death statistics collected from a pediatric hospital. We compared the data before and after the pandemic and made predictions for the next 12 months. Results: A drastic drop in hospitalizations was noted coinciding with the partial lockdown in Cameroon. Paradoxically, at the same time, the number of deaths per month doubled though the causes remained the same as in the past. Conclusion: The COVID-19 pandemic was marked by drop in hospitalizations and paradoxically, an increase in child mortality. These deaths were probably due not to SARS-Cov-2 infection, but rather due to the usual illnesses whose management was delayed, a probable consequence of the confinement.

Strategic Health Purchasing Progress Mapping in Cameroon: A Scoping Review

Many low- and middle-income countries are adopting far-reaching health financing policies using strategic health purchasing (SHP) approaches to address their health sector challenges. However, limited efforts have been directed toward analyzing the SHP activities nationwide. Our objective was to explore the scope and development of SHP in Cameroon. We conducted a scoping review applying the framework developed by Arksey and O'Malley and modified by Levac et al. to identify and extract data from relevant SHP studies and documents published between 2000 and 2019, which focused on Cameroon. Among the existing 30 health financing schemes, 5 present the elements of SHP: (1) national health insurance (NHI), (2) performance-based financing (PBF), (3) voucher system, (4) private health insurance, and (5) mutual health organizations. The findings suggest that the governance function of purchasing is very challenging due to the multiple purchaser markets and the resulting fragmentation of the health financing system. In addition, the misalignment of the different benefit packages across schemes leads to considerable gaps and overlaps in the population coverage. The issue of multiple highly fragmented payment systems also remains a big concern across the different schemes, with tentative harmonization observed with NHI and PBF. Achieving the full potential of SHP in Cameroon will require (1) a defragmentation of the multiple schemes, (2) an effective oversight arrangement, and (3) an alignment of provider payment method to a coherent set of incentives across the system, with the ultimate aim of promoting equity, efficiency and quality.

Gauging Cameroon’s resilience to the COVID-19 pandemic: implications for enduring a novel health crisis

Purpose

This paper aims to examine Cameroon’s health service resilience in the first five months (March–July 2020) of the coronavirus (COVID-19) outbreak. The motive is to diagnose sub-optimal performance in sustaining health-care services during the pandemic to identify areas for improvement and draw lessons for the future.

Design/methodology/approach

This is principally qualitative, exploratory, analytical and descriptive research that involves the collation of empirical, primary and secondary data. A conceptual framework [health systems resilience for emerging infectious diseases (HSREID)] provides structure to the study and an anchor for interpreting the findings. The research validity has been established by analysing the aims/objectives from multiple perspectives in the research tradition of triangulation.

Findings

Cameroon has exerted much effort to combat the COVID-19 pandemic. Yet, several constraints and gaps exist. The findings reveal limitations in Cameroon’s response to the COVID-19 pandemic in the provision of fundamental health-care services under contextual themes of health infrastructure/medical supplies, human capital, communication/sensitisation/health education, governance and trust/confidence. Analysis of the identified impediments demonstrates that Cameroon’s health-care system is not resilient enough to cope with the COVID-19 pandemic and provides several insights for an enhanced response as the pandemic accelerates in the country.

Originality/value

This is one of the first scholarly articles to examine how Cameroon’s health-care system is faring in COVID-19 combat. Underscored by the novel HSREID model, this study provides initial insights into Cameroon’s resilience to COVID-19 with a view to enhancing the health system’s response as the pandemic unfolds and strengthens readiness for subsequent health crises.