In the wake of the United Nations’ publication of the Millennium Development Goals (MDGs) and later the Sustainable Development Goals (SDGs), African countries have embraced an inclusive development dynamic, integrating all dimensions of sustainable development, such as individuals and communities’ health [1]. While some countries, such as Algeria, South Africa, Kenya or Rwanda, have made remarkable progress towards universal health coverage – the hallmark of SDG 3 – others, such as Cameroon, are still struggling to find the right recipe [1,2].
In a country with a weak and vulnerable health system, suffering from low financing, lack of qualified and specialized human resource and infrastructure, health disparities, challenges with accessibility, affordability and quality of health care services, Universal Health Coverage (UHC) is a critical milestone in the journey towards “good health and wellbeing for all at all ages”. Although the country has some 6,000 health facilities, they are unevenly distributed across the nation (mainly concentrated in major urban areas), ill-equipped and understaffed [3,4]. With a health care workforce density of 11.53 per 10,000 inhabitants – 1.5 doctors per 10,000 inhabitants and 9.9 nurses per 10,000 inhabitants – the skilled healthcare workers gap remains a critical challenge for the country [5]. In addition, only 57.7% of health facilities have an observed availability of essential medicines, with disparities between regions and categories of facility [5]. The backbone of achieving UHC, health financing, also faces similar challenges. While the population suffers catastrophic healthcare expenditures and contributes over 70% of healthcare costs via out-of-pocket payments, the government’s healthcare budget remains stagnant around 6% of the state’s annual budget [3].
Experience from other African countries demonstrates the benefits of pre-payment and risk sharing mechanisms in improving quality and access to healthcare [6]. Aside from government financed mechanisms such as social health insurance, rethinking and expanding private insurance may contribute to accelerate progress towards UHC [7]. This paper summarizes reflections and recommendations from experts convened by the Nkafu policy institute to discuss strategies to leverage on private health insurance to achieve universal health coverage in Cameroon.
The State of Universal Health Coverage and Private Health Insurance in Cameroon
Cameroon’s government commitment to achieving Universal Health Coverage, materialized with the launch of the phase I of its UHC strategy on April 12, 2023 in Mandjou (East region). Fully operational in 5 of the 10 regions of the country, UHC phase I covers preventive and curative services, through healthcare packages targeting vulnerable populations such as pregnant women and neonates, children aged 0-5 years, people living with chronic conditions (HIV/AIDS, tuberculosis, kidney failure) [8]. However, although the number of enrollments and beneficiaries among the target groups keeps increasing [9], many Cameroonians are still excluded from the benefits of UHC. In addition, as the first phase is almost exclusively funded by the government and its technical and financial partners [9], future phases will require a sustainable funding mechanism supported by a robust legal and regulatory framework. To alleviate these limitations, populations will need to adopt financial protection mechanisms that complement UHC, such as private health insurance.
There are limited data on the state of private health insurance in Cameroon, and these services are mainly provided by private banks and insurance compagnies [10]. They are commercial entities, owned by individuals or group of individuals, which offer health insurance services principally to make profit [10]. Health insurance schemes vary from one operator to another, but insurance services provision is overseen by the ministry of Finance and regulated by the Inter-African Conference on Insurance Markets code [6]. Based on the Association of insurance compagnies in Cameroon data, 17 approved non-life insurance compagnies operates in the country, with a total amount of 44 273 325 FCA of premium turnover in 2021 for bodily injuries and health [11]. Private health insurance is set for significant growth over the coming years, with a projected market volume of 143.10m USD by 2029 [12]. This reflect an increasing demand from population seeking financial protection against rising health cost and the potential of private health insurance to expand and serve a wider population [12].
The role of private health insurance in attaining Universal Health Coverage
Private health insurance risk sharing mechanism
Operation of private health insurance like other health financial mechanisms comprise three phases: mobilizing funds, pooling and purchasing of healthcare services [13]. In Cameroon, private insurance compagnies partner with public or private health service providers [10]. Different schemes are available, with specific benefits packages. Clients – Individuals, group of individuals or employers – subscribe to their chosen scheme and pay an annual premium [10]. The cost of health expenditure is then shared between the patient and the insurance provider in an agreed percentage (Up to 25% of the cost of care can be covered by the client) [6,7].
Potential benefits
Private health insurance has the potential to complement and accelerate the progress towards UHC in Cameroon, although the current proportion of people covered is very low, accounting for about 6% of the population [14]. Potential benefits of health insurance include [13]:
- Household protection from impoverishment due to out-of-pocket health expenditures
- Increased access to and use of health services
- Improved quality, efficiency and effectiveness of care by influencing consumers and providers behavior
- Private sector involvement in national health goals and objectives
- Generation of additional and more stable resources for health
Limitations and challenges
A major limitation of private health insurance in Cameroon, is the cost of premiums perceived to be very high, with an average annual premium cost of 155,000 FCFA (265 USD) per adult [6]. Private health insurances often target wealthier households and public or formal private sector employees, thus excluding vulnerable populations and informal sector workers who constitute the majority (90%) of the active population in the country [6,15]. Other challenges to private health insurance subscription in Cameroon include the absence of a national exchange and regulatory body to ensure ethics and good practices, technical challenges with purchasing and reimbursement mechanisms, limited knowledge and lack of trust in existing schemes, and sociocultural barriers (high reliance on traditional medicine, weak insurance culture) [14, 16].
Policy recommendations
Develop research to generate accurate data on priority health needs of the population, willingness to pay for health insurance, health insurance compagnies operations.
Enhance collaboration between Universal Health Coverage division at the Ministry of public health and Private Health Insurance compagnies to design policies that ensure coherence and affordability in subscriptions premiums.
Adapt the premiums and private health insurance schemes according to the basic health needs of the community (Focus on primary healthcare).
Advocate for the design and promotion of inclusive private health insurance schemes targeting the poor and informal sector workers.
Adopt a holistic approach integrating economic empowerment initiatives to increase financial capacity of the population.
Develop a unique national digital platform for subscriptions, reimbursement and coordination of health insurance compagnies operations.
Solange Dabou
Solange DABOU holds a Master of science in Clinical Biochemistry from the University of Dschang and have followed a distance learning training in epidemiology and health statistics from Aix Marseille University.
Regina Sinsai
Regina Sinsai holds a Bachelor of Arts Degree in Psychology from the United States International University – Africa, in Nairobi and an HND in General Nursing from the Humanity Health Professional Training Center (HHPTC) in Yaoundé.
Dr. Bruna Djeunang Dongho
Ghyslaine Bruna Djeunang Dongho, Ph. D., is the Senior Researcher in Global Health and Public Health at the Nkafu Policy Institute.
