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Poor Governance, Inequity and Inequality in Health, The case of Cameroon

 

Health can be considered the most important capital of a Nation. Furthermore, only a healthy people can effectively and meaningfully contribute to the development of a Nation. Therefore, doing all in our capacity through good governance to promote, preserve and restore the health of a nation is a priority and not an option.

To achieve this goal, decisions pertaining to health must be apolitical, free from corruption and bribery and guided by the principle of necessity. We cannot improve the health of a nation significantly when most decisions are politically motivated, biased through corruption and bribery and not based on health needs. The health affair of a Nation is too precious to be politicized and manipulated through unscrupulous means. The health of citizens must be placed high above any political ambitions, personal and financial gains. The absence of the respect of these basic guiding principles has further compounded the inequity and inequality in health in Cameroon, creating and deepening social injustice across the nation.

As a public health worker, my first posting after graduation was to a remote area in the South Region of Cameroon where I served for 4years. Though this was a small community with no specialists and a very scanty population, which could not have justified the presence of an autonomous Medicalized Health Center, this facility was so beautifully constructed with every service present. There were tons of medical equipment in boxes that had never been opened and I was told it had been so for the past several years. What then justified the presence of such a magnificent and well-equipped health facility in a forest? They were lucky to have a son of the soil who was a prominent figure at the helm of the Ministry of Health some years back. To please his constituents, he provided a luxurious facility with the most sophisticated medical equipment that up to date are not present in some Regional Hospitals around the country. This was a pure waste of hard to come by resources that would have been used in areas with real need, but were absent. Worst of it, they justified the presence of a Physician in this facility, a very expensive and scarce human resource, simply because it existed. I had a luxurious house and yet there were simply no patients to be attended to. On numerous occasions, I requested to be transferred but this was simply impossible because no one dares to mess with the politician’s hometown. Indeed I was caught between the devil and the deep blue sea. Whether to remain here and like many unscrupulous Cameroon continue to receive my due and lazy about, take long trips back to town, open a private clinic elsewhere and so forth or to request for a transfer to a more demanding area where I can serve my country and put into use the knowledge I have been trained to offer Cameroonians from what can be aptly coined the “cheapest medical school in the world” with the government bearing the cost of training.

My posting, which was politically motivated, and not based on context specific necessity, is not an isolated occurrence in the Ministry of Public Health. My colleagues will attest to the fact that they have been posted to areas with health facilities that exist exclusively on paper for pure political motives. This leads to waste and deprives several other Cameroonians in real need from benefitting from their expertise. This goes a long way to create health inequity and Inequality across the nation and the population, respectively.

While we all acknowledge the shortage of physicians and other health personnel in Cameroon, it is deplorable to see the huge discrepancy in personnel distribution across the Nation.  Hospitals in some localities, mostly the urban areas, are over staffed while others, mostly in the rural areas are completely nonfunctional and at best dysfunctional because of  the inadequate number of personnel. This deplorable state is because postings are simply traded and bargained as any other goods on the market. Bribery, corruption and political motives with total disregard on the needs and practical reality on the ground but instead on the wants of some greedy political and misguided moral putrids,  seem to be a major determining factor in the allocation of human resource. This further compounds the problem of shortage of health personnel and deepens existing health inequity and inequality across Cameroon.

If we must make meaningful gains in providing Cameroonians with accessible, affordable and quality healthcare, reducing the huge gap of health inequity and inequality across the country, we need to make informed and justified decisions backed by the necessity of service and not otherwise, take just and rational decisions, avoid tribal, linguistic and cultural influences, be patriotic, loyal to the national colours, and promote excellence.

 

By Chobufo Ditah, MD MPH

 

Dr. Chobufo Ditah, is a seasoned Public Health Specialist with degrees from the prestigious Faculties of Medicine, University of Yaoundé I-Cameroon (MD), and the Hebrew University of Jerusalem, Israel (MPH). He is currently the Chief Medical Officer at CMA-Njinikom. Despite the challenges faced by the health sector in Cameroon, Dr. Chobufo is committed to providing the highest quality of care to Cameroonians with the limited resources, placing special emphasis on mass prevention. He has gained extensive experience working in several African Countries (South Sudan, Central African Republic, Chad) executing missions with Doctors Without Borders (Médecins Sans Frontières (MSF). He has a huge exposure to and mastery of health systems around the globe including several African Countries, China, USA and Israel. He looks forward to designing a health system that works in Cameroon by piecing together the best concepts from these different systems.  He is also passionate about universal health coverage and having seen his clients suffer the direct consequences of out of pocket payment for health services, he’s committed to the fight for universal healthcare coverage for all Cameroonians. He strongly holds that the major barrier to attaining universal health care coverage in Cameroon is the lack of political will and strong government policies as and not the lack of finances as many Cameroonians have been erroneously led to believe.