In 21 years, the share of the budget allocated to health in Cameroon has never exceeded 7%.
The reasons for this underperformance are related to insufficient political will, low capacity to mobilize resources and poor use of available funds.
This is a failure that strikes the mind of anyone with an interest in the implementation of the April 2001 Abuja Declaration in Cameroon, which calls on African States to allocate 15% of their national budget to the health sector each year. In 21 years, this Central African country has never succeeded, even for a single year, in achieving this objective.
In its 2011 National Health Accounts’ produced in 2014, the Ministry of Public Health (MOH) published a table that traces the trend of the share allocated to this sector in the overall State budget. And it appears that between 2000 and 2011, the budget allocated to the health sector has varied between 3.7% (2000/2001) and 7.07% (2009). Most often, this share is between 4% and 5% of the overall budget. In addition, in the 2016-2027 Heath Sector Strategy, the MOH notes that the proportion of the national budget allocated to the Ministry of Health between 2012 and 2015 ranged from 5% to 5.5%.
An overview of successive annual budgets shows that from 2015 to date, there has been no improvement in this performance. The best rate in this period was recorded in 2016, and stood at 5.57%. The lowest rate was in 2022 (3.70%), followed by 2018 (3.86%). Thus, Cameroon has never, in any year, reached the 15% target since the adoption of the Abuja Declaration. Its best performance remains the 7.07% recorded in 2009.
The Ministry of Public Health of Cameroon refused to comment on and explain this gap with respect to the 15% target, and referred us to the Ministry of Finance, where the budget department did not respond to our requests for information. However, in the evaluation of the 2001-2015 period included in the 2016-2027 Health Sector Strategy, the MOH writes that “political commitment at a very high level (…) is not sufficient with regard to the percentage of state funding allocated to the health sector “. This document is in line with the analysis of Albert Zé, a health economist in Yaoundé, who claims that “in Cameroon, health is not a priority, reason why it is highly neglected.
In an article published in October 2020 in the “Africa Renewal” magazine (the Africa section of the UN Department of Public Information), Nkechi Olalere and Agnes Gatome-Munyua list some of the specific reasons why the continent is not achieving this goal. These include low gross domestic product (GDP), low levels of tax collection, competing priorities, etc.
Analyzing the specific case of Cameroon, Jean-Colbert Awomo Ndongo, a lecturer and researcher at the Center for Research in Applied Microeconomics (REMA) at the University of Yaoundé II, indicates that one of these competing priorities is, for example, the financing of the defence of the national territory, which has been facing security challenges for several years now.
In his view, missing this target will have implications such as failure to eradicate malaria, tuberculosis and HIV/AIDS. A goal that was one of the key motivations for the Abuja Declaration. He adds that the other consequence of this situation is the country’s difficulty to implement Universal Health Coverage, planned for several years.
But according to Albert Zé, it is not necessarily the failure to meet this 15% target that is problematic in the health sector in Cameroon, or even in Africa. In his opinion, the health system in Cameroon is currently experiencing “huge challenges” ranging from its organization to the use of allocated funds. “And several countries with strong health systems have never achieved this goal,” he said.
Nkechi Olalere and Agnes Gatome-Munyua share this view when they write that “Actually, it is less important to meet spending targets than to ensure that health systems have adequate resources and that these resources are used as efficiently as possible.”
To improve performance, they propose “reducing spending on inefficient or inequitable public programs, such as fuel subsidies that disproportionately benefit the wealthy, which can be redirected to increase government revenues and possibly to increase allocations to the health and social sectors.
Jean-Colbert Awomo Ndongo adds that in the case of Cameroon, such a reduction should also apply to certain operating expenses of ministries that inflate their budgets. He mentions, for example, the purchase of vehicles, the organization of seminars, conferences or symposiums. “The reason why I am suggesting a reduction,” explains the researcher, “is that some Ministers, while defending their budgets, presented operating expenses of nearly 80% against 20% for investments. Thus, some ministries could see their budgets decrease to increase health allocations”.
The first thing to do, according to Albert Zé, is to ensure the sound management of the existing budget.” It is not appropriate to increase the budget while the current budget is not being managed properly. We must prioritize the health of the population by rationally using the budget already allocated. Can you imagine,” he wonders, “that currently about 90% of the budget allocated to health is not spent on health needs? We can do great things with what we currently have, all we need is for our leaders to show commitment to providing quality health care to their populations.
The 2011 National Health Accounts confirm these figures by indicating that “more than four-fifths (87.7%) of current health expenditures by the State are related to the governance and administration of the health system. Medical products and preventive care constitute 5.6% and 3.8% of these expenditures respectively. Curative care accounts for 2.4% of current government health expenditure. Ancillary services and rehabilitative care are almost non-existent.
Moreover, Albert Zé believes that this 15% objective “has never been realistic. “The Abuja declaration is problematic because it does not take into account countries’ specificities. It is always very embarrassing to have a decision proposed to a group of countries as if their situation was identical. It is time for Africans to start thinking specifically for Africa and their countries.”