The center for the development of best Practices in health (CDBPH), a research unit

set up in June 2008 at the Yaounde Central Hospital to easy exchange and application of

knowledge stemming from research, has organized last 11 th November 2009 at Centre Jean

XXIII de Mvolyé -Yaounde, a deliberative forum on the theme “HOW TO SPEED UP

ENROLMENT IN COMMUNITY-BASED HEALTH INSURANCE”. Some forty participants coming

from North-west, Littoral and Centre regions, as well as from public administrations, civil

society, health mutual organization promoters, research institutes and cooperation agencies,

exchanged around a synthesis of research results on community-based health insurance

(CBHI) in developing countries prepared by the CDBPH. While the CBHI have been

recognized since 2001 by the government as priority strategy of promotion of voluntary

health insurance and reduction of out-of pocket payment of health care’s and services, the

national coverage rate remains below 2%. According to WHO estimations (World health

statistics 2009), 95,8% of the 600 billion spent in 2007 by Cameroonians to finance health

were in form of out-of pocket during illness periods.

So the aim of the forum was to allow the key actors of CBHI in Cameroon to discuss

not only on the reasons of low infuation of the population for this voluntary disease

insurance model, but also about the conditions and successful experiences in developing

countries; the finality being that they became able to exploit, to use the research results in

an enlighten choice of appropriated strategies to achieve at last a coverage rate of 40% of

the Cameroonian population settle as objective to the national strategy of CBHI promotion

by 2015.

The work took place in an atmosphere of serenity and through workshop focus

around, research results and strategical options to speed up the population support to CBHI

in Cameroon. The following consensus were arrived at after the discussion.

1- CBHI are and must be considered not only like a priority, but also as a necessity to

free Cameroonians from anxiety of disease and high risk of huge expenses pushing or

driving a large number of Cameroonians into poverty in case of illness.

2- The freedom of set-up of CBHI given to communities must been inspired by positive

initiatives of associations in which some municipalities have embarked with the local

health authorities to offer disease insurance to the population.

3- The absence of regulations, legislatives and legal framework making easier and

promoting the establishment and functioning of CBHI in Cameroon make up one of

the main sources of discredit and suspicion that CBHI are victims of.

4- In fact, the absence of common understanding of disease risk concepts; best

practices and norms in allowances collection, spending for health care services and

norms on the health parcel covered and the care quality keep alive in the population

which close to 40% live below the poverty line (55% in rural areas) a high level

reluctance towards disease insurance model.

5- Population, including opinion leaders and political elites are lest informed on

advantages of CBHI and those who are informed don’t believe in CBHI capacity to

assure a universal coverage of disease risk.

6- Out-of pockets payment and the handling of cash in health facilities make corruption

easier.

7- The establishment of a moderate ticket in hospitals, the implication of health care

providers at the local level as well as the set up of social control mechanism to

improve the management of these CBHI and sanction of unethical behaviors will

encourage the population to subscribe.

8- The payment of member ship fees and allowances must be flexible to fit the local

economical production mostly in rural areas or in urban areas for the actors of

informal sector who represent more than 80% of the urban population.

9- Taking in the consideration the present level of monthly health expenditures of

household and that of their monetary resources, a wide proportion of Cameroonian

household is unable to pay their allowance and member ship fees. So, it is

appropriate to consider the set up of mechanism of subvention to allow poor and

destitute household to pay their allowances.

10-Medias have a critical role to play in information and education of the population on

the advantages of community based health insurance.