Universal Health Coverage (UHC) ensures that no one is denied access to quality care or delivered a substandard care than available just because he/she cannot pay.  It also guarantees that no one gets bankrupt because of falling sick, which is really not of their fault. To accomplish this, we need to eliminate direct payments at the time people need care (users fees: consultation, laboratory, surgery, physiotherapy, hospitalization, etc. and payment for medications) and replace them with universaland comprehensive pre-financed schemes. With health being a fundamental human right that cannot be left in the hands of private individuals to manage, the government MUST andSHOULD take RESPONSIBILITY and be a major player in financing, regulating and dispensing UHC services. The main limitation in providing UHC is the lack of funds for such an ambitious and costly program.


Financing UHC is a huge challenge especially in low and middle-incomecountries, which spend very little on health care and rely heavily on Foreign Aid (25% of average health expenditure), which is a serious threat to planning and execution,and poses a greater threat on sustainability. While it has been recommended that finances from several sources including foreign aid should be considered in the stride towards providing UHC, I strongly oppose foreign Aid as a significant source of finance for UHC. Foreign Aidmay only be considered in the short run to supplement National efforts with an existing or ongoing plan to replace Foreign Aid with indigenous sources as soon as possible. This will avoid dependence on Foreign Aid, which is a major threat to the stability and sustainability of projects in developing countries. This will also ensure that Cameroon does not rely on outsiders for providing the most precious and important services to her citizens, healthcare.


Several different strategies through which finances can be raised to ensure UHC have been proposed. While many are applicable to the Cameroonian context, all are not necessary for a start to generate the necessary funds required for this.  The major difficulty in Cameroon is certainly not the lack of appropriate ways to generate finances needed for UHC, but probably the lack of a strong government commitment and policy to do so. Cameroon is a very rich country that has been relegated to the ranks of a poor and heavily indebted country by the lack of political will, poor government policy and mismanagement of available resources.


How much is required to provide UHC to Cameroonians and can we raise enough funds for this?


WHO has estimated the annual per capita cost of providing UHC in Cameroon to be 35,000F CFA. With a current population of about 23,000,000 inhabitants, this amounts to about 805 Billions francs CFA. This is seemingly a very huge amount, which instantly scares Cameroonians and sounds like an impossible task. To make things further difficult, there is a huge informal sector in Cameroon that makes it difficult to target everyone one through a tax based scheme on earnings to generate these funds. Targeting goods that are universally consumed, but considered deleterious to health can circumvent this difficulty. Some of these include tobacco, alcohol and unhealthy foods. With the alarming rates of beer consumption in Cameroon (second highest consumer of beer after Poland, 2015), beer consumption can be easily targeted. No other industry has been so efficient at getting its products to the doorsteps of every Cameroonian than the brewing sector.


In 2015, Cameroonians consumed 800Million Hectoliters of beer brewed locally, which equates to 80billion liters of beer. The average size of a bottle of beer in Cameroon is 50cl and therefore this would provide 160billion beer bottles. By imposing JUST an additional tax levy of 5frs per bottle of beer produced and consumed, representing a meager 1% of current sales prices, we would have raised a combined 800billion CFA as additional health revenue in 2015 from the sales of locally brewed beer alone. This amount is identical to the projected annual budget of 805 Billions CFA required to provide UHC to all Cameroonians.


Critics of this approach may argue that an increased in the price of alcohol will inadvertently lead to a backdrop in consumption and a subsequent drop in projected revenues. While this seems plausible, history has shown this is unlikely becauseof the fairly inelastic demand of beer. This will therefore not cause any significant drop in alcohol consumption and projected revenues needed for UHC. Even if there were to be a drop in consumption, this will generatea positive public health impact on Cameroonians through a reduction in cancer rates, heart diseases, digestive disorders, liver diseases, drunk driving and road traffic accidents, etc. through reduced alcohol intake. Therefore, no matter the end result of an increased tax on beer, it remains a win-win for Cameroonians: Either in providing the needed health care services or preventing alcohol related diseases.


Increases in the prices of beer might also be met with stiff resistance from the brewingcompanies. However, with a strong government policy and shiftingthis tax entirely to consumers, this can be easily addressed. Moreover, no government should accept any negotiations aimed at exposing her citizens to harmful products such as beer.


Would this sustainable over long term with increasing population?

The number of persons consuming alcohol will increase in direct proportion to increasing population, which will allow for sustainability in the long-term. However, with constantly increasing cost of health care and the need to adopt more sophisticated and expensive health products, additional sources of financing must be earmarked and exploited to keep pace with healthcare advances. These could include taxes on tobacco, unhealthy foods, mobile phone calls, imported spirits and wines, etc. Similar to the audiovisual royalty tax in Cameroon paid to CRTV, a health tax can be applied to all workers and deposited directly to the UHC funds basket.Let’s not forget that sufficient finances would only serve as a catalyst for UHC if it is well managed and there are sufficient personnel to dispense quality health services to the masses.


In conclusion, this is a simple, feasible, easy to implement strategy towards the provision of UHC to all Cameroonians. I urge the government to embrace the concept of UHC and formulate strong policies aimed at generating and managing the necessary financial, human and managerial resources needed to provide Cameroonians with the healthcare they need by letting beer consumption pay for healthcare cost.


By Dr. Chobufo Ditah, MD MPH

Public Health Specialist

Chief Medical Officer, CMA-Njinikom





Widgetized Section

Go to Admin » appearance » Widgets » and move a widget into Advertise Widget Zone