Photo: Edmond Bagde Dingamhoudou/World Bank
An inequitable system
Results-based financing: the right solution?
- Systematic collection of health data to evaluate conditions and measure results
- Establishment of financing mechanisms for the neediest families to encourage them to visit health centers
- Better distribution of health personnel nationally to alleviate geographic disparities, achieved by incentives such as bonuses for work in rural settings.
A pilot project covering four regions (Littoral, Southwest, Northwest and East) and 3 million inhabitants (out of a total population of 20 million) was recently founded, with World Bank support, to model the soundness of this approach. No fewer than 400 health centers have signed results-based financing (RBF) contracts and are being paid according to the quality and quantity of care provided. Centers situated in areas considered difficult to serve receive additional credit and bonuses. “Adopting a remuneration system based on performance is an effective way to change health care providers’ behavior,” says Sorgho, adding that in Cameroon, absenteeism is a major problem in isolated rural areas. According to a recent World Bank survey, in the Southwest region alone 32% of health centers were operating (on the survey date) with a single staffer at each center.
In the Littoral region, the last few months have shown encouraging results, as centers where RBF was introduced demonstrated a significant increase in usage of critical services such as prenatal care, child vaccinations and modern contraception methods. The sub-Saharan African countries Rwanda, Burundi and Sierra Leone, which have established results-based financing as a national policy for health care, have also seen tangible results.
Raju Jan Singh, the economist, expressed optimism about Cameroon’s ability to improve its health care performance record, since the government adopted a budget program in 2013 aimed at improving the productivity of public expenditures. “With this framework, ministers will enjoy greater autonomy in planning and executing their budgets, but in exchange they will be expected to answer for the results. That is why the country needs better data-gathering techniques, because to get results, you need reliable data,” he concluded.