An innovative approach for easier access to medications
Across Africa, a lack of access to even the most basic of medicines results in loss of lives on a daily basis. In Cameroon, regional funds for health present a viable solution – not only by tackling corruption and promoting community empowerment, but also by helping to fight against the continent’s biggest killers.
One of Africa’s most dangerous serial assassins on the loose today continues to be the mighty mosquito. Though treatable with conventional medicines, in 2015 alone, malaria, together with tuberculosis and HIV/AIDS, claimed the lives of 1.6 million Africans. Timely access to legitimate medication is crucial and remains one of the key challenges across sub-Saharan Africa. In Cameroon, an initiative to tackle this began three decades ago, and is today operating across the country.
Regional Funds for Health Promotion began with the support of the German Federal Ministry of Economic Cooperation and Development (BMZ) in the 1980s in order to make essential medicines easily accessible and available, even in the most remote regions of the country. Today, the programme, which is implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, operates as a joint initiative between the Cameroonian government, financial and technicalGerman partners, including Germany’s development bank KfW, the World Bank, the French development agency AFD, and the local community. What is more, thanks to its community-focus operational model, it is tackling other essential health-related challenges.
Financial Crisis and Budget Cuts
The initiative began in 1987 in the country’s North-West region at a critical time as Cameroon’s economy was in a deep recession. That year, for the first time in its history, the country’s budget was slashed by almost a fifth of its total, including that of its health ministry.
“The medicine distribution from government wasn’t working as it should have for reasons of corruption and mismanagement,” adds Marc Ramaekers who oversaw the German support to the Regional Funds in Cameroon as GIZ-advisor for seven years. “As a result, medicine was available at the national level but not at the regional level.” Unable to obtain the necessary medicine, many people, particularly those in the rural parts of Cameroon, died, while others suffered developed life-threatening diseases which rendered them unable to work and provide for their families.
In order to put in place a more effective and efficient system, the Regional Funds initiative was set up with the help of German Development Cooperation. The idea was to establish a way of distributing medicine swiftly, efficiently and without incurring additional unnecessary costs by setting up a three-way leadership involving the Cameroonian government through its Ministry of Health, the German government through its development arm, and local community representatives from the North-West region.
“GIZ organised a mechanism where it wasn’t only the government in charge of the management and distribution of medicines,” explains Mr Ramaekers. “It was a new concept which integrated the community as well as the financial and technical partners. Today, our cooperation with many of our Cameroonian colleagues from the Ministry of Health on the Regional Funds, and their commitment to them, is quite exceptional.”
How it works
The Funds purchase the essential medicine needed from the governmental medication provider (Centre National d’Approivisionnement en Medicaments et consomables, CENAME). Once purchased, the Funds ensure that these drugs are delivered to all the necessary distribution points, such as hospitals and health centres, monitoring all the receipts to ensure the system remains water-tight.
The system is auto-financed and self-sustainable, as the turnover from the sales of medication is re-invested directly back into the Funds. In each region, a General Assembly made up of representatives of the three key stakeholders manages the operations, meeting together regularly in order to collectively steer the programme and adapt it to the specific needs of the individual communities.
The Solidarity Principle
A key component of the programme is the so-called ‘Solidarity Principle’. In the past, people living in the more remote parts of the country had to pay higher prices for medications, due to the additional transportation costs involved in delivering them. Today, the Funds guarantee that the medications cost the same wherever they are purchased, ensuring that Cameroonians living in the more remote areas of the country are not at a disadvantage compared to those located in the urban centres of Yaounde or Douala.
Following initial success in the North-West, the Regional Funds programme was rolled out in the South West and the Littoral regions and, since 2010, they now exist in all ten regions of the country. In the process, a new legal status – Public Interest Groups (PIG) – was created which could in the future also be used for a national health insurance fund.
Reinvesting back in the community
As well as the provision of medicine, from 2010 onwards, the funds have also taken on an additional role in their host communities, explains Mr Ramaekers. “Now those regional funds do much more than management and distribution of drugs.” The profits are reinvested into community projects decided upon by key stakeholders from the community during the General Assembly meetings.
One example are the ‘family planning’ educational initiatives, explains Josselin Guillebert, Technical Assistant from the Regional Funds Secretariat working directly within Cameroon’s Ministry of Health. “The training provided helps the districts improve the quality of services,” Mr Guillebert says, “providing training for those who advise local communities on contraception. The trainers educate the communities on family planning methods so that they can share the knowledge with others in their families and in their villages on the various methods available.”
“People certainly need it,” says Dr Irene Kaptué, administrator of the Regional Funds for the West region. “Due to certain traditions, it [family planning] is not a subject that is talked about enough – often, it is a taboo.” “People need to be aware the impact that family planning has on their lives, both professional and personal, and be prepared for it,” she says. “Sometimes people don’t have the courage to talk about it on their own.”
Sanitation and Hygiene Training
In the West region, where many illnesses are the result of infections, communities channel profits from the Regional Funds into sanitation and hygiene training, notes Dr Kaptué. “There, the link between cleanliness and poverty is emphasized, in particular how keeping good hygiene can prevent certain illnesses.”
With the support of a joint KfW-AFD programme, another new initiative soon to be incorporated into Regional Funds programme is ‘chèque santé’ or ‘health voucher’ . It aims to tackle Cameroon’s high maternal and and neonatal mortality rates. This subsidized voucher can be bought by the pregnant women for the sum of 6,000 CFA (9 euros). This contribution represents 90% of the real pregnancy and delivery costs; the balance is covered by the Cameroon Government Subsidy with financial support from France and Germany. The voucher is used for four antenatal check-ups, treatment of conditions that can disrupt the pregnancy, the costs of the delivery as well as any post-natal check-ups for mother and baby for a period of up to 42 days”.
Nurturing public trust
But many challenges remain. “In seven years, you can’t have a fully functioning system in full operation across the whole country”, says Mr Ramaekers. In the past, he notes, Cameroonians had “lost confidence in the health system”.
But precisely because the Regional Funds are de-centralised, transparently governed and operate under close supervision, they have helped build up the public’s confidence in the system, says Mr Guillebert. Eventually, he says, this confidence will help pave the way to one of Cameroon’s biggest health goals: to implement universal health coverage across the country.
Inna Lazareva, April 2017