Practices in health (CDPBH): improving governance for health district development in Cameroon: executive summary

In the early 1990s, Cameroon implemented a decentralised health system in accordance with the health district and primary healthcare frameworks recommended by the Africa Regional Office of the World Health Organization (AFRO-WHO). To enhance both responsiveness and equity and to foster participation in the financing and management of the district health system, community dialogue structures were established as governing bodies. Such participatory governance was intended to elicit the views of stakeholders (bureaucrats, health development promoters, community representatives, healthcare providers and patients), and to improve accountability and to strengthen district health systems in order to achieve better health status for the population. During the mid-term evaluation of the 2001-10 Health Sector Strategy (HSS), stakeholders expressed dissatisfaction and identified poor governance and weak health district development as major reasons for Cameroon being unable to achieve its health-related Millennium Development Goals. Several underlying factors were identified for the failure to effectively implement the recommended changes within the framework of health decentralization reforms. Accordingly, recommendations were made for the improvement of district development governance as a key priority for the revised 2001-2015 HSS. The Technical Secretariat of the Steering and Follow-up Committee for the Implementation of the HSS asked the Centre for Development of Best Practices in Health (CDBPH) to summarise the available evidence.

Retaining human resources for health in remote rural areas in Cameroon

This policy brief was prepared at the request of the Human Resources Directorate of the Ministry of Public Health to inform the deliberations leading to the development of the national strategic plan for the health workforce. It describes the magnitude, the consequences and the underlying factors of the desertion of rural Integrated Health Centres (IHC), District Health Centres (DHC) and some district hospitals considered "difficult areas" by health care staff. It offers three evidence-based options and related implementation considerations to improve access to the priority minimum package of primary health care. This is part of health service delivery for the districts and contributes to the fight against rampant poverty (55% of the population) in rural areas. "Difficult" rural areas are remote or landlocked health areas, subdivisions and health districts underserved by modern amenities where health services are provided by low-skilled professionals and poorly equipped in health technology. Typically, it is a rural area located between 80 and 400 km or between 1-4 hour drive in good weather from the first referral hospital as these delays make it impossible to guarantee a continuity of care. The ten regions of Cameroon have difficult rural areas, but Adamawa, East, the Far North and North and the areas reassigned after the resolution of the Cameroon-Nigeria border dispute have the largest number of IHC and DHC deserted by health staff.