From NHO Cameroon

Cameroon Health Profile combines the most recent validated data and information on populations health. The document includes an introduction, the methodological note and the following six chapters:

• Introduction to the context ;
• Health status and emerging trends ;
• Overall progress in achieving Millennium Development Goals and the transition to Sustainable Development Goals;

• The health system, specifically the results of the system, governance, the health information system, as well as evidence and knowledge, research , health financing, provision of services, health human resources, medical products including vaccines, equipment and universal health coverage ;
• Specific health programs, as well as noncommunicable diseases and neglected tropical diseases ; and finally
• Determinants, including health risk factors, physical environment, food security and nutrition, and social aspects.

The main steps below were followed:

• Working sessions between the AHO-rSIS focal point, the NHO Coordinator and the research team set up by the Consultant recruited by WHO;
• Identification of domestic data sources in the following order: surveys, publications produced from surveys and administrative data with a minimized risk of conflict of interest, and finally those that have a possible conflict of interest;
• Identification of international data sources: global and specialized international and / or UN system databases including those of WHO, UNICEF, UNFPA, the World Bank, etc.;
• Development of the structure of the Health Analytical Profile 2016, based on the profile model proposed by the WHO Regional Office;
• Development of data collection matrices on Excel spreadsheet, for the production of charts and tables;
• Extraction of data from the sources mentioned above;
• Production of the preliminary report;
• Review and finalization of the document at a participatory workshop;
• Production of the final document for validation by the Scientific Council and adoption by the Steering Committee of the NHO;
• Dissemination of the final report by the NHO.

Cameroon has 10 regions, 360 districts, 360 municipalities and 14 urban communities and an estimated global population of 22,179,707 in 2015. Life expectancy at birth has increased from 51 years in 2000 to 57.3 years in 2015. The country faces the double burden of communicable and noncommunicable diseases.

Progress have been made on some of the Millennium Development Goals indicators, but only the trend in HIV prevalence has been reversed.The number of new HIV infections increased from 47,958 in 2008 to 44,477 new cases in 2015 (CNLS, 2016). The HIV / AIDS prevalence rate among adults aged 15-49 has declined sharply since 2004, from 5.5% to 4.3% in 2011. The number of people under ARVs treatment increased from 17,156 in 2005 to 168,249 in 2015. However, the active list remains low compared to ARV needs estimated at about 650,000 people in 2016.

Infant and child mortality increased from 144 deaths (1990-2004) to 103 deaths (2011-2014) per 1,000 live births for a target of 76 deaths per 1,000 live births by 2015. The maternal mortality ratio has increased from 430 deaths to 782 deaths per 100,000 live births between 1990 and 2011.

The proportion of children under five years of age, sleeping under an LLIN has reached 54.8% in 2014. The free care of simple and severe malaria in children under five years of age has been introduced since 2011 and 2014 respectively. Hospital malaria morbidity increased from 40.6% in 2008 to 30.1% in 2014. The number of new positive microscopic pulmonary tuberculosis cases rose from 11,655 cases in 2004 to 16,008 cases in 2015 with cure rates of about 85%. The main bottlenecks in the health system are: (i) the lack of an Integrated Monitoring and Evaluation Plan, (ii) the inadequacy of the expected results with available resources, and (iii) the deficit in accountability mechanisms .There is a partnership strategy (Order No. 1433 / A / MSP / DCOOP / CPAT of 16 August 2007) which organizes the national and international partnership. However, community participation is poor.

The health information system is characterized by a multitude of non-integrated subsystems and nonharmonized data collection tools. The DHIS 2 and the Cameroon Health Data Collaborative are being implemented. An average of 21 research authorizations are issued each year and few reports of this research are transmitted to MINSANTE by the researchers. As far as health financing is concerned, in 2012, 70.42% (474.5 billion CFA francs) of health expenditure came from households, 14.54% from the State, 7.7% from companies and 7.11% from TFPs.

Health facilities are organized into seven categories: (i) general hospitals, (ii) central hospitals, (iii) egional hospitals, (iv) district hospitals, (v) district medical centers,(vi) Integrated health centers and (vii) mbulatory health centers. In 2011, the ratio of health personnel (physician, midwife, nurse, pharmacist) / opulation was 1.07 per 1000 population.The PHC Reorientation policy was adopted in 1993 and the health system was organized into districts in 1995. In 2001, the country developed its first Health Sector Strategy 2001-2010, which was updated to cover the period 2001-2015. A new strategy 2016-2027 and theNational Health Development Plan 2016-2020 were developed in 2016. Non-communicable diseases (NCDs) are on the rise and accounted for 31% of all deaths in 2014.

In Cameroon Health Analytical Profile 2016, three trends emerge from health indicators:

• Improvement of indicators: these are mainly interventions related to vertical programs such as malaria, HIV / AIDS, tuberculosis and immunization;
• Stagnation: life expectancy, public funding and development of health districts are found here;
• Regression: mostly maternal mortality, family planning, and disease coverage.

In general, the health system performance is poor and inadequate with available resources. There are many opportunities for a more significant improvement in of the populations' health. Efforts should be made to implement the new 2016-2027 Health Sector Strategy and its first 2016-2020 Health Development Plan.

For this reason, we suggest that:

• Development of the stewardship (strategic management) at all levels of the system so that each actor follows the logic of learning and continuous improvement of performance;
• Update and dissemination of regulatory texts and putting in place mechanisms and strategies for their effective implementation;
• Strengthening of action and operational research in order to identify bottlenecks and operational challenges for the implementation of specific health interventions;
• Development of routine National Health Information System to ensure effective follow-up of health interventions and evidence-based decision-making;