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Cameroon |
HEALTH
According to a Study made by a private organization
working with the Ministry of Health, ensuring the nation’s health needs are taken care of,
helps developmentIn the Study, a national group of economists and health specialists say: «Poverty is the main cause of ill health in Cameroon and of diseases prevalent in certain low-income areas, especially in the eastern provinces — Adamaoua, North and the Far-North. These constitute a major obstacle to Cameroon’s economic growth. The group asks that national health expenditure for these provinces should be considerably increased. The Study was made by the Africa Population Research Group (APRG), directed by Emmanuel Fru Ebong, an anthropologist. Entitled: «A Study on Macro-economics and Health» (September 2002), the Study shows that economic repercussions of health problems on individuals and the nation in general, are much more serious than previously estimated.
An expensive bill
The group states that to offer basic health care to poor people, is both technically realizable and profitable. Results can be spectacular. Each year, 300,000 human lives could be saved and profits from development would be increased by millions of CFA francs in economic activities. Introducing the Study in Yaounde on 16 October 2002, the APRG‘s president said: «Collaborating in providing adequate health care is not just a question of charity — it’s also a good decision from the economic point of view».
But it costs a lot. The group estimates that Cameroon’s annual health expenditure will increase from the current 25 billion CFA francs (38.11 million euros) to 48 billion CFA francs (73.17 million euros) in 2010. Then to 70 billion CFA francs (106.71 million euros) in 2015. And this does not include the 2-3 extra billion CFA francs required each year in the campaign for fighting against AIDS, which is allocated directly by the State or indirectly by external donors, to the National Committee For Fighting against AIDS, and to NGOs working in this field.
The suggested increases grossly exceed the State’s means, and will require an enormous and most improbable increase in help given by donor countries. The authors of the Study recognise that their work is thus, «just one more estimate of what it’s necessary to do, rather than what will be done». However, the cost of doing nothing will be even more, when measured in lives lost, development one again put on a backwards trend; and a danger to peace and national security». They state: «The onslaught of disease destabilizes the nation’s entire social structure and national unity, and rebounds on its economy».
Taking care of one’s neighbour
Hard cash needed will just finance «essential» health services, making it possible to achieve the minimum health goals designated by the United Nations Development Programme (UNDP) in Cameroon, which has outlined a programme of ambitious aims for reducing poverty. These aims are based on work carried out previously by a National Health Commission towards the end of the year 1997, and are as follows: During the period 2002-2010, to reduce by half, death-rates of the under five’s; by 2015 to reduce maternal death rates by 75%; to curb the spread of HIV/AIDS, malaria and tuberculosis by 2015; and to start to reduce the incidence rates of these diseases.
The group says this can be achieved by targeting a small number of transmissible diseases, in particular AIDS, tuberculosis, malaria, children’s infectious diseases, and food deficiencies responsible for the majority of deaths and diseases in the most affected provinces.
Mr. Fru Ebng Many explains: «A number of medical treatments are very effective and can be administered in underprivileged areas. But, to a great extent and that’s the shocking situation, these treatments are not available to those who really need them, because neither the poor nor the State have the means of getting hold of these treatments which could save people’s lives. The treatments are effective but the real problem is not enough people can reach them.»
A new partnership
The Study explains: «The solution would be to ensure cooperation on a national level between Cameroon’s civil society, the private sector and the State in the field of health care. The State could increase its health expenditure, but the group recognizes that only a fraction of the costs can come from national resources. It’s necessary that the authorities agree to redefining their health priorities, by concentrating less on the urban elite and supporting more the rural areas and the poor, who need it most».
The Study suggests that in order to ensure adequate medical care and facilities are available especially in areas where poverty is greatest, grants-in-aid should be made available in the form of gifts rather than loans, and these should be accompanied by more significant financing in related sectors, such as education and providing clean water, both of which have a direct influence on health.
Pessimists and optimists
Certain «pessimists» say bad management and corruption, plus deteriorating infrastructures are so prevalent, that it’s almost impossible to provide Cameroon with an effective health service. But the group, on the other hand, is of the opinion that a community-based health care system which is properly financed; which consists of dispensaries and primary health care centres managed and run by local people who’ve received a basic medical training; which is backed up by a network of regional general hospitals and specialised hospitals — could provide the basic health service needed by Cameroon and could be set up relatively quickly. «The irony is», says Mr. Fru Ebong, «and pessimists take note, wherever investments have been made in health care, there’s been almost miraculous successes. This has happened following various campaigns against small-pox, poliomyelitis and river-blindness». These diseases have been virtually eliminated.
The group severely criticises those (the eternal optimists?) who oppose any significant increases in health care expenditure — i.e. people who are persuaded that improvement in health will come about naturally through current economic growth and development. According to the Study, there’s no direct relationship between high growth rates and health improvement. On the other hand, «the onslaught of disease delays economic growth. What is needed is a concerted world strategy, which offers Cameroon, greater access to essential health services».
High investment and output
Most attention has been drawn in the group’s Study, to the fact that disease prevents development and hence, there must be a massive increase in health expenditure.
Mr. Fru Ebong explains: «Traditional economic analyses on the impact of diseases, regard diseases as an unhappy consequence of poverty, and reckon that once there is an increase in economic development, then there will be a consequent decrease in diseases. Our group completely reverses this reasoning. True, while we agree that in a country such as Cameroon which is badly hit by AIDS and malaria, poverty is a consequence of these chronic diseases, we have discovered that malaria results in both tragic deaths and a decrease in direct foreign investment in Cameroon. It harms both tourism and trade. So far, the effects of malaria, AIDS and other diseases on the whole of our nation’s social and economic structure have not been taken into account when calculating what these diseases have cost the country. When the cost of combatting disease plus the effects of disease are calculated, then the total cost of the disease is much higher than former estimates would have it, because the disease affects the individual, and also prevents economic growth and causes poverty in some areas».
The APRG thinks that if traditional economists have underestimated the cost of diseases, they have also underestimated the economic advantages resulting from improving a nation’s health. Mr. Fru Ebong says: «We have shown in a very convincing way that improving health isn’t just advantageous in terms of helping people live longer lives. It also makes it possible to maintain a faster economic growth».
Possible economic advantages
Taking into account additional revenue generated and higher growth rates (due to the improvement in health), and multiply these by the 300,000 human lives which, according to the APRG‘s estimates, could be saved each year, you get an annual economic profit of 10 billion CFA francs (15.24 million euros). And even this is a prudent calculation. «We could say that the real economic advantages are much higher. It’s almost irresponsible not to launch out into this kind of very profitable investment».
But these necessary investments for attaining the millennium health goals are almost inaccessible for the fifteen million Cameroonians. Remember — the annual national expenditure of health per person is 17,700 CFA francs (26.9 euros). According to the APRG‘s Study, both government and citizens have earmarked about 21 billion CFA francs(32 million euros) for healthcare in 2001. To achieve the PNUD‘s aims, Cameroon will have to appeal to donor countries and multilateral agencies to increase their total financing for Cameroon’s health sector. Only then will the world community’s health programmes achieve their top priority.
- Sylvestre Tetchiada, Cameroon, October 2002 — © Reproduction authorised, with usual acknowledgment