“Benchmarks” and health reforms in Cameroon

1. “Benchmarks” and health reforms in Cameroon Peter M Ndumbe, MD, PhD Dean, Faculty of Medicine

2. Principles of Health Reforms • Health for All by the year 2000: Alma Ata Declaration, 1978 • Health is a social, economic and political issue and above all a fundamental human right: People’s Health Charter • The Constitution of Cameroon, 1996 version

3. Missions: Faculty of Medicine • Training of health personnel at all levels • Research into the major problems of health of populations • High quality health service delivery to selected populations

4. Social Responsibility • Pertinence of training: Deal first with most serious problems • Quality of training: reliable data and appropriate technology • Efficiency of training: greatest impact with available resources • Equity: high quality health services are available to all

5. Utilization of “benchmarks” • Training: • Medical students • District Medical Teams • Process: • Evaluate benchmarks • Identification of indicators • Central Coordination • Research: basic and operational

6. Benchmarks and social justice • Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and death • Health is primarily determined by the political, economic, social and physical environment and should with equity and sust. development be a priority in policy making at all levels

7. Evaluation of benchmarks • Inter-sectoral public health • Barriers: financial, non financial • Comprehensiveness of benefits and tiering • Equitable financing • Administrative efficiency • Democratic accountability • Patient and provider autonomy

8. Evaluators • 70 medical students • 18 of the 165 districts • 20 district medical officers • 4 organisations: WHO, UNICEF, UNFPA, FEMEC • The Ministry of Health • 10 Faculty • Some onlookers

9. Inter-sectoral public health • Difficulties in getting non-medical data such as “% of districts with iodised salt in the market” or indeed “literacy by gender”. • Most health centre or district hospital-related data could be collected from the district or provincial services concerned.

10. Financial barriers to access • very sensitive benchmark , as many health units not ready to give information on finances. • all provided data required for the filling in the questionnaires. • difference in readiness to supply data from public, private for profit and private non-profit units

11. Non financial barriers • data were fairly easy to obtain • difficult to get accurate data requiring the measurement of distances because these were generally approximate

12. Equitable financing • data for the indicators for this benchmark was difficult to collect because health units do not respect the instructions of the Minister of Health regarding payments for services. • Most health units did not cooperate in providing this data

13. Efficacy and quality of care • data for the indicators of this benchmark were easy to obtain, where they existed. • Little or no controversy except in the case of indicators which inquire after practices that may not be currently carried out, e.g., the accreditation of health units.

14. Administrative efficiency • The data for the indicators in this benchmark were easy to obtain where they exist, although it was difficult to measure the “drugs not bought from the Central Provisions Store”.

15. Democratic accountability • The data required were easy to obtain where they exist.

16. Students’ good points • Know how the HS functions • Realise that a lot more needs to be done in our system • Put me in direct contact with the health district and its problems • Learned how to do research • Provided justification for reforms • A global approach to evaluation

17. Students’ bad points • Benchmarks: interpretation and use of results. • The Health System. • Non participation of other sectors • Ignorance of district actors on the functioning of the health system • Poor records in districts • Financial opacity

18. Conclusion • The “Benchmarks” have proven to be an excellent tool in the teaching of Public Health • The main problem is with the scoring and utilisation of data obtained by the districts • We intend to pursue our other objectives to broaden their use.