Five Ways Cameroonians Can Better Finance Their Health
As a medical doctor practicing in a rural area, there are so many patients who present to the hospital late with complications because they had no money to pay for healthcare. In 2017, the World Health Organisation estimated that about 100 million people all over the world are pushed into extreme poverty each year due to health expenditures. In the case of Cameroon, this usually occurs because most people still depend on out-of-pocket expenditures in times of sickness.
Universal Health Coverage (UHC) entails that, families or individuals should be able to access quality health care without them going broke or having to forfeit other basic needs to pay hospital bills. In countries like Rwanda, health coverage stands at 75% as a result of private-public partnerships fuelled by good governance and void of corruption. In Cameroon, UHC is still far from being achieved.
Below, I discuss five ways Cameroonians can use to save for health and cater for their health needs without breaking the bank or depending on fundraising when a household member falls sick.
These methods are a combination of different experiences from individuals, lessons from other countries and a consideration for low-income earners in Cameroon who cannot afford standard insurance premiums. These may also be beneficial to individuals and communities from other low- and middle-income countries.
1. Piggy Banks:
Most Cameroonian at some point in their childhood and even adulthood had a cube-like structure called a bank with a slit on one side, enough to accommodate the largest coin (Figure 1). These are usually broken on special occasions to reveal the sum total of savings geared towards a particular purpose. Ironically, hardly is this saving ever used for health purposes. This method can be used by low income earners who can dedicate as low as 200 FCFA per day for health into that bank. This gives a total of 6000frs per month which is able to afford basic health care.
2. Thrift and loan society savings:
Out of our solidarity for each other, we belong to one “njangi” house (thrift society) or another. In most “njangi” houses, contribution of money is given to one member usually determined by ballot. There is however a factor which fuels the success of most thrift societies; social cohesion. This means that everyone knows everyone in the “njangi” house and there is usually a common thing which binds them together be it work, tribe, school etc.
These enhance trust and sustainability, thereby being the perfect place for the development of a health fund. It may take 2 ways: a percentage of every thrift or savings could be kept aside and withdrawn only for health expenses or each member could be obliged to invest a part of their thrift sum in a health insurance scheme. Each member will consequently have a baseline amount of money to spend for health care.
3. Community Based Health Insurance (CBHI):
This method is what Rwanda has used to achieve 74% of health Coverage. It requires prioritization of primary care, reinforcement of minimum health care package and proper management of funds.
In this scheme, each member of the community is placed into earning categories and an amount is assigned to be paid per year. Once registered, there is a minimum package you are entitled to which covers consultation, child birth and infant care. This method can be well replicated in Cameroon.
4. Health Assistance Schemes:
For some years now, some individuals have developed health assistance schemes to reduce out-of-pocket expenditure for health. An example is the Bamenda Ecclesiastical Province Health Assistance (BEPHA) Scheme (Figure 2). In this scheme, families or individuals pay a certain amount per year and up till 75% of their health bills in partner hospitals is covered. For those who can afford this and have access to these hospitals which support this scheme, this is an acceptable method as there have not been any major negative review regarding misappropriation of funds.
There is also the micro insurance scheme by Activa Insurance whereby a group of people contribute money and subscribe to a standard insurance plan. Each time any member of that group has a health emergency, the contributions of the others are used to pay.
5. Digital Insurance:
This method is not yet functional in Cameroon but provides a reliable method of health financing as evidenced by results in Kenya. In Kenya, their mobile money service called m-pesa has partnered with some other companies to incorporate a digital health service called m-tibawhich allows people to save, send and spend funds specifically for health. Once money is saved in your m-tiba account, it can only be sent to the code of a standardized registered health provider or facility in the network. It allows people abroad to directly pay the medical bills of their families into the hospitals account.
“No one should die because they could not afford healthcare.” For this to be a reality in Cameroon, better ways of financing health need to be sustained as a step towards achieving universal health coverage.