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00:00:35Access to health care is a fundamental human right,
00:00:39which places a legal responsibility on states
00:00:43to ensure access to timely, acceptable,
00:00:47and affordable health care for their citizens.
00:00:52The high fraction of health services that are paid for
00:00:56out of the pocket in Cameroon today
00:00:59represents a significant obstacle for any Cameroonian
00:01:03in accessing health care.
00:01:06About 70% of the total health care expenditure
00:01:10for Cameroonians is borne by households,
00:01:14which nearly doubles the regional average of 34%.
00:01:19This ranks Cameroon third in sub-Saharan Africa.
00:01:24And this leads to financial hardship,
00:01:27hinder the uptake of health services,
00:01:31and negatively impact health in the country.
00:01:35That government initiated and is now rolling out
00:01:39a process for establishing a functional, universal
00:01:43health coverage system in the country
00:01:46that eases access to high-quality health care services
00:01:50for Cameroonians while reducing household health expenses
00:01:56stands to be saluted.
00:01:5936% of Cameroonians spend more than 5% of their income on health.
00:02:06Nearly 5% of Cameroonians spend above 40% of their income on health,
00:02:13leading to ruinous payments to access health in the country.
00:02:18These figures portray, first, a massive mismatch
00:02:23between the health, equity, and financial protection
00:02:27of the citizens, and second, the fact that Cameroon's poorest
00:02:33are the ones who suffer the most pinch
00:02:36of the country's catastrophic health expenses.
00:02:41However, there is a strong and high-level political will
00:02:46to deliver universal health care in Cameroon,
00:02:50which presupposes a consequential rise in health expenditure
00:02:55for the country to realize its vision
00:02:59of equitable health care access for all its citizens.
00:03:04The journey towards universal health coverage in Cameroon
00:03:09and the forging of a path to equitable health care access for all
00:03:14is the main thrust of today's edition of your program.
00:03:19Hello, everyone. I'm Ben Menopufong in Yaoundé.
00:03:23Welcome to News Inside Out.
00:03:27It's exactly 16 months today since the government of Cameroon
00:03:32launched its universal health coverage program,
00:03:36a program whose ambition is to lessen the excruciating weight
00:03:41of health costs on Cameroonians while reducing the cost of health
00:03:46to the people of Cameroon.
00:03:49Its ambition is to lessen the excruciating weight of health costs
00:03:54on Cameroonians while reducing health-related out-of-pocket expenses.
00:04:00It marks a critical step towards helping vulnerable populations,
00:04:05including children, pregnant women and people living with HIV,
00:04:10access to affordable and quality health care.
00:04:15The overriding ambition being to curb excessive out-of-pocket payments
00:04:20that have been distancing Cameroonians from health care.
00:04:25Inside Out's Moki Edwin Kinzaka has been observing the country's
00:04:30health care delivery system in the absence of the universal health coverage
00:04:36and comes away with the take that not only are the health services
00:04:41and infrastructures inadequate, but that they are plagued by rising poverty rates
00:04:48in health care seekers that further complicates issues for health care givers.
00:04:54Hello Moki.
00:04:59Hello Ben Minipufong. Cameroon has a well-elaborated and beautifully conceived
00:05:04or carved-out health map.
00:05:07Calling the nook and cranny of the triangular state, the health map is configured
00:05:12taking into consideration the 10 regions of the country, the 58 divisions of the country
00:05:17and about 360 subdivisions, and the count keeps on.
00:05:23Now, let's meet our expert.
00:05:26You have the subdivisional hospitals, which we call them sometimes in French the SEMA,
00:05:31and you have the district hospitals, they follow immediately.
00:05:36And the district hospitals with the subdivisional hospitals are all under a district health care
00:05:44which is headed by a district health officer appointed by the Minister of Public Health.
00:05:51From the district hospitals, within the district hospitals we could send now,
00:05:56we consider them to be at a divisional level.
00:05:59When there are difficulties at that level, we call them the fourth categorized hospitals.
00:06:05They could now send them to specialized hospitals like emergency centers in Yaoundé,
00:06:14like central hospitals.
00:06:16But when you go to central hospitals, we have them here.
00:06:21So cases that are difficult, we refer them to central hospitals.
00:06:24All of this make up a total of 2,260 public health facilities, a majority owned by the government.
00:06:34The lay private and confessional hospitals also exist in the country.
00:06:39Among them are facilities owned by the Catholic, the Baptist, the Presbyterian churches,
00:06:46and they say besides helping people by treating them of their ailments,
00:06:51they also treat them spiritually.
00:06:54They are also found in the 10 regions of the country, making the health map again very beautiful.
00:07:00But Ben Poufong, the multiplicity of hospitals and health centers
00:07:05are yet to provide adequate health coverage in the national triangle
00:07:11because Cameroonians are generally very poor.
00:07:14Bad routes from their destination villages to the hospitals
00:07:18and the problem of affordability props up its ugly head.
00:07:24The government has made it very simple for us.
00:07:27The way we run hospitals now in terms of delivery is very simple.
00:07:31When you have a woman who is supposed to deliver,
00:07:37you have to follow all his consultations in the government hospital.
00:07:42Some of those things are done free now with what we call the universal health coverage.
00:07:49In district hospitals, some of their tests and some of their exams they have to run are free.
00:07:55It is given by the authority and they only need to register in the platform of the universal health coverage.
00:08:02It's just the same like the little children who are in the pediatric world.
00:08:06We consult them free.
00:08:08From zero to five years, consultation is free.
00:08:10And some of their tests, they are run free.
00:08:12It is because of the universal health coverage which is being implemented
00:08:16by the Ministry of Public Health under orders of the Cameroon government.
00:08:21Now, when you look at these people who come in for delivery,
00:08:26simply delivery here is 8,000 francs which you pay when you deliver simply.
00:08:32But when to be given an operation, there are kits which are all kept there day and night.
00:08:39In case of any emergency, the delivery kits are used.
00:08:44And they are used without asking you a dime because save their life first.
00:08:50You may want to know also that 60% to 70% of Cameroonians seek medical help at traditional African medical institutions.
00:09:00They call them traditional practitioners.
00:09:02And about 20% to 30% or maximum 40% go to hospitals.
00:09:06The reason again, they are very poor.
00:09:09They only go to the hospitals when they find themselves in desperate conditions, desperate situations.
00:09:16But how will these patients be handled in the hospital whenever there is no money to pay?
00:09:21How are insolvent patients handled?
00:09:24There was a day I went to my office here and I saw a lady sitting outside who came in to a hospital.
00:09:30Nobody was by her.
00:09:32She was from our northern part of the country.
00:09:34She could not even answer anything in French and in English.
00:09:37We had to look for a translator.
00:09:39And when I took her to the gynecologist, this lady was already set for delivery.
00:09:45And they had to operate her.
00:09:48We took upon ourselves.
00:09:50Sometimes we contribute from our pockets.
00:09:53We took the kits and they operated her.
00:09:56And thank God, she had no complications.
00:09:59Some of them, they end up not having the money and we let them go free.
00:10:03Because we cannot do otherwise.
00:10:06We struggle, first of all, to save their lives before we talk about money.
00:10:10And most of them, they go free without paying.
00:10:12The director gives them a reduction.
00:10:14Some, they reduce 50%.
00:10:16They don't even have the money.
00:10:18Some, they give it even 75%.
00:10:20They don't even have the dime.
00:10:21You see, somebody is sitting.
00:10:22He doesn't even have food.
00:10:24We need sometimes to go and give them food to eat.
00:10:27And you will see that it is really very difficult for Cameroonians to pay.
00:10:30And you cannot hold them here.
00:10:32You don't have the right to hold them here.
00:10:34Because we consider them our own brothers and sisters who are in difficulty.
00:10:39And being a public hospital, we have a right and a duty to treat them.
00:10:44But sometimes it worries us at the level of the pharmacy.
00:10:49Because when they need drugs, it is difficult because the pharmacy is not owned by the hospitals.
00:10:56Now, imagine Cameroon has a serious problem of internally displaced persons,
00:11:02problems of refugees, problems of returnees.
00:11:05And all of them are in a desperate situation looking for medical attention.
00:11:08They go to these hospitals.
00:11:10But they also meet difficult conditions because they have to cover long distances.
00:11:14They have to live hard to access areas to hospitals that are not always nearby.
00:11:20They have to look for specialists that are not always in towns or villages where they are located.
00:11:25They need to move to Yaoundé Douala, at times now Garoua, to find treatment.
00:11:30Facilities are non-existent in some cases.
00:11:33The hospitals are ill-equipped and medical staff are absent.
00:11:38It is not a secret that a lot of them, in fact thousands, have gone to Europe,
00:11:42especially to Canada to seek for greener pasture.
00:11:46And then the situation gets preoccupying back at home,
00:11:49making the situation more difficult, especially in the rural areas.
00:11:53This again means that much is expected from the government.
00:11:57If not, Health for All, that is the slogan, will take a long time to be achieved.
00:12:05Or can we call it a far-fetched dream?
00:12:09Moki.
00:12:10Edwin Kinzika, reporting.
00:12:13Thank you very much, Edwin, with those figures.
00:12:17Since the outbreak of the civil crisis in the English-speaking regions of Cameroon,
00:12:23health care delivery systems in those parts of the country have been stretched beyond tolerable proportions,
00:12:31especially in regions that were already hit by frail and typically rudimentary health services and infrastructure.
00:12:41The Northwest region, for instance, is a region whose health map credits it
00:12:48with over 400 health facilities owned and run by government, confessional institutions and private capital.
00:12:57In spite of all these facilities, access to health care in the region is still hampered
00:13:04by the shortage of qualified personnel and equipment, coupled with economic challenges
00:13:11detrimental both to the health personnel and to the people in need of health services in the region.
00:13:19Let's now connect with Inside Out's Mercy Cousy in Pamenda
00:13:24with a painting of the reality of health care delivery in that crisis-devastated region.
00:13:34Health care delivery in the Northwest has been limited to some particular areas
00:13:39tacked green zones as a result of the socio-political crisis.
00:13:43A couple of renowned confessional and public health facilities now function far below their capacities
00:13:50due to consistent lockdowns and violence that scares sick people from accessing hospitals in those areas.
00:13:58About bigger hospitals in Shisong, people are not able to go there now because of obvious reasons.
00:14:05That's why now you see we have cardiologists that are going around in Catholic hospitals.
00:14:10They walk here in St. Mary's, you will see it, they say there a cardiologist is going.
00:14:14That's just to cope, to attend to the patients that are not able to go to Kumu as they used to go before.
00:14:19We have those, also this geographical accessibility.
00:14:25You know, patients need to be referred. If you see a big reference hospital, they need to come from far.
00:14:32And so with this crisis too, we have these lockdown days, ghost town days.
00:14:39Even in town, it's really difficult. And this accessibility even affects the health care providers.
00:14:45Imagine, we know, I think Mondays are very challenging days.
00:14:50You don't have taxis moving, you don't have vehicles moving in town or very few moving.
00:14:55Staffs need to be collected by the ambulances.
00:14:58Ambulances need to move around the town to collect the nurses, the doctors and all of the paramedicals
00:15:05to come and work and then take some of them back.
00:15:08And so you find that some staffs may not even have to sleep in the hospital longer
00:15:13because they are unable to go back to their various homes.
00:15:19Those challenges has made the job of health care providers quite daunting.
00:15:24The result being mass exodus of qualified medics to safer and greener pastures.
00:15:30Hence, the few resilient ones get to work long hours and suffer from burnout.
00:15:37The demand for emergency services and specialist doctors increases by the day.
00:15:44But most hospitals and health centers are thrown into total confusion when such cases arrive.
00:15:52We have been receiving a lot of road traffic accidents and even trauma cases.
00:15:57This has been a challenge. It's a hospital with 12 surgeons.
00:16:01And so when you see every time and then the emergency center is really, really always busy with trauma cases.
00:16:09Where I find one thing right now is the issue of mental health.
00:16:13And many of our young people are engaging in drugs, engaging in many things that set them off.
00:16:19And we are not able to manage them in our setting.
00:16:22We don't have enough counselors. We don't have enough psychotherapists.
00:16:25We don't even have. I can't say, I'm not talking of enough. We don't have them.
00:16:30Things get more complicated with the presence of quacks who stop at nothing to exploit desperate people.
00:16:37Even when they know they cannot deliver what patients are in need of.
00:16:41Nurses, I don't know whether they're coming from also the outskirts.
00:16:46Everybody wants to open a small place, a chemist and all that.
00:16:50So clients are receiving care at different places in town.
00:16:54Sometimes they are coming to the hospital when it's already late.
00:16:57Sometimes they are coming to the hospital when it's already late.
00:17:00There are lots of health services that are not even certified.
00:17:03Even individuals, everybody is trying to.
00:17:06And also because there are so many nursing schools in town. So many.
00:17:09So they're training nurses who don't have employment.
00:17:12And once they cannot be employed, they want to do their private businesses.
00:17:16So healthcare in the town is like everybody can do it, yet very few people are actually providing the required services.
00:17:28Before now, there had been constant education of the public to cultivate good habits
00:17:35by going for regular check-ups and consuming medication only upon doctor's prescription.
00:17:41Now more health complications are said to have developed in some people who do the contrary.
00:17:47They either come to the hospital late or do so after wrong diagnosis and prescriptions.
00:17:54Many here still can't afford their medical bills.
00:17:57In the year 2023, we had 46 million of unpaid bills where we had to treat over 1,008 poor and vulnerable.
00:18:07You know, with this crisis now people are finding it very difficult to pay their bills.
00:18:12And just for the first six months, first semester 2024, we had 24 million of unpaid bills for patients we have treated.
00:18:21When the emergency comes, we don't tell them to pay before we treat them.
00:18:26We uplift the crisis, treat the patients and we wait for payment.
00:18:30But some are unable to pay.
00:18:33Since the beginning of the crisis, a lot of people moved from the different villages into the town like here in Bamenda.
00:18:40Many of them are jobless.
00:18:42They fall sick, they come to the hospital, they cannot afford to pay their bills.
00:18:47And we cannot leave them. Being a cardiac health institution, you know, we have to serve them first.
00:18:55So they come here, we take care of them. At the end of the day, they cannot pay.
00:18:59Sometimes staying in the hospital, we incur more losses.
00:19:03Using electricity, using water, more beds being occupied and all that, we leave them to go.
00:19:08Some may come back and pay, but many don't come.
00:19:12The safety of medical staff is as well a green challenge in the region.
00:19:17As most of them are sometimes caught between belligerents in the conflict,
00:19:22there is a long list of medical personnel who have also lost their lives while on duty.
00:19:33A truly green picture there in the northwest region.
00:19:38Thank you, Mercy.
00:19:39Down in the southwest region of the country, the health map is not any different.
00:19:44Even if, as the regional health officials are laying claim to, a relatively brighter picture prevails there.
00:19:54Yet challenges abound.
00:19:56Challenges that are not only routine, but common to the rest of the nine other regions of the country.
00:20:04Like in the northwest region, and against the backlash of the simmering socio-political upheaval,
00:20:11essential health services and infrastructure in most areas in the region have all collapsed.
00:20:19And reaching out to people in hard-to-reach areas has remained an uphill task.
00:20:28As Ndoto Diale captures in the following package,
00:20:32access to health care in the southwest region has become an everyday challenge
00:20:38from the central, the intermediate and the peripheral standpoints.
00:20:43For some time now, the southwest region is experiencing an improvement in its state of health.
00:20:50If it is believed that the greatest wealth is health,
00:20:54then it will be prudent to say the southwest region is almost there,
00:20:59especially with the birth of the presidential plan of the universal health coverage.
00:21:04The migration of internally displaced persons from the peripheries to the central towns of the region,
00:21:10like Goya, Limbe and Tiku, due to the socio-political challenge,
00:21:15has resulted to an overburdening of existing health facilities.
00:21:20This has prompted the sprouting of unauthorized health structures.
00:21:25We had a lot of challenges in accessibility to health facilities.
00:21:30We had more than 50% of our health facilities in remote areas that were shut down.
00:21:35But as of date, I think we are 10 to 15% of our facilities that are still non-functional,
00:21:42either because the structure has been vandalized, looted and there is no personnel there.
00:21:50So the structures are not functional.
00:21:53Personnel shortage is a general problem in the whole of Cameroon.
00:21:57It is not only in the southwest and not only in the health sector.
00:22:01We have shortage here, acute and chronic shortage of personnel, quality personnel,
00:22:07because it has to go with the quality of care that the universal health coverage is warranted from the population.
00:22:16There are some areas that are security-wise challenging,
00:22:22but some that are geographically-wise very, very challenging.
00:22:26So there are many aspects that make these areas difficult to reach.
00:22:32So these are the specificities with respect to accessibility to our health facilities,
00:22:37the 21 health districts that exist in the southwest region.
00:22:41Another bone in the throat is the use of hard drugs and root-type medications.
00:22:47The consequence of this has increased the burden of the lone hemodialysis center
00:22:52based in the regional capital, Boya, which is also the third largest in the country.
00:22:58Nonetheless, the treatment center has braced the current challenges
00:23:03in giving affordable and quality health care to all its patients.
00:23:08We used to pay 5,000 francs for every dialysis session, dialysing two times a week.
00:23:15But with the universal health coverage, we now pay 15,000 francs.
00:23:22That covers us for the whole year, and it is renewed every year.
00:23:28As of January 2024, the state of the dialysis patients at the Boya Regional Hospital Hemodialysis Center
00:23:37has greatly improved because we received 13 brand-new machines,
00:23:43and the old machines that we had, seven machines, have later on been rehabilitated.
00:23:50The low turnout in routine immunization in the region in general
00:23:55is another issue that needs to be addressed urgently.
00:23:59As of last year, we were at 72% coverage for most of our indicators,
00:24:07but this year we've experienced a significant drop of more than 10 points
00:24:12of most of our immunization, our antigens.
00:24:16This is coupled with the challenge of the pre-enrollment of children 0 to 5 years old
00:24:21into the first phase of the universal health coverage.
00:24:25Nonetheless, communication has been reinforced and re-strategized
00:24:30to encourage more parents pre-enroll their children in the health scheme.
00:24:35We are doing advocacy with regional stakeholders where the governor is actively in the field
00:24:43encouraging other delegations, especially the delegation of basic education
00:24:48that's dealing with children and also the delegation of women empowerment.
00:24:52So these two delegations are in active collaboration with the delegation of public health in the southwest region.
00:24:58Although the construction of the referral hospital center is still much awaited,
00:25:04the region has succeeded to seal through outbreaks and pandemics.
00:25:08Once battered, the region is on the alert to intercept such challenges in the future if they occur.
00:25:15Public sensitizations are paying off, an indication that people have understood
00:25:21that early diagnosis and treatment, as well as the observance of basic hygiene,
00:25:26play a crucial role in combating most health challenges.
00:25:31And there is definitely still more in the pipe in Dotu Diale.
00:25:38One of the most pressing challenges in hospitals in Cameroon all of these years
00:25:57has been the deficit in the number of beds to accommodate the rising number of patients in hospitals,
00:26:05especially in suburban areas.
00:26:08The frequent movement of sick people to Yaounde dwellers and other major towns
00:26:14to seek adequate medical attention and treatment
00:26:18has sometimes produced gruesome scenes with patients lying on the floor
00:26:24or along the corridors of hospitals owing to the short supply in hospital beds.
00:26:31The health sector agenda currently being rolled out in the country,
00:26:36concretized by the construction and equipping of state-of-the-art general,
00:26:43referral and specialized hospitals across the country,
00:26:47while renovating some existing but dilapidated ones, is not perchance.
00:26:54Inside Out's Christian Chiatam has been keen on these bold recent-year investments
00:27:00which are revolutionizing the health sector in Cameroon
00:27:05and posits that they constitute the biggest ever one-time investment
00:27:12in the nation's health industry since independence.
00:27:16Christian?
00:27:21The credibility of a health system depends on its ability to respond efficiently to the needs of patients.
00:27:28This can be gauged not only through the doctor-to-patient ratio
00:27:32but equally through other indicators like the hospital bed density.
00:27:36The hospital bed density, which represents the number of hospital beds per 1,000 persons in Cameroon,
00:27:42has been fluctuating over the years,
00:27:44but some sources put it today at between 1.4 and 1.5 beds for 1,000 Cameroonians.
00:27:51The government has always nurtured the ambition of improving the hospital bed density in the country
00:27:57and of setting up modern infrastructure in all the 10 regions
00:28:01in order to improve the quality of health care provided to Cameroonians and to reduce the cost.
00:28:07That dream seems to be taking shape now as within the past three years,
00:28:12modern and highly equipped health facilities have been inaugurated in different parts of the country.
00:28:19The key to the recent expansion of hospital facilities in Cameroon
00:28:23can be found in the three-year emergency plan launched under the guidance of the President of the Republic.
00:28:29Under this audacious plan, the target was to improve the technical platform of health infrastructure in Yaoundé and Douala
00:28:37and above all to construct regional hospital centres in each of the eight other regions.
00:28:43The dream is already taking shape now
00:28:46as at least six out of the eight regional hospital centres are already operational
00:28:52with most of them inaugurated.
00:28:55The Betwa Regional Hospital Centre was the latest in the series to be inaugurated.
00:29:00The full impact of the eight new regional hospital centres in Cameroon can be gauged from many angles.
00:29:07First, they have improved the hospital bed per patient ratio in the country.
00:29:12Each of the six new infrastructure inaugurated so far have an accommodation capacity of about 100 beds
00:29:20both for care, rehabilitation and long-term admission.
00:29:25Regional hospital centres are also strategic
00:29:28in that they make available the medical equipment necessary to address a wide variety of health issues
00:29:35thereby reducing the movement of people to seek high-quality health care in the centre and littoral regions.
00:29:42Regional hospital centres have already been inaugurated in the West, the South, the North and East regions
00:29:49while the one in Ganderi is already operational and Marwa also close to completion.
00:29:55The two regional hospital centres of the North West and South West have been delayed because of the crisis in the two regions
00:30:03but hopefully it won't be too long before these hospitals are opened.
00:30:08Apart from regional hospital centres, the government has been working with its partners to develop other health infrastructure.
00:30:17This is the case with the Garwa General Hospital.
00:30:20Providing quality health care is a constant preoccupation for every government
00:30:24because health is the basis for wealth creation.
00:30:28With the plethora of health facilities set up across the country of recent
00:30:33the government is confirming that health remains a priority.
00:30:40Christian Chiat, I'm there with the infrastructure boosts in the health sector in Cameroon in recent years.
00:30:48But all of these colossal investments in the health sector may sum up to nothing
00:30:55if the manpower is not there to add value and enable them to deliver on the health needs of the people.
00:31:04Data from the Cameroon Medical Council puts the current doctor-patient ratio in Cameroon at 1 doctor per 50,000 people
00:31:15way far below the WHO's recommended ratio of 1 doctor per 10,000 patients.
00:31:23The Medical Council attributes this overwhelming doctor-patient imbalance
00:31:30to the massive flight of doctors from the country for greener pastures elsewhere.
00:31:37Yet the country's Ministry of Public Health needs a staggering 30,000 health care practitioners
00:31:44to align with the WHO exigency of 1 doctor per 10,000 people.
00:31:51The picture becomes even bleaker when the need for specialisation steps in.
00:31:57Domain-specific doctors are in short supply in Cameroon
00:32:02and the few still hanging out there tend to be overworked
00:32:06given the huge number of patients they attend to on a daily basis.
00:32:12Yoti Kalelisonge has been keen on the question of manpower in the health sector of Cameroon
00:32:20observing that among the several challenges facing the sector today
00:32:26the challenge of specialisation is a daunting one
00:32:30especially as the universal health care is now making bold in-routes
00:32:36into the country's health care delivery system.
00:32:40Yoti?
00:32:43One doctor per 50,000 persons
00:32:46a figure of the doctor-to-patient ratio in Cameroon that speaks for itself.
00:32:52To provide some sort of a remedy
00:32:55medical practitioners are obliged to spend less than the required time
00:32:59when diagnosing the possible cause of an individual's discomfort.
00:33:03The dynamics change when one x-rays right to the number of medical specialists.
00:33:09The statistics are alarming in fields like rheumatology
00:33:13the branch of medicine that deals with painful
00:33:16typically inflammatory or infectious conditions of the joints
00:33:20and other parts of the musculoskeletal system.
00:33:23There are just 35 rheumatologists in the nation
00:33:27and based on the 2023 statistics published on the Pan-African Med Journal
00:33:33five of the 10 regions of Cameroon are without a rheumatologist.
00:33:37Imagine someone with lupus, for example, in one of those areas.
00:33:42Your guess is as good as mine.
00:33:45They may resort to unorthodox practices for relief.
00:33:48Perhaps sometime in 2025
00:33:51with the graduation of the 13 Pawnia residents in training
00:33:55at the Faculty of Biomedical Sciences of the University of Yaounde I
00:33:59the scenario would change.
00:34:02Until then, specialists are trying to make do with the available resources.
00:34:07We perform less than 40% of the interventions we were supposed to be performing
00:34:15because of so many reasons.
00:34:17Number one, the chief reason is that the patient is unwilling to succumb to what the doctor says.
00:34:22Adhering to what the surgeon says is a major challenge in Cameroon
00:34:26because people, by the time they get to the hospital, they come with their opinions
00:34:30given to them by the taxi man, the motorbike man, the relative who says
00:34:35that I think that it has to go to this way, to that way.
00:34:38So we finally have about 30 to 40% of patients who are willing to be managed
00:34:43by standard medical or surgical care.
00:34:46So we have about 30% of our total population that we are supposed to manage
00:34:52and the rest 70% are in the society, in the environment, moving around
00:34:57going from one traditional healer to the next.
00:35:00Day in, day out, the medical staff deficiency gap is being reduced.
00:35:06By the end of 2021, for instance, Cameroon had gone from having only 5 nephrologists in 2013
00:35:14to 28 and the number keeps increasing.
00:35:17Ten years ago, the country counted less than 15 orthopaedic surgeons.
00:35:23Currently, there are over 50.
00:35:26We are in all the cities in Cameroon, the big cities, Yaoundé, Douala, Bafousam,
00:35:31you can find orthopaedic surgeons in Marwa.
00:35:34We don't treat all the patients because we have general practitioners
00:35:38who can treat the patient with cases which are not very difficult.
00:35:44So we receive only very tough cases because we are not enough to treat all the patients.
00:35:52It's true that we are not enough to cover all the needs in our specialty.
00:35:59So it's quite difficult, but we are trying to satisfy the maximum of patients.
00:36:07But the outcome is seemingly slow.
00:36:09With a growing burden of non-communicable diseases,
00:36:12the doctors feel the pulse of the patients' ever-surging demands,
00:36:17a reality that sometimes plays on their blood pressure, owing to little or no rest.
00:36:23This also summarizes the price they pay to respect the Hippocratic Oath.
00:36:29Each year, we train so many anesthetists.
00:36:31But in the process of integration, the government takes just a few.
00:36:35And now you realize that in most of the hospitals, especially the district hospitals,
00:36:39we have just anesthetists that are managing the patients.
00:36:42And most of us, we are few.
00:36:44We even lack the materials, we lack everything, so the challenges are too much.
00:36:47Let's also take the case of physiotherapists.
00:36:50There are 0.10 per 10,000 persons.
00:36:54In a 2019 report of the World Confederation of Physiotherapy,
00:37:00it is estimated that 250 physiotherapists exist in Cameroon.
00:37:06The number of neurosurgeons, too, stands at approximately 25,
00:37:11for a population of close to 30 million.
00:37:14Dr. Kamgang Kuli Steve Chakye,
00:37:17a fourth-year neurosurgery resident at the Kenyatta National Hospital in Nairobi, Kenya,
00:37:24plans on returning home, precisely in the far north region,
00:37:28to soothe the pain in that part of the country.
00:37:31Further research attests that medical personnel in the nation have their hands full.
00:37:37Even though general practitioners continuously give their best to alleviate the situation,
00:37:43some sad truths remain,
00:37:46like the 20% population in need of comprehensive eye care services.
00:37:51In February 2023, Dr. Henry Kumbe,
00:37:54renowned ophthalmologist and specialist in cataract, retina, glaucoma and refractive surgery
00:38:01at the Maghrebi Cameroon Eye Institute, admitted the fact.
00:38:05Some pointers also indicate that the learning environment is not quite favourable.
00:38:10Our training is marked by humiliation from beginning to the end.
00:38:15From everybody, from your professor to the assistants, the consultants, the lecturers,
00:38:25the doctors, the nurses, everybody disrespects you.
00:38:29And it's so humiliating and belittling that nobody would wish to go through that kind of training.
00:38:35Notwithstanding, the medical frontliners keep hope alive,
00:38:40believing that someday they will have the perfect antidote to bridge the gap in health care provision.
00:38:47Perhaps in the future, they will experience a multiplication dose,
00:38:52despite brain drain, which is one of the main factors negatively impacting the physician ratio.
00:39:01...with that gaping deficit in the doctor-patient ratio interplay in Cameroon today.
00:39:10And that's just one side of the coin.
00:39:14The flip side of it is even more appalling.
00:39:18And this concerns the phenomenon of brain drain.
00:39:23This is a gangrene that has been plaguing the health sector in most of Africa,
00:39:29but Cameroon seems to be facing it with a rather biting acuity.
00:39:35It has been and is still depriving Cameroon of her finest crop of physicians
00:39:41who are all flying abroad to seek better work and better financial incentives out there,
00:39:48leaving the country's health sector in a precarious state.
00:39:53Laris Nane-Epote has been doing the diagnostics and submits that there is a pressing need
00:40:02to incentivize the health sector and stop this brain drain hemorrhage
00:40:08that is treacherously sapping an already hyper-anemic sector.
00:40:14Laris?
00:40:17Migration of medical professionals from developing countries has become a major concern.
00:40:23This brain drain, in return, worsens the already depleted health care resources in poor countries
00:40:29and widens the gap in the health inequities worldwide.
00:40:33Despite training over 7,000 medical practitioners in Cameroon annually,
00:40:38the country faces a deficit of 83,000 medical professionals,
00:40:43a situation that questions the quality of medical professionals trained in Cameroon.
00:40:49According to actors in the field, this brain draining can be explained by low salaries,
00:40:54minimal recruitment and restrictive laws.
00:40:58There are many of them being trained every year and the recruitment is being reduced.
00:41:05So the ratio between those who are trained and graduates
00:41:09and those who are going to stay in the country
00:41:12has recruited by the main employer, who is the state.
00:41:16The fact that we are no more taking them in these public health structures.
00:41:21Many of our students, even those in specialization,
00:41:25when they go abroad, the hospital and the services there are finding that they are of good quality and they keep them.
00:41:34Gone are those days when medical practitioners travel abroad for specialization
00:41:39and then head back to Cameroon to practice in hospitals.
00:41:43Now, they stay in the host country or travel to others of the same standard of living for greener pastures.
00:41:51They have a capacity to work, offer and render services,
00:41:56which are satisfying those people abroad and they keep them.
00:42:00Meaning that the training is good.
00:42:02Among our trainees here, we have good medical personnel.
00:42:07And when they go abroad, they are certainly kept by the other countries, unfortunately for us.
00:42:15Cameroon, in its different medical learning institutions, offers quality professional training.
00:42:20But actors in the sector attest more and more students patronize the field of medicine,
00:42:26not because of the passion for the job, but to make ends meet
00:42:30or fulfill the desire of their parents of having a health worker in the family.
00:42:36The government, through its numerous efforts to offer advanced health care services,
00:42:42has been applauded but called upon to see into the recruitment of these brains,
00:42:47especially the outstanding ones, which is highly needed to boost the quality of health services rendered in hospitals across the country.
00:42:55If the working conditions, especially for those in crisis-stricken areas, with little or no development are ameliorated,
00:43:03it will go a long way to motivate the health workers to carry on their duties.
00:43:09It could be a kind of specificity in consideration of those who are spending their days to save lives.
00:43:17That's the kind of motivation by certainly a kind of salary.
00:43:23I don't know how to say it because it's inducing some financial impact,
00:43:28but I am sure that if we improve their conditions and also improve the environment where they are working,
00:43:35it's very important for a medical doctor to work with a plateau technique which is suitable.
00:43:41I think that we could be promoting the staying of these young doctors,
00:43:46even maybe the coming back of some who have stayed abroad to come and work in our country.
00:43:52It is certain that brain training cannot be stopped, but the number in which they migrate to other countries can lessen
00:44:00if adequate measures to keep these brains are reinforced.
00:44:05Let me say, following that report, that if you need them, keep them,
00:44:10and government definitely knows what it takes to keep these doctors fleeing the country.
00:44:18Health is wealth, so goes the adage,
00:44:22which presupposes that there is a clear nexus between the state of healthcare in a country and its economic situation.
00:44:31The health insurance system in Cameroon is somewhat oblivious of this existential connection.
00:44:39For one thing, health insurance here lacks a legal framework,
00:44:44and for the other, it does not extend benefits to the entire population,
00:44:50and that's where the shoe pinches most.
00:44:54Inside Out's Alphonse Abongo-Altu explores the complex interplay of challenges and opportunities
00:45:03of health insurance in Cameroon's healthcare delivery system and set-up,
00:45:09and says, with measured conviction and assurance,
00:45:13that insurance schemes that were supposed to be a saviour for most people,
00:45:20especially the less privileged, have rather become a dilemma for Cameroonians today.
00:45:30On the hierarchy of the United Nations Human Development Index, HDI,
00:45:35health appears at the top position.
00:45:38This suggests that every country driving on the highway to national development
00:45:43must exert more pressure on an acceleration pedal known as access to healthcare for its population.
00:45:50Health insurance, therefore, comes in as one of those key tools to meet this target.
00:45:56Some people think health insurance is a privilege.
00:46:00It's not a privilege, it should be a necessity,
00:46:03because a personnel that is not in good health cannot be productive,
00:46:07and a company that provides health insurance for its personnel is a company that is sure of its productivity,
00:46:14because a worker who lives home with a wife sick,
00:46:17and does not have money to buy just paracetamol to calm down the temperature,
00:46:20cannot be productive at the work site.
00:46:22But when you know that your wife is sick, your children are sick,
00:46:25and they can get treated under health insurance coverage, you go to work with less stress.
00:46:30A conventional health insurance covers a wide range of domains and works systematically.
00:46:36A normal health insurance policy covers from consultation, hospitalization, pharmacy,
00:46:43laboratory analysis, ambulance, and even evacuation.
00:46:48The Minister of Health has defined a package,
00:46:50and the National Syndicate for Medical Doctors has also defined a package.
00:46:55That, for the Minister, is suitable for government hospitals,
00:46:59from the district hospitals to the reference hospitals,
00:47:02whereas the package for the National Syndicate for Medical Doctors is suitable for private hospitals.
00:47:08Expert view holds that, on paper, Cameroon has an appealing health insurance policy,
00:47:13yet the ecosystem is still blighted, with several loopholes,
00:47:18given that the reality in some areas tells a different story.
00:47:22We have a very well-structured health insurance policy,
00:47:27which, unfortunately, isn't being consumed by the majority.
00:47:30Health insurance coverage in Cameroon is still very weak,
00:47:34and it is as a result of the weak insurance penetration.
00:47:39Today the market is less than 10% covered.
00:47:41In some public and parapublic corporations of the country,
00:47:44the insurance policy is described as epileptic.
00:47:48Staff complain that they oftentimes have to self-fund their health care expenses,
00:47:54and this reluctantly too.
00:47:58Insurance functions today and tomorrow, it is suspended.
00:48:01The procedure is not good.
00:48:03You are asked to spend your money for a later refund.
00:48:06You spend to buy lenses for yourself and your children,
00:48:10and it takes six months for them to refund your money.
00:48:13At times, the document gets missing in an office.
00:48:18By experience, personnel covered by health insurance
00:48:22find the process simple when they get to the hospital.
00:48:26Regarding legislation on insurance,
00:48:28the country does not yet have its own independent laws.
00:48:32Cameroon does not have its own insurance laws.
00:48:34Cameroon uses community insurance laws.
00:48:36There is a CIMA code, which is applied in other 15 or 16 countries.
00:48:41Cameroon is one of them.
00:48:42So that is the code that we are using that covers all insurance activity,
00:48:45health insurance inclusive.
00:48:47In some public health facilities,
00:48:49information gaps between patients benefiting from such insurance
00:48:54and their health often land them into unhealthy brawls
00:48:59with officials in charge of insurance follow-up in the hospitals.
00:49:03Barely 10% of Cameroonians are said to have health insurance.
00:49:07Experts opine that there is still room for improvement
00:49:11if the government takes its full responsibility.
00:49:15The destination in this domain within Cameroon is still far
00:49:19and the distance covered to reach there is low.
00:49:22The population waits expectantly to get respite from the powers that be.
00:49:37Universal health coverage,
00:49:39the latest catch in Cameroon's health care delivery,
00:49:43is now coming in as debate to build Cameroonians
00:49:47from the whims and purposes of insurers.
00:49:51This is a scheme whose leitmotif is to ensure
00:49:56that everyone has access to basic quality health care,
00:50:02irrespective of their socioeconomic status and geographical location.
00:50:09This is a scheme whose leitmotif is to ensure
00:50:14that everyone has access to basic quality health care services,
00:50:20irrespective of their socioeconomic status and geographical location.
00:50:26Health experts and health anthropologists consider it
00:50:30of utmost importance in Cameroon,
00:50:34particularly against the backdrop of the high costs required
00:50:39of the citizens to meet their health needs.
00:50:43Once holistically and concretely functional,
00:50:47the universal health coverage will trigger a quick turnaround
00:50:52in the country and become the game changer
00:50:56in the country's health care delivery system.
00:51:00This, you say, Beatrice Lostamba,
00:51:03will lead the government to walk the talk
00:51:06rather than merely talking the walk.
00:51:11The government marched words with actions
00:51:14when in April 2023,
00:51:16Phase 1 of the universal health coverage scheme
00:51:19was launched in Manjou in the East Region.
00:51:22The objective of Phase 1 was by 2025
00:51:29The objective of this first phase is to be able to reach 6 million Cameroonians by 2025
00:51:35and now we have 4 million pre-enrolled and 3 million benefiting
00:51:39and so we have made some strides here.
00:51:45That the scheme is underway does not mean everyone can just walk to the hospital
00:51:50and receive quality health care free of charge right away.
00:51:54First, you have to register to the universal health coverage
00:51:57using your identification documents at a pre-enrollment post
00:52:01or online through the electronic platform Cameroon Health Coverage
00:52:05after which you get a card.
00:52:07When this is done, for now,
00:52:09a select group of people only can access the gains
00:52:12as the first phase of the universal health coverage targets
00:52:15children below 0 to 5 years,
00:52:18pregnant women,
00:52:19tuberculosis,
00:52:20HIV AIDS and dialysis patients
00:52:23and these were only a few illnesses considered as public health problems.
00:52:28It's a remarkable difference among dialysis patients.
00:52:31Before, they had to pay 5,000 CFE francs for each dialysis session,
00:52:3640,000 CFE francs a month
00:52:38and 520,000 francs to have hemodialysis per year.
00:52:44Today, they no longer need to spend all that money.
00:52:48With universal health coverage,
00:52:50they pay a social contribution fee of 15,000 CFE francs
00:52:54at a dialysis center to proceed to obtain free dialysis every year.
00:52:59When we're paying dialysis,
00:53:02I was also doing my monthly test
00:53:04and buy my drugs.
00:53:06So now that they have reduced that charge of dialysis for us,
00:53:11at least it's a good thing for me
00:53:13because it's really helping.
00:53:14I mean, that 5,000 can buy one drug.
00:53:16The problem is the problem of blood.
00:53:19So it's not really easy.
00:53:20Then the price of the blood is too expensive.
00:53:23To further move the ambitious health agenda forward,
00:53:27the government introduced the health vouchers for pregnant women.
00:53:32With just 6,000 CFE francs,
00:53:34they have access to prenatal services
00:53:37attended to during delivery.
00:53:39In case of a C-section,
00:53:41they are entitled to free care with a 6,000 CFE francs voucher only.
00:53:47And after delivery during the postpartum,
00:53:50women receive visits until about 42 days later.
00:53:54The health vouchers are available in five regions,
00:53:57extending to the northwest and southwest regions this year.
00:54:00The littoral, central, and west regions
00:54:02are the only regions yet to be reached.
00:54:05The first phase of the universal health coverage
00:54:07targets 6 million people.
00:54:09About 4 million have pre-enrolled.
00:54:13The challenge to get many others enrolled is real.
00:54:16When the first phase ends in 2025,
00:54:19the government is working on widening coverage
00:54:22to ensure that everyone,
00:54:23irrespective of their socioeconomic status and geographical location,
00:54:27receives quality health care.
00:54:29We just lost somebody there with the government
00:54:32and its health care choices and options.
00:54:47The use of traditional medicine,
00:54:50especially in the pharmacological aspect,
00:54:53is on the rise globally.
00:54:55While the developed world has found ways
00:54:58of making huge economic gains
00:55:01through robust integration plans,
00:55:05there appear to be a huge challenge
00:55:07among the developing countries
00:55:09towards realizing such gains
00:55:12through greater access and exploitation
00:55:15of traditional medicine,
00:55:17which paradoxically supplies
00:55:20the most of the local population's health care needs.
00:55:24Due to negative stigma attached to this form of medicine,
00:55:29integrating traditional medicine
00:55:32into the formal health care delivery system
00:55:35continues to suffer a lot of criticism.
00:55:40Though most of the issues raised
00:55:43to affirm the seemingly inadequate status
00:55:46of traditional medicines
00:55:48and the absolute undesirability
00:55:52for its integration into formal health care delivery
00:55:56are compelling,
00:55:58they are not insurmountable.
00:56:01Mukwele Prince Wiladuma
00:56:03has been reassessing the historical development
00:56:07of traditional medicine practice in Cameroon,
00:56:10the challenges of its integration
00:56:13into the formal health care delivery system,
00:56:16and the way forward for ensuring a sustainable integration,
00:56:20and posits that it is crucial
00:56:23for government and other stakeholders
00:56:26to develop a more holistic implementation plan
00:56:30for traditional medicine integration
00:56:33into the formal health care system.
00:56:38The Association of Traditional Medicine Practitioners in Cameroon
00:56:42is not listed amongst funder entities
00:56:45to health care delivery in the country.
00:56:48While government, public enterprises, religious missions,
00:56:51and NGOs wield their influence
00:56:54through the he-who-pays-the-piper-calls-the-tunes mantra,
00:56:57the situation is interpreted as discrimination
00:57:00or sheer underestimation of the financial capability
00:57:03of a sector that shouts its ability
00:57:06to treat all types of diseases.
00:57:30The first product that had an award on it
00:57:33is a medicine for gastric ulcer,
00:57:36which I protected at the African Intellectual Property Organisation.
00:57:39The second is that for years in the stomach,
00:57:42intestine worms,
00:57:45the gastric ulcer,
00:57:48which I protected at the African Intellectual Property Organisation.
00:57:51The third is that for years in the stomach,
00:57:54intestine worms,
00:57:57and yeast,
00:58:00intestine worms and any bacteria in the stomach.
00:58:03These products have won a lot of prizes.
00:58:06On Pea Prize I've won,
00:58:09on Minrese Prize I've won,
00:58:12on Small Medium-Sized Enterprise Prize I've won,
00:58:15the recent one that I've won
00:58:18with this medicine for gastric ulcer
00:58:21is with a CIAC that held from the 22nd to the 31st of July 2024.
00:58:24is with a CIAC that held from the 22nd to the 31st of July 2024.
00:58:27is with a CIAC that held from the 22nd to the 31st of July 2024.
00:58:45But inside this clinic,
00:58:48signs of growing collaboration with conventional health care providers seems irreversible.
00:58:53Trained practitioner, an independent researcher in the Ministry of Scientific Research,
00:58:58President of the GEFE Foundation, Vice President of the National Order of Ethnicity in Cameroon.
00:59:04Even the Ministry of Public Health, that sent me to the Ministry of Scientific Research.
00:59:08When they discovered that I have two patent rights,
00:59:12they said, no, this man, you are somebody great.
00:59:15We want you to go to the Ministry of Scientific Research so that you can carry out all your
00:59:19tests, so that your product can be put into the pharmacy.
00:59:22Because your product, it doesn't only calm the gastric ulcer, but it eradicates it.
00:59:27When a patient comes for such complicated illnesses, like fibroid, like malaria,
00:59:34we send them, first of all, to the hospital.
00:59:37When they come back with the results, it is from there that we know the product to administer.
00:59:44And when we finish administering the drug, we send the patient back to the hospital
00:59:48to verify whether the patient is well or not.
00:59:52For instance, if a patient is sick, then he comes to me with a particular problem
00:59:58that is a little bit complicated.
01:00:01I have to send her back to the professionals, the lab technicians in the hospital,
01:00:09so that they should conduct her a test.
01:00:12From there, when she comes back, I will get her report.
01:00:17Then from there, I prescribe them.
01:00:19So that's our link between us and the medical doctors.
01:00:27A lot of health personnel, like doctors, have failed.
01:00:32Why? Because they depend on computers.
01:00:36They depend all their work on computers.
01:00:39But in those days, when there were no machines, when there was nothing,
01:00:43even our forefathers, we come from nature, this natural medicine.
01:00:50They deal with signs and symptoms.
01:00:53So when a patient comes, they evaluate you, they check the signs and the symptoms.
01:01:01If for nothing, the universal healthcare delivery system,
01:01:05current mascot of government's expression of an increase in access to healthcare for all,
01:01:12will continue what is seen as an upward curve
01:01:15with the possible factoring of inputs from traditional medicine.
01:01:19But not yet, and the reason is simple, negative perception.
01:01:24When we take this as a product to the Ministry of Scientific Research,
01:01:28we are the ones who give the dose of our product that we give.
01:01:34It is in the lab that they verify to see if it is correct,
01:01:37before they can put it there.
01:01:40So if somebody says that it doesn't have dose,
01:01:44just know that the person is telling a lie.
01:01:46Because here I receive medical doctors, I receive everyone here.
01:01:50Take for example, I was in India.
01:01:52There was a medical doctor who came and met me in the Cameroon stand.
01:01:57He had waist pain and a lot of poison, toxins in the body.
01:02:01He told me that he has taken a lot of products, a lot of products, but to no avail.
01:02:06But I gave him my medicine.
01:02:08When I gave him, two days later he called me and said that he is fine.
01:02:12That he has taken drugs, his own drugs that he knew.
01:02:15He went even to his colleagues, complained that I gave him drugs, but it never worked.
01:02:22But when I left here, I went there and gave him my drugs.
01:02:26I am telling you, it was marvellous.
01:02:29Because he even invited me in his college,
01:02:33Baraji College of Education, where he trains all the medical personnel.
01:02:37Where I took my drugs there, and even tested it on most of those students,
01:02:42where the result was 100%.
01:02:46It shows that herbal medicine is really working,
01:02:48because you look out there, you see a lot of doctors.
01:02:51The universal health care, with different components,
01:02:55therefore opens the possibility of down-costing of treatment of pathologies
01:03:00that take up the bills in hospital structures,
01:03:03given expenditure imposed by conventional handling.
01:03:06First of all, I thank the President of the Republic, Paul Bieh.
01:03:09Because Paul Bieh, he wants that the health of Cameroonians,
01:03:13Cameroonians should have good health.
01:03:16That's why he has decided that this program should be introduced.
01:03:20Most people, they don't have money.
01:03:22And when they come here, you see, I would like to help them
01:03:25on the amount of money that they have.
01:03:27So if the government can think of something like this,
01:03:31it would be very, very important.
01:03:34Because the program is to help each and everyone,
01:03:39from the first class to the third class citizen.
01:03:43If the government opens the door to us, it would be very nice.
01:03:47And the government already opened it,
01:03:49because, as you see here, I'm the president of traditional healers
01:03:54in our district hospital of Vogada.
01:03:57We have collaboration.
01:04:00There, they know what we treat,
01:04:04because there is a register,
01:04:07where we register all the healers that we treat.
01:04:11And we will receive patients from those hospitals
01:04:15found in the district hospital of Vogada,
01:04:19where, when they send it, we give treatment,
01:04:23and we send the patients back to the hospital
01:04:26for research to see if the person is well,
01:04:33to which degree, to which level.
01:04:36That's why, you see, the collaboration in between traditional healers
01:04:41and the conventional medicine is really fruitful.
01:04:45Their growing number reveals business is good for them.
01:04:50Business, revamped by the many more patients knocking at their doors,
01:04:54is turning these practitioners into dependable actors
01:04:58in what is supposed to be an inclusive health care delivery system in the country.
01:05:03If you can't beat them, join them.
01:05:06The state knows this.
01:05:12World Health Organization
01:05:17News Inside
01:05:22Guest on News Inside our tonight
01:05:25is Professor Von Wilfred Bacham.
01:05:28Professor Von Wilfred Bacham is
01:05:30Titular Professor of Public Health Biotechnology
01:05:34and the Chair of the Board of Trustees
01:05:37of Malaria Consortium UK.
01:05:40Okay, Professor Mbacha, you're welcome on the program.
01:05:42Thank you very much for inviting me.
01:05:45How would you react to the fact
01:05:47that the universal healthcare is here at last?
01:05:50Well, you know, when the idea emerged in 2015,
01:05:55we saw the government gravel and made some little strides
01:05:59in what they were trying to do.
01:06:02I mean, 2019, I constituted a team
01:06:05that went to assess whether Cameroon was on track
01:06:07and concluded that we're very much on track
01:06:09because we had compared the local realities
01:06:12and the evidence that was emerging
01:06:14from the international community.
01:06:16And we were able to publish that
01:06:18and to show that Cameroon was on track.
01:06:20I was so pleased that in 2020,
01:06:24then the fundamentals of all that was needed
01:06:27had been put in place for it to ultimately be launched
01:06:30in 2023.
01:06:32Once that was launched, I think it was everybody's guess
01:06:37that, oh, Cameroon may not be able to meet up
01:06:39with what it requires.
01:06:41Yes, there are a few challenges
01:06:42which we'll be able to talk about,
01:06:44but by and large, Cameroon has been able to meet up
01:06:48with the challenges because they started in a way
01:06:50that normally scientists would advise them to do,
01:06:53which is start small and then slowly expand
01:06:56the pilot program to cover more regions.
01:06:58And this is exactly what was done.
01:07:01And I think that currently I can say with confidence
01:07:05that Cameroon is on track and they've done a good job.
01:07:08There are a few more hitches which I think can be overcome
01:07:12and then for us to have it universal,
01:07:15really covering the entire Cameroon's population.
01:07:18From a purely medical standpoint,
01:07:20how would you explain the fact that it has taken this long
01:07:23for it to come real?
01:07:24Well, first of all, for universal health coverage to happen,
01:07:28somebody has to pay for it.
01:07:30So I think what happened was the government
01:07:33needed to look for the resources
01:07:36to be able to put in place.
01:07:38So that universal health coverage can happen.
01:07:40That's the first.
01:07:41The second is that the landscape in Cameroon
01:07:44and the terrain is not the same like in any other country.
01:07:47So you have to master the things that need to be put out
01:07:51and to know exactly what kinds of challenges
01:07:53you would meet on the field for this to happen.
01:07:56Number three is that people have to buy into it.
01:08:00Usually when you give something for free,
01:08:02everybody's suspicious and says,
01:08:04hey, if this thing is for free, is there a catch to it?
01:08:07So you had to ensure that there was a buy-in
01:08:09for the population,
01:08:10you understood the challenges on the field
01:08:12and that there was the resources necessary to put in.
01:08:15We still have a challenge,
01:08:16which is that of the medical staff.
01:08:18We don't have enough doctors,
01:08:20we don't have enough nurses,
01:08:22we don't have enough healthcare givers
01:08:24and therefore healthcare providers
01:08:27and therefore it's still important for us
01:08:29to provide these health personnel
01:08:33so that what it is that we call
01:08:36the universal health coverage
01:08:37would be attained in its fullest dimensions.
01:08:41Despite all of those hiccups that you are enumerating,
01:08:45the scheme is here at last.
01:08:47It is almost 16 months already,
01:08:49we're counting, that the pilot phase
01:08:51has been set rolling in Cameroon.
01:08:53How would you appreciate the way
01:08:55that it is playing out in Cameroon?
01:08:57Well, number one, when they started off,
01:09:00they were focused on women, pregnant women,
01:09:04and they were focused also on children
01:09:07less than five years old,
01:09:09because these are the most vulnerable of the population.
01:09:12We started off in three regions
01:09:14and we're able to add things like TB and HIV care
01:09:18and also looking at the malaria situation.
01:09:21And I think as of now,
01:09:23we've covered in Cameroon
01:09:26more than 130,000 HIV patients
01:09:31who've had adequate care,
01:09:35meaning from diagnosis,
01:09:38all the tests that need to be done,
01:09:40all the way to treatment.
01:09:41We've had more than 380,000 children
01:09:45who've undergone full and almost free treatment for malaria.
01:09:49We have for dialysis and those with kidney problems,
01:09:53those who are able to pay just 15,000 francs
01:09:57or $25 for their sessions.
01:09:59Instead of 520,000.
01:10:02Thousand, exactly.
01:10:03So this is some of the gains that we've had
01:10:06from the universal health coverage,
01:10:07which is actually making us know
01:10:10that it is something worth implementing.
01:10:13And especially when you are ill,
01:10:16that's when you know how valuable your health can be.
01:10:18And for these individuals to experience that,
01:10:21it's something which money itself cannot buy.
01:10:24And I think that with the experience that we've gained
01:10:27from the northern, the southern, and the eastern regions,
01:10:31it's going to gain traction with the rest of the population.
01:10:34And I think with that in mind, Cameroon needs to gear up
01:10:38because the universal health system,
01:10:41for it to be able to work perfectly,
01:10:44you offer a number of services almost for free.
01:10:47And these services are picked up by the population.
01:10:50And I think we're going to see gains.
01:10:52If we're aiming to have Cameroon developed by 2035,
01:10:56then universal health coverage is part of that
01:10:59contributing factor that will make us emerge.
01:11:02Now, Prof, this scheme has, in Cameroon,
01:11:05it has targeted some regions,
01:11:08and it is not covering the entire population yet.
01:11:11It is going out for some sample,
01:11:13some targeted portions of the population.
01:11:16You're talking about HIV patients,
01:11:18pregnant women and children.
01:11:20Now, how universal then is that scheme?
01:11:24Well, first, the universal health coverage
01:11:26is that a number of health services are provided
01:11:29for the benefit of the entire population.
01:11:31So that's what makes it a universal health coverage.
01:11:33Of course, we're still going to attain that universality
01:11:37when we cover the entire population of Cameroon.
01:11:40Now, it has to go in phases.
01:11:42So phase one was the launch, and it's pilot phase.
01:11:45Then slowly, a number of other regions
01:11:48will be taken on board.
01:11:49Some major towns have been taken on board.
01:11:52And therefore, as we make progress,
01:11:55we're going to see that it's going to be spread.
01:11:57Currently, I think 185 interventions were targeted.
01:12:01So that's a lot.
01:12:02And to understand that, with those targeted interventions,
01:12:07we're going to see the ripple effects.
01:12:09Because if your brother is ill and gets attention,
01:12:13then it's like putting money into your hands.
01:12:16And when that happens, you don't feel it
01:12:18because you don't palpate, you don't touch the money.
01:12:21But ultimately, you make gains on it
01:12:23because you're able to use the money for something else.
01:12:26And slowly, it's going to get that universality
01:12:29when the entire population would feel the benefits of it,
01:12:33in addition to covering the entire 10 regions of the country.
01:12:37Now, it is playing out in just some select few regions.
01:12:40And can we know what were the criteria that were used
01:12:44to be able to select those regions?
01:12:46What made them different from the other seven?
01:12:48Well, when you look at the northern region,
01:12:50they are adversely hit by climate.
01:12:53They're adversely hit by sparse population
01:12:58and the nomadic population.
01:12:59But at the same time, the ecosystems of the north
01:13:03are kind of peculiar.
01:13:05Now, when you look at the south,
01:13:06then you notice that it's an entirely forest region.
01:13:10And when you look at this forest region areas,
01:13:13then the climates also and the ecosystems are very different.
01:13:18Now, when you look at the eastern region
01:13:21and you know that a lot of refugee populations
01:13:23were also displaced and came in,
01:13:25you can tell exactly why these regions were kind of picked,
01:13:29in addition to other regions,
01:13:31which I think the ministry does master very well.
01:13:34But they were picking regions in the extremes
01:13:37of the ecosystems to be able to see what challenges
01:13:42could be encountered with these different ecosystems
01:13:45so that it can now be slowly spread to all the others.
01:13:48I mean, the lessons that we learned from the south region,
01:13:52it's easy to spread it all across to the littoral.
01:13:55Those we learned from the northern region,
01:13:57we can spread it to the extreme north
01:13:59and we can spread it to the Damawa
01:14:00and the western regions,
01:14:03which have the Sahel, Savannah, and all of that.
01:14:06So these are the things that went in.
01:14:09At the same time, you don't want to spread it
01:14:11to 27 million people.
01:14:14So from picking from these regions,
01:14:16they were targeting about seven million individuals.
01:14:19And this is a population to manage.
01:14:22You can learn new things from these regions
01:14:25and then you're able to do.
01:14:26But also the other factor is that the partners
01:14:29who are already present in this region,
01:14:30who needed to accompany the University of Health Coverage,
01:14:33like USAID, like GIZ,
01:14:36with its associate organizations.
01:14:40So by using, by leveraging on what
01:14:43these international bilateral donors could offer,
01:14:46it was easy to target these regions to start off.
01:14:49Because again, universal health coverage costs some money.
01:14:52And you don't want to start off on the lame step
01:14:56because you don't have all the resources necessary.
01:14:59So by these partners being in these regions,
01:15:01it was easy to start.
01:15:03So if I understand you clearly,
01:15:05the scheme is such that the governments
01:15:06cannot go it alone.
01:15:07It needs the support from partners.
01:15:09Absolutely.
01:15:10How much is, what is the input, the financial,
01:15:14how much will it take a country like Cameroon
01:15:17to fully roll out the universal health coverage?
01:15:20Well, it's difficult for me to put on a figure
01:15:24because it involves quite a bit.
01:15:27And I think that the government in mobilizing
01:15:30its hospital staff, in mobilizing its directors,
01:15:33in mobilizing all the caregivers that it has,
01:15:37in mobilizing the population in itself,
01:15:40all of that, it's a lot of money that goes in.
01:15:43People cannot really feel what it takes,
01:15:45but it's a lot of investments.
01:15:47And sometimes you don't even quantify,
01:15:49you can't even fully quantify.
01:15:51Because when you look at issues of cost,
01:15:53then there's the whole issue of volunteer time,
01:15:56where volunteers are putting so much time
01:15:59which you cannot pay in monetary terms.
01:16:01So all of that constitutes a huge financial burden.
01:16:05Besides, it's just that people cannot quickly
01:16:11appreciate what goes in.
01:16:13But if you calculate that for a population
01:16:16that earns a certain amount of money,
01:16:1870% of that income goes as out-of-pocket payment
01:16:23for health services, that's a lot.
01:16:25So if we calculate on the basis of that, that's huge.
01:16:28And that's exactly what the government is trying
01:16:30to put back in the hands of the population
01:16:32by offering universal health coverage.
01:16:35In other words, when the scheme goes fully operational,
01:16:39the 70% of my money that is going to my health
01:16:42will come back to me indirectly.
01:16:43And you can use that for other developmental purposes.
01:16:46Okay, we're talking about resources, quite okay,
01:16:48but then how much is manpower,
01:16:50how much does manpower factor into this scheme
01:16:54for it to be successful in our country?
01:16:57Well, first of all, when I talk manpower,
01:17:00I don't even quickly go to what it takes
01:17:05to have them engaged in it.
01:17:07I go to the different kinds of people
01:17:11who are needed to have it run properly.
01:17:14You need managers of health organizations,
01:17:17you need insurers, you need the medical staff itself,
01:17:21and we are in very, very short supply of the medical staff.
01:17:25So to have heard association of nurses or midwives
01:17:28trying to fight the Ministry of Higher Education
01:17:33on who should train.
01:17:35Precisely, when you leave high school,
01:17:37it's the responsibility
01:17:38of the Ministry of Higher Education to train.
01:17:41And then you put it at the disposal
01:17:43or you make them available to the Ministry of Health
01:17:47who can now use them.
01:17:48If they think that that training is not adequate,
01:17:51they should set up a competitive exam
01:17:53through which they recruit people
01:17:54that they wish to employ.
01:17:56This is what is done everywhere.
01:17:58And I think that rather than engage in this fight,
01:18:01we should look for ways and means
01:18:03in which we promote more training.
01:18:05We are in short supply of nurses,
01:18:07we're in short supply of medical doctors,
01:18:09we're in short supply of midwives,
01:18:10we're in short supply of medical laboratory staff.
01:18:14So it takes all of that to do.
01:18:16Now, I think very few institutions train
01:18:19in health administration and health management.
01:18:21It is essential, it is necessary.
01:18:24The government has to run its operation
01:18:26as though it's running a health management organization.
01:18:29These organizations that virtually
01:18:31would look at preventive care,
01:18:32would look at primary health care,
01:18:34would look at the way services are done with quality experts
01:18:38and be able to provide the kind of quality services that is.
01:18:43So an HMO is almost like an insurance company,
01:18:46but it's almost the midway between an insurance company
01:18:50and what government will do.
01:18:50So these HMOs are necessary.
01:18:52In the United States, there are abundance of HMOs.
01:18:55We need to institute those here.
01:18:57And government operations should run almost like HMOs,
01:19:00where you have targeted physicians and doctors
01:19:03where you can go to,
01:19:04you have targeted pharmacies where you can go to,
01:19:07you have targeted a number of places
01:19:10that you are required to go
01:19:12for you to get the adequate health attention that you need.
01:19:15And all of this is important.
01:19:17We have those particular requirements
01:19:19that you're talking about
01:19:20in some of these training institutions.
01:19:22Yes.
01:19:22They're mushrooming everywhere in the Republic.
01:19:24Well, they're not mushrooming
01:19:26because by the time you give an authorization
01:19:28for an institution to operate,
01:19:30there have been inspectors
01:19:32in which there were medical doctors,
01:19:33there were laboratory medical technologists
01:19:35who came onto the field,
01:19:37checked on these organizations
01:19:38and ensured that they had the labs.
01:19:41So if the Association of Nurses or Midwives
01:19:44or Medical Laboratory Technologies
01:19:46desire to find out if these institutions are there,
01:19:49they should do an impromptu visit
01:19:53and see whether these institutions are operating
01:19:55or teaching the students
01:19:56according to what is required by the curriculum.
01:19:59And just to let you also know
01:20:02that by the time they put them out,
01:20:05most of our nurses are being trained,
01:20:07but they're also going for greener pastures in Germany.
01:20:10They're going for greener pastures in the UK.
01:20:12They're also exiting to the United States.
01:20:14If they went, if they have gone to these places
01:20:17and they are performing,
01:20:19it means that their training here was more than adequate.
01:20:23Now, we just veered there to talk about
01:20:25the issue of the midwives and nurses.
01:20:27We're talking specifically about the input of manpower
01:20:31before you touch on that.
01:20:32Precisely.
01:20:33And so all of this technical stuff is needed.
01:20:37And it's a machinery which even the Ministry of Health
01:20:41itself cannot manage alone.
01:20:43I'll take the issue of counterfeits.
01:20:46The ministry needs to involve other sectors
01:20:48to be able to fight the counterfeits.
01:20:50Currently in this country,
01:20:52it takes three nurses to form a common initiative group
01:20:58and they will source for their license
01:21:00from the Ministry of Agriculture to be able to operate.
01:21:06Because the Ministry of Agriculture is the only ministry
01:21:09that was given the mandate to give out licenses
01:21:12for common initiative groups.
01:21:14Meanwhile, they're supposed to be responsive
01:21:17to the Ministry of Health.
01:21:18If you take the case of patent medicine dealerships
01:21:22that you find everywhere in the Anglophone regions,
01:21:24they are answerable to the Ministry of Finance.
01:21:27Yet they operate these patent medicine dealerships
01:21:30almost like pharmacies,
01:21:32to the detriment of the pharmacists
01:21:33who try to open up their own shop in those same regions.
01:21:36So these are things that the government itself
01:21:38needs to rework and bring it back into the centerfold.
01:21:41So if I'm providing you with adequate and good
01:21:44and quality health through universal health coverage,
01:21:47and you're still going to the neighborhoods
01:21:49and buying the drugs that are littered on the streets,
01:21:52going also to pharmacies that are patent medicine dealerships
01:21:57and having these common initiative groups
01:21:59that cannot be regulated by the Ministry of Health,
01:22:02then you can see where the battle is.
01:22:04So there's still a lot of homework that we need to do
01:22:06to bring things to be centrally organized
01:22:09and controlled by the Ministry of Health.
01:22:11And who takes responsibility for that control?
01:22:13Well, all of us.
01:22:15All of us take responsibility.
01:22:16Because if things are not running well,
01:22:19I have a mandate and a duty
01:22:23to bring that to the attention of the authorities.
01:22:26Now, the authorities also have their own responsibility
01:22:29to make sure that the regulatory bodies
01:22:32that they have so duly instituted are working properly.
01:22:36Sometimes this, again, is not a mono-directional thing.
01:22:40It's a thing where many sectors are involved
01:22:42and everybody would be happy at the end of the day.
01:22:45There are things that we as scientists would also do.
01:22:48There are things that we as members
01:22:50of the Cameroon Academy of Science
01:22:52would also point out to the government
01:22:53and say, hey, look, your decisions are wrong
01:22:56and these are the facts.
01:22:57So we do that and if everybody takes up
01:22:59their responsibility, I think that our agenda
01:23:02would move forward in the right direction.
01:23:05A moment ago when you were enumerating the actors
01:23:07that come to play in the universal health care,
01:23:10you talked about insurers.
01:23:13How do they play in this whole, what role do they assume?
01:23:17Okay, this is a particularly good question.
01:23:20Habitually, the government is playing the role
01:23:23of the insurer by looking for resources,
01:23:27by using little tax systems to be able to take money
01:23:31from those who have and provide health service
01:23:34for those who do not have.
01:23:35So it's a question of an equity approach.
01:23:39Now in Rwanda, for example, the rich are taxed,
01:23:44not a lot of taxing, but just a little bit amount
01:23:47and the money that is derived, taken from the richer folks
01:23:51is actually used in providing universal health coverage
01:23:54for the poorer folks and I think that this is something
01:23:56what is, you may not know, poor people don't travel
01:24:00by air going abroad, so they always stay in the country.
01:24:03But everybody who goes abroad pays a 500 francs tax,
01:24:08which is called an airport tax,
01:24:09which is actually used in addressing issues
01:24:12of poverty-related diseases.
01:24:15Now, such a small hinge on your meager incomes
01:24:22can actually help the poorer people,
01:24:24because remember that when the rain is going to fall,
01:24:26it doesn't fall on one person's housetop,
01:24:28it falls on everybody's housetop.
01:24:30So if I am in good health and my neighbor
01:24:33is not in good health, then you can imagine
01:24:35what the situation is, because the infections
01:24:38that he has will ultimately reach me.
01:24:40The flies that go to where he dumps his refuse,
01:24:43the flies that go to land on his wounds and everything else,
01:24:46the flies that carry infection don't decide
01:24:49who is the richer or the poorer person.
01:24:51It flies everywhere and it will ultimately land on my plate
01:24:54and I will take the infection.
01:24:55So I have a duty and an obligation,
01:24:58a social responsibility to take care also
01:25:01of those who do not have.
01:25:03Since we're talking about insurance,
01:25:05what appreciation do you make of health insurance
01:25:08in Cameroon in general?
01:25:09Is there a sector to be taken seriously?
01:25:12Well, I think things, when you talk about insurance
01:25:16in general, that's fine, they do what they do.
01:25:19But what I'm concerned about are people
01:25:21who do health insurance.
01:25:22Exactly, that's what I'm talking about.
01:25:23And quite often, people don't even know
01:25:25that when they take up the insurance,
01:25:30they have a duty first within themselves
01:25:33to prevent an infection, to prevent them
01:25:37coming developing systemic diseases.
01:25:41Once they have that notion that they themselves
01:25:44have to do things to prevent them from getting ill,
01:25:48then if they should then fall ill,
01:25:50then they can now go to the hospitals
01:25:53and then be paid for by the insurance companies.
01:25:56It takes a lot of hassle, a lot of hassle
01:25:59to get the insurance to actually attend
01:26:02to the health of people.
01:26:03This is why most people don't want to go to them.
01:26:06However, with the coming age of digitalization,
01:26:09it is easier for you to have medical records
01:26:11that are digital, and in real time,
01:26:14you can be diagnosed, the insurer can be informed,
01:26:18they will do their nitty gritty,
01:26:20and be able to respond to you in real time
01:26:22on what is happening.
01:26:23But most insurers don't even have a database
01:26:26of their patients, and this is what we desire
01:26:29to see and to have happen, that they actually
01:26:33go digital and are able to store these health records
01:26:36so that each time that you go to the hospital,
01:26:39it's with one click of the button,
01:26:40it's easy to go to those records
01:26:42and to see exactly the evolution of your health,
01:26:45but also that it is true that you're not well
01:26:48and be able to pay for what services.
01:26:51Otherwise, if you go to some hospitals nowadays,
01:26:53you go with a card, they will enter that information
01:26:56and they update their databases,
01:26:58and they can actually provide health for you
01:27:00without you having to pay enormously.
01:27:02But then, we still need the specialists.
01:27:04We still need the experts,
01:27:07because why most people travel abroad
01:27:09is because they don't have the confidence
01:27:11in the experts that are here.
01:27:13And more and more, private hospitals
01:27:16with very good equipment are being put in place,
01:27:19and I think that with time, these insurance companies
01:27:22that are doing health insurance
01:27:24would convert into health management organizations,
01:27:28and then we'll see, we'll get real good health
01:27:31in this country.
01:27:31Professor, we've talked about the financial resources.
01:27:35We've talked about manpower.
01:27:36Now, let's settle on infrastructure.
01:27:38How infrastructurally ready is Cameroon
01:27:41to assume the universal healthcare it is playing out?
01:27:44Well, I think slowly, the country's getting to the stage
01:27:48where we have some of this sophistication
01:27:52in terms of the infrastructure.
01:27:53It has been a program that started many decades ago,
01:27:56where the hospitals have been upgraded.
01:28:00We have specialist hospitals that have been provided
01:28:02with some of this sophisticated equipment.
01:28:06I think one of the things that we need to do
01:28:09is to raise programs that can do repairs
01:28:12of these same machines.
01:28:14It's for us to invest in technology
01:28:18such that our own citizens, our own scientists,
01:28:22can even make some of those machines,
01:28:24because sometimes the machines get bad,
01:28:27and you're trying to buy a spare part,
01:28:28and they tell you that this machine is obsolete
01:28:31because it's no longer manufactured,
01:28:33and that is luring you into buying a new equipment.
01:28:36So while we invest in the infrastructure
01:28:38and we equip the hospitals,
01:28:40we think people should go and be able to develop
01:28:44ways of repairs of these machines,
01:28:46but also invest in technology
01:28:48that can make our own machines, which we can use.
01:28:52If you were to prioritize in Cameroon today,
01:28:55which sector or sectors in our healthcare delivery system
01:29:00do you think needs the most of attention?
01:29:02Well, I think two things need to be improved upon.
01:29:07One is medical education,
01:29:10and the number of experts that operate in this area.
01:29:15Secondly, the technologists also need to be trained,
01:29:19because they would ensure that the different equipment
01:29:24and the different diagnoses and caregiving machines
01:29:30in proper shape.
01:29:32And then I would also encourage that the government
01:29:35improves on its training of health management personnel,
01:29:40because this is particularly important.
01:29:43Otherwise, the complexities of how health
01:29:46has to be delivered cannot stay at the level
01:29:49of the medical doctors.
01:29:50You need health management personnel,
01:29:52and this is very underdeveloped,
01:29:55and I think that this is an area which needs to develop.
01:29:59The fourth area, which I think needs to have us go,
01:30:04make an extra edge, is with interventions,
01:30:08either drugs or vaccines.
01:30:10We need to be in a position to produce our own.
01:30:12We need to be in a position to ensure that the vaccines,
01:30:16even that come in of quality,
01:30:17we need to be in a position to make sure that actually
01:30:20the drugs and the vaccines that are being administered
01:30:23are doing the right thing.
01:30:24And this is where public health biotechnology comes in.
01:30:27This is where the Forbang Institute comes in.
01:30:30Professor Macham, given the pace with which
01:30:33the universal health care scheme is rolling out in Cameroon,
01:30:38would you think that the dream of attaining
01:30:40universal health care by the year 2030,
01:30:43is that dream tenable in Cameroon?
01:30:46Well, you know, I'm happy that we've made progress so far,
01:30:50but I have no clue and I cannot predict
01:30:53what will happen in the next decade.
01:30:57The reason being that we are now in 2024,
01:31:01almost entering 2025.
01:31:04We have 10 years to reach the national
01:31:07strategic development plan goals.
01:31:11We cannot tell.
01:31:12If the country stays the way it is and stable,
01:31:15and the resources keep on coming,
01:31:18and there are no pandemics or epidemics
01:31:21that ravage the country unduly,
01:31:25I think that with the current progress,
01:31:27we would edge towards attaining that goal.
01:31:31However, however, the one thing that
01:31:34the government itself should know
01:31:36is that the health personnel should be very stable.
01:31:39And the health personnel should also be diverse.
01:31:41If you look at the ministry,
01:31:43most of the directors are surgeons, okay?
01:31:46So this needs to have some amount of diversity.
01:31:48The ministry itself has to be stable,
01:31:51and without changing ministers often every now and then,
01:31:55because when you do that, you perturb the system
01:31:57and everybody who comes tries to readjust
01:32:00and start a new thing.
01:32:01And that would cause some rocking of the system.
01:32:07But we need to have a stable form of government
01:32:13and stable performers who can deliver the goods.
01:32:18And if we keep on at this pace,
01:32:20we would, in five years, we will be talking
01:32:23almost of the 80% of the country covered,
01:32:26and those are areas that are hard to reach,
01:32:30and we will start to do.
01:32:31Why?
01:32:32Because the more and more we advance,
01:32:34the more technology comes in.
01:32:36I was very happy to have visited
01:32:40the zip line operations in Rwanda,
01:32:44where drones are sent to deliver blood
01:32:46into places that are very difficult to reach.
01:32:50Zones were sent out to map areas
01:32:52where mosquitoes were predominant,
01:32:53and the same drones were sent out
01:32:57to spray those same areas which they had GPS mapped.
01:32:59So these are ways in which we can use technology
01:33:02to reach those very hard to reach populations.
01:33:05And I think that NGOs that have some amount of money
01:33:08should start investing in these drone technologies
01:33:11for delivery of certain services
01:33:13to the hard to reach populations
01:33:15that are found in the hinterlands of the country.
01:33:18And if we do that, if we start now,
01:33:21in five years we'll be able to cover 100%
01:33:23of the national territory
01:33:25with universal health coverage.
01:33:27Okay, now the question I'm going to ask you,
01:33:29you touched it a moment ago,
01:33:30but I want us to dwell on it a bit longer now.
01:33:34Statistics indicate a very gaping disproportion
01:33:38between the doctor-patient ratio in Cameroon.
01:33:42What would you think it would take
01:33:44for us to bridge that gap?
01:33:46A lot of training, a lot of investment in training.
01:33:49If you see the situation of Morocco,
01:33:52and I'll take the example of France,
01:33:5560% of those schooling in schools of technology in France
01:34:00have come from Morocco.
01:34:01And the government has invested quite a bit
01:34:04in training these people.
01:34:06And they have a placement program
01:34:08once they finish for them to be deployed.
01:34:10It will take a lot of training,
01:34:13a lot of training by the Ministry of Higher Education,
01:34:16by the Ministry of Health,
01:34:17to have the appropriate health personnel of good quality
01:34:22that you can actually deploy to deliver this.
01:34:25This is one of the major obstacles
01:34:27for universal health coverage.
01:34:28If people want to go to the hospital,
01:34:30they want these free services,
01:34:32the free services have been offered,
01:34:34and the medical personnel is not well-trained,
01:34:37then you don't get it.
01:34:38And therefore, this is where the government
01:34:40needs to put in a lot of emphasis
01:34:42and invest in the training.
01:34:44Luckily, they have authorized more schools of health,
01:34:48more schools of medicine around the country.
01:34:51It needs to be followed by the technicians
01:34:53who have to help the medical doctors.
01:34:56And so this bogus fight
01:34:58between the Association of Health Midwives
01:35:01and Health Nurses, Midwives,
01:35:03and Medical Laboratory Technologies
01:35:05against the higher institutions of learning,
01:35:08it makes no sense because they cannot fulfill
01:35:11what is required in health personnel
01:35:14to deliver universal health coverage.
01:35:16And therefore, it is the responsibility by text
01:35:20of the Ministry of Higher Education
01:35:22to train people post-baccalaureate for two years,
01:35:26and they can be redeployed into the field.
01:35:28And by competitive exam, or what they call concourse,
01:35:31let them test the knowledge of these people
01:35:33if they are adequate,
01:35:34just like the way medical doctors are trained,
01:35:36just like the way teachers are trained.
01:35:38It is trained by higher education
01:35:40and given back to secondary and technical education.
01:35:42So they train them, and they deploy,
01:35:44and they say, you have them do the competitive exam,
01:35:47take them in, have them give them registration numbers
01:35:50if they meet the criteria.
01:35:51This is what is done elsewhere in the world.
01:35:53And so this fight is useless.
01:35:55Because you use that energy
01:35:57and channel it into the training of these people,
01:35:59rather than fight who has the mandate to train
01:36:01and who hasn't the mandate to train.
01:36:03So this is my take on it.
01:36:05Does traditional health medicine have any place at all
01:36:08in the universal healthcare that we're talking about today?
01:36:10It has its place.
01:36:12And the earlier we integrate it, the better.
01:36:15Because you and I know that there are certain teas
01:36:19that you will take that will make you sleep better.
01:36:22There are certain teas that you will take
01:36:23that would energize your body.
01:36:25So somehow these plants have values.
01:36:29So what we need to know is to find out exactly
01:36:32what other toxic effects may come about
01:36:36because we're using those plants.
01:36:37And help the traditionalist package it in a way
01:36:40that it is improved traditional medicine,
01:36:43which can be taken.
01:36:44There are many countries in which it is part
01:36:46of the health system.
01:36:48There are ones in which once it has been almost impossible
01:36:52for Western-style medicine to cure
01:36:54or to use Western-style medicine,
01:36:56they send you to the ward that has to do
01:36:59with traditional medicines.
01:37:00Most of our medications came
01:37:02from the traditional medical plants.
01:37:04And I think we should go back and be able to look at it.
01:37:07What we in the medical area sometimes stand to fight,
01:37:12which we do not understand,
01:37:13is that we need to standardize a number of things.
01:37:16Biologists have not been used to standardization.
01:37:19And this is exactly what is the problem.
01:37:21For example, if I tell you to take one hand of an herb,
01:37:25what measure is one hand?
01:37:28So that's the first.
01:37:29The second aspect is that we need to know
01:37:31the toxicity level of the things that are in the plants.
01:37:34Why?
01:37:35Because sometimes you give them,
01:37:37in trying to cure malaria, you induce a cancer.
01:37:42And therefore, especially for people going for massages,
01:37:44for example.
01:37:45Now, by looking at those other toxicity aspects,
01:37:50we can be able to say that in this condition
01:37:52or that condition, please don't use this or don't use that.
01:37:55This is what is the reproach.
01:37:57And I think rather than fight them,
01:38:00we should assist them, be able to do.
01:38:02Now, out of all that I have learned
01:38:05and been able to reach where I am,
01:38:08I think there's some great value,
01:38:10a lot of great value in medicinal plants.
01:38:13Very great value in medicinal plants.
01:38:15But we need to have them as improved medicinal
01:38:17or improved traditional medicines
01:38:19and be able to give these to the patients
01:38:23in the way that we still respect the cardinal ethics,
01:38:26cardinal principles of bioethics.
01:38:28One, that is beneficial.
01:38:30Two, that it does not cause harm.
01:38:32Three, that as a researcher, I take responsibility
01:38:35for everything else that happens with the patient.
01:38:38And the fourth is that in giving it,
01:38:40I should be able to ensure equity
01:38:43that everybody can use it.
01:38:45Or if people can, if it's not everybody who can use it,
01:38:48I should be able to determine which segments
01:38:50of the population can use it and those that cannot,
01:38:53so that it is known in the population
01:38:55that children below this age cannot use,
01:38:57adults above this age cannot do,
01:38:59and this is the population.
01:39:01So it's basically, these are the issues
01:39:03that we need to move towards
01:39:05the traditional medical practitioners
01:39:08and be able to help them perfect that particular trait.
01:39:12And what do you think should be done
01:39:13to be able to ease this tension
01:39:15that exists between you,
01:39:17the modern doctors of modern medicine,
01:39:19and those practicing,
01:39:21doing with the traditional pharmacopoeia?
01:39:23The first is that we should open up
01:39:26a department of traditional medicine
01:39:29and be taught systematically,
01:39:31like everything is taught in the university.
01:39:34And then these traditional doctors
01:39:36will come and see exactly what we are approaching them for.
01:39:39And those that will be sent out
01:39:41would be able to practice it in a way
01:39:43that's easily acceptable by the others.
01:39:46And slowly it will gain traction.
01:39:48This is what I would suggest as the approach.
01:39:51It's useless trying to go to them
01:39:53and always trying to convince them and give them knowledge
01:39:56that you think, oh, this is the way to do it.
01:39:58No, you should go down and learn exactly
01:40:01what it is that they practice and help them improve on it,
01:40:04because these guys have knowledge, a lot of knowledge.
01:40:08And if you see what they do,
01:40:10and you can convert that by reverse epidemiology,
01:40:14picking up what they do,
01:40:15understanding what the principles are,
01:40:17you can always improve on it.
01:40:19And I think this is the approach that should happen
01:40:22very early on than waiting to have that later.
01:40:26The Chinese have done that, and they have it.
01:40:28We all drink ginseng,
01:40:29but ginseng, they had to look exactly
01:40:31what kinds of oils would go with ginseng,
01:40:34and then bottle it the way it is,
01:40:36and then we're still drinking it.
01:40:37Let's do the same with our roots.
01:40:39Let's do the same with our backs of trees.
01:40:41Let's do the same with our leaves.
01:40:43Medicine in Cameroon will make me.
01:40:44Thank you.
01:40:46Thank you very much, Professor Willis van Baartschem,
01:40:48for talking to Inside Out.
01:40:50Thank you very much for inviting me.
01:40:52Oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh.
01:41:07Although the past is sobering,
01:41:11and the present challenging,
01:41:13there are grounds for measured optimism
01:41:16about the future of healthcare system in Cameroon.
01:41:21The Universal Health Coverage Scheme
01:41:23lays the foundation for transforming a dysfunctional system
01:41:28into one that works for the population,
01:41:32especially for the poor.
01:41:35While progress is being made in this endeavor,
01:41:38there is still a long way to go
01:41:41in achieving set objectives.
01:41:44Significant progress can be made
01:41:47by improving access to healthcare services.
01:41:51Access to healthcare services,
01:41:53which consists of three dimensions.
01:41:57Physical accessibility,
01:41:59which ensures that health services are available
01:42:03within reasonable reach
01:42:05and operate during convenient hours.
01:42:10Financial affordability,
01:42:12which measures individual's ability to pay for the services
01:42:16without experiencing financial hardship.
01:42:20And acceptability,
01:42:23which refers to people's willingness to seek health services.
01:42:29As Cameroon strives to enhance its healthcare system,
01:42:34achieving universal health coverage
01:42:37and universal access with equity
01:42:40should be at the forefront of policy decisions.
01:42:45By addressing the dimensions of access,
01:42:49reducing disparities,
01:42:51and prioritizing the wellbeing of all citizens,
01:42:56Cameroon can make significant progress
01:42:59towards a more inclusive and effective healthcare system.
01:43:06And that's our take on the program today.
01:43:08Many thanks for the privilege of your company.
01:43:12Come back, same time, same day, same station, next month.
01:43:18Bye for now.
01:43:19Oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh,
01:43:49oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh,
01:43:50oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh,
01:43:51oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh,
01:43:52oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh,