MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Background
Cameroon is a central African country bordered by the Federal Republic of Nigeria to the west; the
Republic of Chad to the northeast; the Central African Republic to the east; and the Republic of
Equatorial Guinea, the Gabonese Republic, and the Republic of the Congo to the south. The
country is home to 18.5 million people and averaged a 2.2% annual population growth between
2001 and 2007 [1]. With a gross domestic product (GDP) per capita of 2005 (PPP constant 2005
international dollars) [2], Cameroon ranked 150 th out of 179 countries on the UN Human
Development Index in 2006 [3].
The first AIDS case in Cameroon was diagnosed in 1985 [4]. Today, the country suffers from a
generalized HIV epidemic characterized by high disparities between genders, provinces and rural
versus urban areas: the HIV prevalence rate reaches 5.5% in the adult population (15 to 49 years of
age) and between 10.7% and 11.9% among adult women in the most affected areas, which include
the provinces of the North-West, South-West and East and the capital city of Yaoundé [5]. By the
end of 2007, the number of people living with HIV/AIDS (PLWHA) was estimated to be 540 000 [6].
In 2006, Cameroon had an infant mortality rate of 87 per 1000 live births, and a maternal mortality
rate of 1000 per 100 000 live births [7]. WHO estimated that incidence of smear-positive pulmonary
TB in Cameroon was 83 per 100,000. Of all new cases, 15% occurred in HIV-positive individuals, and
1.7% were multi-drug resistant (MDR-TB) [8].
Administratively, Cameroon is divided into ten semi-autonomous provinces (“regions”), each
headed by a presidentially-appointed governor. These provinces are then further sub-divided into
divisions, sub-divisions, and finally districts. The health system in Cameroon is organized at three
levels: a central level including national administrative units in the Ministry of Health, as well as
referral hospitals, responsible for setting policy; an intermediary level, including regional
delegations and regional programme coordinators, in charge of technical support to district-level
programmes; and a peripheral level, composed of health areas grouped into health districts, which
is considered as the operational level for the provision of primary health care services.
Out-of-pocket expenses made up more than two-thirds of total health expenditure and external
resources 7.1% in 2006 [7]. Government health expenditures represented 1.46% of GDP in 2005 [2].
With an average of 2 physicians and 16 nurses per 10,000 inhabitants, the country has been
classified as by the World Health Organization as one of the 57 countries in the world having a
critical crisis in its health workforce [9]. Moreover, human resources for health are largely
concentrated in the urban areas: in 2004, 69.94% of the country’s physicians worked in cities, but
only 53.42% of the population lived in cities [10].
Official development assistance to Cameroon was $1.68 billion in 2006 [2]. Debt relief under the
Heavily Indebted Poor Countries initiative in 2006 brought Cameroon’s total external debt down
from US$ 7.2 billion in 2005 to US$ 3.2 billion in 2006 (or 17.7% of GDP) [1,2].
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