Pilot Community Social Health Security Management

Regional Snap Shot - Cameroon
Gender Focus Training of Stakeholders on Mutual Health Insurance
By Roseline Ajongafac
On the 23rd and 24th October, 2008 the Chairman of the Pilot Community Social Health Security Project of the Health District of Bonassama, James Achanyi-Fontem, presided over the training of staff and executive bureau members on the management of Mutual Health Insurance Schemes. Opening the workshop, James Achanyi-Fontem said, this was an initiative supported by the ministry of public health through the very poor and heavy indebted countries fund of which Cameroon qualified.
The senior supervisor of the project is the director of Association of Partners of Community Social Insurance Systems in Cameroon, APCAS, Jean Keumo. The training took place in the presence of the representative of the Health District Hospital, Dr. Obam Enam, who also coordinates the Red Cross Crescent in Bonaberi-Douala.
The trainers included Ntock Mouhammed, Chair of the Health Solidarity Association (ASSA), Mrs. Ndoutou Toto Caliste and Kom Doleesse. Douala IV Municipality was represented by the 3rd Deputy Mayor, Kammogne Therese, who promised to advocate for support by the councilors through their participation.
The chairperson of the board of directors, James Achanyi-Fontem, said the objectives of activities, included the negotiation of conventions with health facilities in the health districts of Deido and Bonassama after the creation of the insurance scheme stakeholders committees. This new social security system that focuses on gender promotion aims at making health care accessible to all at low cost. The Community Social Health Security System would contribute to the permanent education of the population and circulate up dates on health care and environmental protection possibilities available.
The members were advised to reflect on micro-projects which on realization would assist in raising fund to be directed in durable initiative that would benefit the entire community and the stakeholder. To achieve this, Achanyi-Fontem added, members should collaborate with other organizations with similar objectives through the organization of conferences, workshops, round table debates on health and community education on relevant issues.
The adhesion to the health security scheme should be with distinction of sex or religion, and members should be be good morality. Dr. Obam Enam welcomed the participants at the workshop which took place at the conference and counseling centre of the HIV screening and care unit of the Health District Hospital of Bonassama. He invited the participants to be attentive to the different presentations which fall in line with national health policy of decentralization for community ownership of health care initiatives in Cameroon.
The principal facilitator, Ntock Mouhammed, in the first module talked about the context and present the origin of the initiative of community health security, which leads to everyone having access to adequate care at all times.
Ntock Mouhammed said, the initiative is based on self-help traditional solidarity systems. He added that self-help is based on reciprocal principles, while solidarity aims at extending a hand to the less advantaged groups in the community. When assisting the less advantage, the stakeholders do not expected any other benefits from them as exchange form the aid given.
Self help can be realized in several forms which include, labour, human resource, financial and material assistance because individuals, families and communities are always confronted with births, marriages, diseases, deaths, and so on. Without joined efforts, it is often difficult to properly address the above issues in the African communities.
It would be recalled that Cameroon like other Africsn countries achieved its independence by inheriting health systems which promoted and guaranteed free health care and treatment of its citizens. But the petrol and financial cris of 1980s reversed the situation by making governments incapable of continuing with free treatment due to the lack of resources.
It was during the conception of the Bamako initiative in 1987, that health ministers of the Africa continent found that free health care to the populations was not realistic due to the galloping economies and populations. This led to the putting in place of the new strategy which required the recovery of health care cost from the sick, while the governments took care of infrastructure, management, training and the payment of the salaries of staff.
From the diagnosis of 2001, it became evident that only 15% of population had access to health care in Cameroon. The principal cause identified was the weak or absence of resources, due the the heavy contributions to keep house holds secured through adequate nutrition and spending on health care. At this period, the public treasury became incapable of paying health bills, while guarantees by the public and private enterprises became limited
The solution by the ministry of public health was to initiate two reforms, which touched on the management systems of hospitals and the promotion of self-help community health initiatives by developing mutual health care insurance systems.
The current system promoted is based on solidarity amongst members of a community, participative and functional democracy where the community elects it own leaders by themselves, the liberty to adhere and belong for the promotion of autonomy, the development of the individual, and above all taking responsibility and operating as a not-for-profit mutual organization.
It should be noted that the principle of solidarity remains the basic foundation of mutual health security systems, because every registered member pays a contribution that is independent of personal risk. This contribution is the same for irrespective of age, sex and state of health of the registered member. In the same way, everyone benefits from the same services in case of illness.
This means that the Mutual Health Security scheme installs a solidarity system between the sick and those who are not, whether young or old and even between the different professional categories.
Addressing the issue of managing registration of members, Mrs. Ndoutou Toto Calixte, reiterated that mutual health insurance systems can survive only when the membership is consistent and members pay their contributions regularly. She distributed work tools with all the relevant information for guaranteeing good governance and transparency in the management of dues contributed. These tools included the membership registration form, the register of beneficiaries, the recapitulative sheet of contributions and the register of contributions.
On the other hand, Mrs. Kom Dolesse, emphasized on the use of management principles that guarantee good book keeping of money collected from members. She added that the contributions are needed for the autonomous functioning of the organization and the reimbursement of health bills of its members.
She enumerated the five different types of contributions which include:
Provisional contributions (Budget0
Registered contributions (dues collected in the current year)
Acquired contributions (left-over after spending)
Advanced contributions (payments received in advance of determined period)
Debt collection (owed dues collected as arrears)

The methods of calculating the contributions also differ and put in four categories:
General contributions
Fix semester contribution per family
Fix semester contribution per beneficiary
Contribution per group
Proportional contribution

As concerns the Community health Security Schemes of Bonassama Health District, the members opted for calculations to be done on basis of fix semester or annual contributions per beneficiary. Before closing the first day of deliberations, participants decided on the type of health offers that would be available for all who subscribe to the health security policy.
The goes with the establishment of partnership conventions with the selected health facilities after verification of the rates adopted for health services offered by the facilities. The target of mutual health security schemes is to get health services to all within a community at an affordable rate. Through this system, health coverage is more effective and covers a wide range of diseases very common in the community.
It was recalled again and again that the mutual health security organization is made up of volunteers that share the responsibility of caring for illnesses and other health risks, especially as the participation in contributions is uniform.
From what was said, it became evident that community mutual health security schemes are another excellent channel of developing a country, guaranteeing health, social and economic well being of individuals, families and the community as a whole.
Within the health fr5ame work, this facilitates access to health care, contributes to the amelioration of the quality of health care, increases the rate of health care visits in facilities and reduces auto-medication and use of poorly conserved street hawking drugs and medication.
In the social plan, this assists the populations to organize themselves for ownership of their health care system through jointly finding solutions to problems faced by the community‘s less advantage and poor populations. Since health care becomes cheap, it is accessible to all at the same moment.
This system encourages communities to acquire the spirit of saving to prepare for emergencies. In reducing expenditure on house hold health care through the solidarity health security scheme, everyone wins by paying less the US $ 2 per person each month for health coverage equivalent to US$ 100 per year.