ANB-BIA SUPPLEMENT

ISSUE/EDITION Nr 458 - 15/06/2003

CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS

In spite of all that has been realised these last years, Cameroon remains one of Africa’s countries where childrens’ health is far from The World Health Organisation (WHO)’s aims regarding childrens’ health. Nearly one child in four dies before reaching the age of five, and of these, one in three from chronic malnutrition. These figures, to say the least, show that a great deal is still lacking in adequate health care in West Africa, indeed in all of sub-Saharan Africa. For a long time, Cameroon’s policy in health matters was not up to the mark. At the end of the 1990s, only 30% of the population had access to basic health services, and nearly half the population lacked drinking water.

These statistics, however, were even worse in the 1980s. Cameroon sees itself as being classified among countries with a moderate revenue, but the health situation does seem to have improved on certain points. In the middle 1990s, polio was completely eliminated — a clear success story. The incidence rate of this disease among infants was always high in Cameroon, reaching a peak in the 1970s and 1980s. At the beginning of 1988, a large-scale vaccination campaign was launched, and this heralded one of Cameroon’s first victories in the childrens’ health sector — the last case occurred in 1995. Other progress followed: guinea worm has been eliminated; yellow fever has almost disappeared for the moment; leprosy is being overcome; river blindness is on the decline.

However, at the moment, according to UNICEF‘s March 2003 Report on Cameroon’s childrens’ health, only 72% of children are correctly vaccinated against polio and diphtheria, whooping-cough and tetanus (DCT). Cameroon’s most fatal diseases, malaria and dysentery, continue their devastating effects, in spite of the efforts and diverse actions taken by the health authorities throughout the country.

The «National Strategic Plan»

In April 2002, the Government adopted its Strategic Plan giving priority to fight malaria during the period 2002-2006, at a cost of 39.5 billion CFA francs. Dr. Helene Mambu-my-Disu is WHO‘s representative in Cameroon. She says: «If we can do something about malaria, it will be a net gain of some 476 billion CFA francs for Cameroon in 5 years, bearing in mind that malaria brings an annual loss of 1.3% of the GDP whose growth would otherwise remain constant». In fact, the United Nations Development Programme (UNDP) points out that life expectancy at birth has now reached 59 years, whereas in 1990 it was only 50 years. Moreover, the Strategic Plan foresees that 60% of under-fives must sleep under a mosquito net impregnated with insecticide, from now until 2006. Urbain Awono, Cameroon’s Health Minister explains that the progress made during the last six years is explained by various factors, most of which «are linked to the evolution of Cameroon’s political situation, characterized by a cooling-off vis à vis unrest within the country». At the beginning of the 1990s, there was a progressive liberalization then democratization of the nation’s institutions. And since 2000, there’s been a decentralization of the administrative services, people have increasingly become aware of what the government’s up to, and anti-corruption units have been established within childrens’ health centres. All these have allowed a certain continuity in declared policies, and enabled appropriate health services to be provided for many of Cameroon’s young people who previously couldn’t benefit from such services.

Economic situation

We cannot ignore Cameroon’s economic situation which has played a role which was not always positive. A striking event was the 1994 50% devaluation of the CFA franc. However, Alim Hayatou, secretary of state at the health ministry puts it this way: «The effects of this devaluation were moderate». It seems that families and children living in the rural areas benefitted from the effects of devaluation. They were able to get more for their farm produce and consequently were able to afford basic food stuffs. Since 1994, this has led to an expansion of the medical services programme and the setting up of private health initiatives.

But in some poor areas of the country such as the three northern provinces and the eastern province, there is an abnormally high percentage of infant mortality rates and malnutrition. This can be explained by the too frequent pregnancies which cut down on the period of time each child can be breast-fed. In urban areas people here have suffered a lot from the effects of devaluation, especially because of Cameroon’s Structural Adjustment Programmes implemented at the end of the 1980s under International Monetary Fund (IMF) pressure.

Five-year health programme

In April 2002, the Government set up a five-year health programme in the northern province. It came into being because of various economic and social factors, and started after two years of dialogue with all those concerned, especially women and the local communities.

It includes a number of strategic reference points which should substantially reduce child mortality and malnutrition in the country. These reference points cover such areas as: Epidemiology checks; preventing malaria and advancing the fight against the disease; providing opportunities for research; developing management skills. The five-year program also considers the development of the relationship between the State and private enterprise in the health sector, and increasing the basic National Social Security cover.

Within the Mother-and-Child sector of the Health Ministry, the Government has considered improving services in the «peripheral areas», especially in the less populated areas where, according to Mr. Hayatou, preventative medicine should be more of a priority.

The concern for equity and the importance attached to the geographical distribution of health centres constitutes a different approach from the past. To involve local communities is a new approach. As the initiative taken by the Health Ministry in the northern provinces shows, and as Mr Awono explains: «The Five-Year Strategic Plan’s success is due to a better coordination with Non-Governmental Organizations». They have initiated a pilot project in the Far-North Province, at Kousseri. Situated on the border with Chad, Kousseri’s population is not much more than 150,000. This population is scattered over an enormous territory and is among the poorest in the country. During the period 4-14 January 2003, the Health Minister and four NGOs opened eight dispensaries in this town and surrounding area. The aim is to reduce the number of miscarriages and deaths among new-born babies, as well as eliminating malnutrition among the mothers and their children.

Towards decentralization

Dr Pierre Ahanda comments: «There could be some improvement in children’s situation through a government decentralization program at the regional level». This program was drawn up in various stages between 1996 and 2002, and aims at the central authority giving up the management of essential local services, as well as the responsibility of financing them. This includes medical supply centres at a provincial level; community health centres; basic health care centres and education at a primary and secondary level.

This is, in fact, a break with an extremely centralized health care system, inherited from pre-independence times. Mr Ahanda goes further: «Nothing will change unless there is a change in mentality on a political level. We’re looking for much more political good-will». Let’s remember, too, that Cameroon is under a great deal of pressure from the IMF big wigs, who are demanding major reductions in budgetary expenditure.