Originally on my previous blog on June 10, 2015.
I am interested in serving underserved populations. Part of doing that involves finding those populations and understanding their needs.
Cameroon is a country with huge gaps in healthcare, which means that there are many people who do have access to quality care, and many people who do not have access to quality care. Factors that contribute to the gap in healthcare are: income, size of family, and location.
Income affects quality of healthcare because people very much get what they pay for in Cameroon. Only 1.0% of the population has health insurance. This means that if someone gets sick, they are required to pay out-of-pocket in advance of any service that they will receive. Since income varies widely across the country, people who may have access to quality care may simply not be able to afford it. If people cannot afford a life-saving drug, then they cannot afford to save their life. The cost of a test or drug is a part of the decision making process of every medical professional in the country, and this prevents them from offering the best care to people who do not have much money. The effect of this can be seen in figures 32 and 29, which I found to be the most interesting from the World Bank report. Among the poorest 20% of the country, almost 19% of children die before they turn five, compared to about 7% of children in the richest 20%.
Another result of so few people having health insurance is that the size and income of a family is an important factor affecting quality of care. If someone gets sick, families and community groups are often forced to pool money and sell possessions to pay for a relative/friend’s healthcare. Unfortunately, people often need to decide between people or possessions when making decisions like this. As figure 40 shows, 32% of the poorest quintile of Cameroonians are forced to sell goods or animals to pay for healthcare.
Location is an important factor because people need to be able to access the healthcare that exists. Cameroon is actually above the WHO recommended minimum number of 1 doctor per 10,000 people, having 1.9 doctors per 10,000 people. The problem is how the doctors are distributed across the country. The three largest cities in the country have 40% of physicians in the country despite containing only 18% of the country’s population. The factor of location is even more significant because the distribution of health workers does not seem to follow health needs. In general, the areas with higher densities of health workers are the areas that show the best health. This seems obvious, but even poor infrastructure make small distances seem larger. In the city, most people take a taxi to an emergency room, while in more rural areas, people can neither afford cars nor support them with quality roads. This means that people go to healthcare that is in walking distance (if they can walk). In the eastern region, the under-five child mortality rate has actually increased by more than 8% in the last seven years, while going down in the two regions with the highest population density.