Two Pilot Social Health Security Projects Take Off in Douala, CameroonIn October 2008, WABA’s MWG Coordinator, James Achanyi-Fontem, who doubles as Chairperson of the Pilot Community Social Health Security Project of the Health District of Bonassama, launched the training of executive bureau members of a Mutual Health Insurance Schemes to give equality opportunities to all in care delivery. Opening the workshop, J. Achanyi-Fontem said, this was a community initiative supported by the ministry of public health through the fund of the very poor and heavily indebted countries of which Cameroon qualified as one due to the low earning power of the populations.
The supervision of the project was attributed to the Association of Partners of Community Social Insurance Unions in Cameroon, APCAS, represented during the training by the director, Jean Keumo. The training delivered at the Bonassama Health District Hospital, with Dr. Obam Enam, who coordinates the Red Cross Cresent in jurisdiction sitting in for the director of the hopsital.
The facilitators of the training were Ntock Mouhammed, Chair of the Health Solidarity Association (ASSA) based in Nylon, Mrs. Ndoutou Toto Caliste and Kom Dolesse. Douala Local Council was represented by the 3rd Deputy Mayor, Kammogne Therese, who called on the social health insurance pilot project to dedicate time for listening to the problems of subscribers to the organisation’s policies..
The Chairperson of the board of directors, James Achanyi-Fontem, recalled the objectives of the training, which included the negotiation of conventions with health care facilities in the district at accept rates with the aim of making health care accessible to all at low cost. The Community Social Health Security project will also contribute to the permanent education of the population on health care and environmental protection updates.
The members were advised to reflect on micro-projects which would assist in fund raising for subsidizing health care costs. He added that durable initiatives would benefit the entire community and especially those who subscribed as stakeholders to the pilot project.
To achieve this, Achanyi-Fontem said, board members and executive bureau staff should collaborate with other health organizations and hold information and education conferences, workshops, round table debates on current health and environmental protection issues.
Membership to the social health security scheme is attributed without distinction of sex or religion. Dr. Obam Enam invited the team to be attentive to the different presentations, that revealed national health policy of decentralization for community ownership of health care initiatives in Cameroon.
Ntock Mouhammed, in a module talked about the context while presenting the origin of community social health security initiative, which leads to everyone having access to adequate care at all times through very little contributions to the scheme..
Ntock Mouhammed said, the initiative is based on self-help traditional solidarity systems. He added that self-help is based on reciprocal principles, while solidarity aims at extending a hand to the less advantaged groups in the community. When assisting the less advantage, the stakeholders do not expected any other benefits from them as exchange form the aid given.
Self help on the other hand, can be realized in several forms through labour, human resource, financial and material assistance or contributions by individuals, families and communities. These groups are always confronted with births, marriages, diseases, death celebrations and so on. Without joined efforts, it is often difficult to properly address the issues in African communities.
Cameroon like other African countries achieved independence by inheriting health systems which promoted and guaranteed free health care and treatment of its citizens. But the petrol and economic crisis of 1980s reversed the situation making governments incapable of continuing with free treatment due to the lack of resources.
It was during the conception of the Bamako initiative in 1987, that health ministers of the Africa continent agreed that free health care to the populations was not realistic due to the galloping economies and fast growing populations. This led to the putting in place of the new strategy which requires recovery of health care cost from the sick, while the governments took care of infrastructure construction, management, training and the payment of the salaries of staff.
From the diagnosis of 2001, it became evident that only 15% of the population had access to adequate health care in Cameroon. The principal cause identified was the low income or absence of resources on general. This was a result of heavy taxes and contributions to keep households secured through adequate nutrition and spending on health care by government. During this period, the public treasury became incapable of paying health bills, while guarantees by the public and private enterprises became so limited and in some parts non existent.
The solution by the ministry of public health was to initiate two reforms, which touched on the management systems of hospitals and the promotion of self-help community health initiatives by developing mutual health care insurance systems.
The current system is based on solidarity amongst members of a community, through participative and functional democracy where the community elects its own leaders; the liberty to subscribe and participate in the promotion of autonomy of the system is seen as another way of promoting gender equity and democracy within communities.
Solidarity remains the basic foundation of mutual health security systems, because every registered member pays a contribution that is independent of personal risk. This contribution is the same for all, irrespective of age, sex and state of health of the individual at the time of subscription. In the same way, everyone benefits from the same services in case of illness.
This means that the Mutual Social Health Security scheme installs a solidarity system between the sick and those who are well, whether young or old and, between the different professional categories in the community.
Addressing the issue of managing registration of members, Mrs. Ndoutou Toto Calixte, reiterated that mutual health insurance systems can survive only when membership is consistent and members pay contributions regularly on annual basis. She distributed work tools with all the relevant information for guaranteeing good governance and transparency in the management of funds collected. These tools included the membership registration form, the register of beneficiaries, the recapitulative sheet of contributions and the register of contributions.
On the other hand, Mrs. Kom Dolesse, emphasized on the use of management principles that guarantee good book keeping of funds collected. She added that the contributions are used for the autonomous administration and functioning of the organization and the reimbursement of health bills of its members when treated in health facilities with agreed conventions..
She enumerated the five different types of contributions as:
Provisional contributions (Budget0
Registered contributions (dues collected in the current year)
Acquired contributions (left-over after spending)
Advanced contributions (payments received in advance of determined period)
Debt collection (owed dues collected as arrears)
The methods of calculating the contributions also differ and are put in four categories:
General contributions
Fix semester contribution per family
Fix semester contribution per beneficiary
Contribution per group
Proportional contribution
As concerns the Community Social Health Security Insurance of Bonassama, members opted for calculations to be done on basis of fix semester or annual contributions per beneficiary. Before closing the workshop, participants decided on the type of health offers that would be available for all who subscribe to the health security policy.
This goes with the establishment of partnership conventions with the selected health facilities after verification of the rates adopted for health services offered by the facilities. The target of mutual health security schemes is to get health services to all within a community at an affordable rate. Through this system, health coverage is more effective and covers a wide range of diseases very common in the community.
It was recalled again and again that the mutual social health security organization is made up of volunteers that share the responsibility of caring for illnesses and other health risks, especially as the financial participation is uniform.
From what was said, it became evident that community mutual social health security schemes are another excellent channel of developing communities, guaranteeing health, social and economic well being of individuals and families as a whole.
This system facilitates access to health care, contributes to the amelioration of the quality of health care, increases the rate of health care visits to facilities and reduces auto-medication and use of poorly conserved street hawking drugs and medication.
In the social plan, this assists the populations to organize themselves for ownership of their health care system through jointly finding solutions to problems faced by the community‘s less advantage and poor populations. Since health care becomes cheap, it is accessible to all at the same moment.
This system encourages communities to acquire the spirit of saving to prepare for emergencies. In reducing expenditure on house hold health care through the solidarity health security scheme, everyone wins by paying less the US $ 2 per person each month for health coverage equivalent to US$ 100 per year.
