Expert Insight

Health For All and by All: Refocusing community’s participation and empowerment as a prerequisite to solid primary health care in Cameroon

Public Conversation with Stakeholders on PHC/Astana Declaration during BCH Executive Book Launch in Douala, Cameroon, May 18, 2022

PHC visions are not yet reality
There have been many commitments on PHC that have not translated to the impact we wanted to see. The objective of the 1978 Alma Ata conference in launching Primary Health Care (PHC) was “Health for all by the Year 2000,” which resulted in population disappointment about their needs in many settings. Then came the Reorientation of PHC in 1993 in Cameroon, with restructuring of its health system in three levels (central, intermediate and periphery). There was the installation of cost recovery for health care in health facilities. Community participation was one key ingredient that got overlooked and needs to be prioritized now for things to change. Health care delivery did not obey health principles that should be integrated, global, continuous and rational. The characteristically permanent services and polyvalent human resources are questionable and reference/contra reference is non-existent. The four pillars of PHC (community participation, inter-sectoral coordination, appropriate technology, support mechanisms) have not been fully achieved.

Community participation is the missing link
Community Participation that was an important innovation of Reorientation of PHC (Reo-PHC) is very weak. Despite putting into place Dialogue Structures and Community Participation and co-management in all Health Districts and Health Centres, it hasn’t been successful since individuals, families and communities have not been empowered to participate actively in co-management of their health services.

The health system is still far off from the ideal situation where communities (who are development partners) are empowered so that they actively participate in management and decision making in all health matters. The designation of Mayors as Presidents of Management Committees in health facilities, should be empowered on principles of Reo-PHC for their understanding of co-financing and co-management principles. The non-implementation of PHC is at the origin of inequalities and social disparities that compromise population wellbeing and socioeconomic emergence of our country. The new primary health care declaration affirms that “commitment to the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind” (Astana Declaration, 2018).  Community participation was one key ingredient that got overlooked and needs to be prioritized now for things to change.

With the Astana Declaration that creates a new pathway for primary health care, all parties concerned should have common actions so as to build primary health care that is more specific and sustainable making it a prerequisite of achieving Universal Health Coverage.

It is evident therefore that we should be able to make bold political choices for health across all sectors by investing and funding a solid PHC so as to put in place UHC in Cameroon that will lead to efficiency and satisfaction of the population. Health is a human right, which calls for individual and collective sharing, encouraging national stakeholders and the powers that be for the imperative reinforcement/strengthening of national health systems by revitalizing primary health care according to the Astana Declaration and engaging a participative dialogue approach that will lead to the installation of a sustainable Universal Health Coverage.

Perspective of Allies Improving PHC
BCH-Africa as one of the Allies Improving PHC, believes that PHC is a 3-for-1 investment that can deliver on the promise of universal health coverage, health security and healthier populations in Cameroon and together we can unite our voices and efforts to strengthen a solid and resilient health system with viable health districts, based on a solid and well-funded primary health care system that will empower communities animated by a sound communication system that is vertical, horizontal and participative.

World leaders must revamp their PHC approach (new global commitment) throughout the health system for effective implementation and achievement of universal health coverage!

This opinion piece is part of a blog series by the Allies Improving PHC for the 75th World Health Assembly that aims to highlight Primary Health Care as the foundation for achieving universal health coverage, health security and healthier populations globally. Pieces will be posted throughout the week of the 75th World Health Assembly, read more here.