Cameroon

Last Updated: December 28, 2011

Senior Program Officer:

Jonas Mbwangue, MPA

• Program Activities
• Health Sector Architecture
• Health Financing
• Budgeting
• Budget Flows and Reporting
• Budget Performance
• Parliamentary Notes
• Immunization Performance Indicators
• Disease Burden
• Useful Links

Program Activities:

• October 2008: Mr. Mbwangue and Program Director Mike McQuestion met with Ministry of Health, parliamentarians and GAVI partner agency counterparts in Yaounde.
• March 2009: Mr. Mbwangue analyzed recent program performance data with EPI team, Ministry of Health.
• March 2009: Mr. Mbwangue attended the Annual EPI Managers Meeting for West Africa organized by WHO in Ouagadougou, Burkina Faso.
• June 2009: Mr. Mbwangue attended an EPI Interagency Coordinating Committee meeting. He also participated in a training session for regional health supervisors for the June 30-July 5 Immunization, Nutrition and Mother Care Week, an activity jointly organized by WHO, UNICEF and Cameroon's EPI Program.
• August 2009: First SVI-sponsored parliamentary briefing was held in Yaounde.
• November 2009: Mr. Mbwangue coordinated a meeting, between Ministry of Health EPI team and Directors of the Association of Mayors, to explore decentralized EPI financing ideas.
• December 2009: Nine counterparts from MoH, MoF and parliament attended the SVI-organized subregional parliamentary briefing on immunization financing, held in Dakar, Senegal.
• March 2010: SIF Program Officer Mbwangue participates in an annual EPI Program planning meeting in Yaounde.
• April 2010: Senior Program Officer Jonas Mbwangue and Director of SIF programs at Sabin, hosted a Cameroon parliamentary/mayors association meeting in Yaounde to discuss approaches in decentralized immunization budgeting.
• May 2010: Mr Mbwangue organized a meeting with the SIF Cameroon Core Team to finalize the recommendations for sustainable mechanism of immunization financing in Yaounde, Cameroon.
• July 2010: Mr Mbwangue participated in the EPI 2010 review program in Bafoussam, Cameroon.
• August 2010: Senior Program Officer, Jonas Mbwangue and the EPI Team prepared and submitted a memorandum to the MOH regarding the establishment of the National Immunization Trust Fund for Cameroon.
• September 2010: Senior Program Officers Helene Mambu-Ma-Disu and Jonas Mbwangue, co-organized a Sabin-sponsored Peer Exchange with government representatives from both the Democratic Republic of Congo and Cameroon; counterparts met in Yaounde to design a protocol for initiating and establishing a National Immunization Fund for both countries. Their call for action to support the establishment of such a fund, is called 'The Call from Yaounde'. Read it, here.
• October 2010: The ‘Yaounde Call for Action’ is sent to the Cameroonian Minister of Health, who approves the request. He asks SIF Sabin to help draft a proposal for the NITF so that it can be presented to all counterparts who will need to cooperate in order to successfully establish the fund.
• December 2010: Hon. Gaston KOMBA and EPI finance officer Sylvain BRICE BANELA traveled as Sabin peer exchangers and presented Cameroon's proposed immunization trust fund to colleagues at the 2nd African Regional Immunization Conference in Ouagadougou, Burkina Faso.
• June, July 2011: Sabin-sponsored parliamentary briefings, Yaounde.
• July 2011: Workshop to monitor EPI Performance and to Prepare the Institutional framework for the National Immunization Fund, co-sponsored by WHO, UNICEF, Helen Keller International (HKI) and Sabin Vaccine Institute. This led to new advocacy activities in the cMYP for 2012-15 and a reorganization of the EPI program (see below).

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Health Sector Architecture:

• Cameroon has been a SWAp country since 2006. The multi-agency Health Sectoral Strategy Management and Follow-up Committee (Comité de Pilotage et de Suivi de la Mise Oeuvre de la Stratégie Sectorielle de Santé, (CPSSS)) coordinates sectoral plans, inputs and monitoring.
• The Government initiated a decentralization effort in 2004. The MoH is one of the first four ministries to begin decentralizing. Decentralization was implemented by Presidential decree on 1 January 2010.
• In 2011, the EPI was moved from the Family Health Division and reorganized into its own division. Now the “Groupe Technique Central-Programme Elargi de Vaccination” (GTC-PEV), it has a board of directors (the ICCA) and a management unit (EPI Permanent Secretary). The Permanent Secretary is equipped with planning, internal audit and information management units and is directed by a Central Technical Group. There is an EPI Unit in each of the 10 regions. In 2005, 83% of the country's 173 health districts prepared and implemented EPI plans of action.
• Planning, coordination and oversight of Cameroon's EPI program are provided through an Inter-agency Coordinating Committee.

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Health Financing:

• In 2007, Cameroonians spent US$104 per capita on health. Health accounted for 8% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
• In 2008,Cameroon received US$41.1m in Official Development Assistance for health, up from US$30.2m in 2007. (Source: OECD Creditor Reporting System)
• Highly Indebted Poor Countries (HIPC)/Multilateral Debt Relief (MDR) Initiatives: Cameroon began receiving HIPC debt relief credits in late 2000. As of mid-2009, the country had received credits totaling US$1.30b (of a total commitment of $6.22b). As per its Poverty Reduction Strategy Paper (PRSP), the government has used these savings to invest more in poverty-reducing programs, including PHC delivery (from $335.6m in 2001 to $1.44b in 2007). (Source: IDA/IMF HIPC and MDRI- Status of Implementation: September 15, 2009)
• National Immunization Program:
  
  • According to the World Health Organization, the Government of Cameroon spent US$5.6m on its routine EPI program in 2001, representing 70 percent of all routine EPI expenditures. For 2002 and 2003 the figures were $5.2m (100 percent) and $5.7m (100 percent). The country received its first GAVI vaccine grant in 2003. In 2006, the government spent $4.3m (57 percent). The figures for 2007-2010 were, respectively, $10.7m (36 percent), $13.2m (44 percent), $2.7m (13 percent) and $5.3m (18 percent).
  • According to the 2007-2011 cMYP, $10m were spent in 2005 specifically on the routine EPI program ($17 per infant born that year). Adding in shared health services expenditures to support EPI increases this to $16.4m ($28 per infant). The government financed $2.9m of the specific routine EPI expenditures (18 percent), about $5 per infant.
  • The 2007-2011 cMYP shows that HIPC funds accounted for half or more of government routine EPI spending during 2000-2005.
  • According to the 2012-2015 cMYP, $22.1m were spent in 2010 specifically on the routine EPI program ($34 per infant born that year). Adding in shared health services expenditures to support EPI increases this to $31.2m ($48 per infant). The government financed $5.3m of the specific routine EPI expenditures (24 percent), about $8 per infant.
  • The overall pattern suggests two trends. Overall investments per child have increased but the government’s absolute contribution has not risen in consistent fashion.
  • Projected annual budgets for the EPI are available in Cameroon's cMYPs. The projections are based on actual 2005 and 2010 expenditures. The 2006-2010 cMYP states that the Government will finance 80% of the routine EPI budget by 2011. The 2011-2015 cMYP states that the Government will finance 64%.
  • Amount spent by the government of Cameroon on routine immunization per infant (USD) (2000 - 2010)

  
  Source:
  ¹WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Cameroon. All data derived from the WHO/UNICEF Joint Reporting Form as follows:
  a: C_6450. This % excludes any external financing from donors.
  b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance.
  "NA" indicates data not available.

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  Budgeting:

  • Cameroon produced a Poverty Reduction Strategy Paper in 2003. The EPI is identified as a key strategy for improving the country's health care system. The plan includes Medium Term Expenditure Frameworks for each sector; the health sector MTEF was subsequently updated. Source: IMF 2007

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  Budget Flows and Reporting:

  • 2006 expenditures for Cameroon's routine EPI totaled $US19.2m, of which $10.0m were recurrent costs. The Government financed $4.4m of these costs. HIPC funds (US$1.3m) accounted for 31% of the Government's contribution. (Source: GAVI Phase II Grant Application 2008)
  • In 2008, routine EPI expenditures totaled US$15.5m, of which the government paid $4.85m (30%). (Source: GAVI Annual Progress Report 2008)
  • In 2009, the government reduced its overall budget ceiling; this reduced immunization operations funding.
  • Following the August 2009 parliamentary briefing, MoF and MoH began collaborating to produce a performance-based health budget. This will allow HIPC funds to be earmarked for EPI.
  • In 2009, Cameroon was one of six GAVI countries to pre-pay their new vaccine co-payments for 2010.
  • Open Budget Index:
  • Open Budget Index: Cameroon scored 5% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides scant budgetary information to the public. Read more here.

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  Budget Performance:

  • In 2008, Cameroon's routine EPI Program immunized 641,965 children with DTP3 and spent around US$24 per DTP3 immunized child (US$15,504,585 total), down from $40 per DTP3 immunized child in 2005. (Source: GAVI Annual Progress Report, 2009 and GAVI Annual Progress Report, 2005)
  • Country Policy and Institutional Assessment:
    The World Bank 2007 CPIA gave Cameroon's budget and financial management systems (Indicator #13) a score of 3.5, equal to its 2005 score. (mean 2007 score for all IDA countries: 3.2) Read more here.
  • Open Budget Index: Cameroon scored 5% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides scant budgetary information to the public. Read more here.

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  Parliamentary Notes
  

  • Cameroon has a unicameral parliament. The National Assembly consists of 180 deputies who represent 49 constituencies. Deputies are elected to five-year terms. The last elections were on 22 July and 30 September 2007.
  • Health and immunization matters are overseen by the Committee on Finance and Budget and Committee on Cultural, Social and Family Affairs.
  • The last presidential election was held in October 2011. Legislative elections follow in July 2012 (Source: ElectionGuide).
  • The Constitution of Cameroon, Part X (Articles 55–62), states that 10 semi-autonomous regions, ruled by regional councils, have responsibility for "economic, social, health, educational, cultural and sports development"
  • Cameroonian Laws 2004/018 and 2004/019, dated 22 July 2004, define responsibilities for decentralizing the government health sector. This provides a legal rational for maires to form immunization budgets.
  • In 2011 a draft decree for the “Fonds National pour la Vaccination et d’Urgence en Santé Publique” was prepared. This document proposes a legal act creating a national immunization fund as a long term mechanism for immunization financing. This act will be supplemented by a national immunization law to be prepared in the FY2012.

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  Immunization Performance Indicators:^*

  Percent of districts reporting at least 80% DPT3 coverage, 2008^*: 60%
  

  ^*Source:
  WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Cameroon. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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  Disease Burden:

  Population (2008): 19,088,000
  Births (2008): 704,000
  U5 Deaths (2008):
  - total 89,000
  - preventable by routine EPI: 12,460¹
  - preventable by routine EPI and new vaccines: 22,250²

  ^{(Source: UNICEF "State of the World's Children" 2009 )}

  ¹ Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
  ² Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

  Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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  Useful Links:

  • SIF Sabin Cameroon Country Fact Sheet.
  • SIF Sabin Cameroon Country Poster .
  • Country Profile from Africa: The Good News
  • Cameroon National Assembly [French]
  • Comprehensive Multi-year Plan
  • Poverty Reduction Strategy Paper
  • GAVI Country Data
  • Millennium Development Goal Monitor