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

Principles of Health Reforms Health for All by the year 2000: Alma Ata Declaration, 1978 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 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 The Constitution of Cameroon, 1996 version

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

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

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

Benchmarks and social justice Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and death 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 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

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

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

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”. 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. Most health centre or district hospital-related data could be collected from the district or provincial services concerned.

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

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

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. 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 Most health units did not cooperate in providing this data

Efficacy and quality of care data for the indicators of this benchmark were easy to obtain, where they existed. 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. 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.

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”. 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”.

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

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

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

Conclusion The “Benchmarks” have proven to be an excellent tool in the teaching of Public Health 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 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. We intend to pursue our other objectives to broaden their use.