Published on Africa Can End Poverty

Health Care in Cameroon: May Results Be Your Quest and May Change Be Your Result

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An Innovative Approach to Health System Strengthening in Cameroon: Performance-Based Financing (PBF)

As President of the Steering Committee for Cameroon’s Health Sector Support Investment Project, I was pleasantly surprised by the innovative character of the Performance-based Financing (PBF) approach; and by its transformative potential.

Performance-based financing is a development approach that provides funding to hospitals and other health care facilities based on how well they provide care for their patients. In our work to expand access to basic health services for people at the district level in Cameroon, the model has quickly demonstrated how it can drive profound and systemic change, particularly in a country that suffers from endemic weaknesses in health care service delivery at the institutional level.

Introduced at the service delivery level, where there has been some skepticism about the value placed on results, performance-based financing has proven to be more than a pilot experience; it is a real vector of change and a driver of results.
The model first helped us better understand and analyze the health sector in the communities covered by the project. We found that providing health care providers the autonomy and resources to develop effective solutions to local challenges led to unprecedented results and a positive response from the communities benefiting from the program. This is in part thanks to the quick and strong engagement of all actors and, believe me, establishing a performance based financing model requires boldness from all actors!

For example, in many health centers and hospitals we’ve seen remarkable improvements in the utilization of key maternal and child health services, along with an average increase of 60 percent in the quality of services and an increase of 30 percent in patient satisfaction. These improvements have been driven by PBF’s capacity to devise local as well as pragmatic solutions to the structural problems of the health system. These were problems even those at the national level had difficulties resolving: A continuous supply of medical drugs, human resource management, and support to destitute populations as well as to people with poor access to healthcare.

Performance-based financing in Cameroon has not only proven itself to be relevant but it has also demonstrated its worth in the health sector which, today more than ever, has to accelerate results after years of stagnating results.

And we are on the way. Based on some of the results we’ve seen, we will be extending the project from the four southern regions of Littoral, North-West, South-West and East, to three additional regions in the north; the Far North, North and Adamaoua. A Community PBF component will be introduced to better respond to the low levels of health service utilization that prevail in these new regions, which are the poorest in the country. While the challenges remain considerable, this agenda contributes to the development of a plan for the scaling up of PBF to the entire country. We are looking forward to working with our partners at the World Bank and other institutions who are providing technical and financial support. 


Emmanuel Maina Djoulde

Director of International Cooperation

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