The 61st PBF course in Ngaoundéré

INTRODUCTION AND GENERAL IMPRESSIONS

The 50 course participants with their Certificates in the Presence of the Governor

The 61st international PBF course was held at Mentong Palace Hotel in Ngaoundéré, from June 19 to July 1, 2017.

Download the detailed course report (rapport du cours)

The main objective of the course was to extend the PBF reform approach in the northern part of Cameroon and notably in the Regions of Adamaoua, North and Far North with in total 7 million inhabitants. These regions have the poorest reproductive health indicators in the country.

The course was marked by the participation of three executives of the Ministry of Civil Registration (BUNEC) from the central level and the Secretary Generals of three Town Halls in Adamaoua Region. The other participants were from the health sector.

The evaluation of the course showed that the course was a success. There were nine distinctions of participants with scores of 90% or more for the final test.

COURSE FINDINGS AND RECOMMENDATIONS

  • In general, PBF has started very well in the three Regions so far covering around 40% of the population to be expanded by the end of the year towards 100%. Hundreds of qualified health workers have started to move towards the PBF health facilities due to the more attractive working conditions as well as incited by the PBF system of awarding Quality Improvement Bonuses (QIB) when health facilities recruit qualified staff.
  • The Regional Funds for Health Promotion (RFHP) continue to impose monopolies in their regions despite that the PBF approach opposes such monopolies. In the Adamaoua region, the Regional Fund has until recently created new sales depots in the health facilities, which they also control. This means that the benefits of the drugs sales are not for the health facilities but rather for the Regional Fund.
  • In the Far North Region, the predecessor of the Regional Fund “CAPREN” even confiscate drugs from health facilities that are not bought from them. The Regional Delegation of the Far North Region has not yet stimulated the private pharmaceutical sector to settle.
  • The mapping and rationalisation of the main contractor holder for the contracts at the primary level and the hospital levels is not yet done in the three regions. This means that there are still serious problems of efficiency of scale.
  • Medical Centres are often managed by the district medical doctors. The participants recommend that it is better to appoint nurses as the in-charges of these health facilities and this liberates the DMOs to focus on their role as regulator.
  • Hospitals in the North Regions (contrary to several in the other PBF regions in the South) still transfer the revenues collected from cost recovery to the treasury and not to their own bank account, which they also control.

The Crater Lake near Ngaoundéré

Recommendations for the National PBF Unit

  • Publicise the national PBF manual as soon as possible so that there will be clarity as to how the PBF program will be managed;
  • Add for the regional CDV Agencies the output indicator “realization of a QIB (quality improvement bonus) for infrastructure and / or equipment.
  • This should also finance for a CDV Agency recruited architect or engineer should to support health facilities with the planning of their infrastructure and to monitor the progress and the quality of their work.
  • Include also for the district the QIB output indicator to facilitate the recruitment of new staff and for infrastructure / small equipment improvements.
  • Advocate for a representation of the peripheral level in the PBF steering committee.

Recommendations the Ministry of Public Health

  • Start PBF in all the regions of Cameroon as soon as possible;
  • Establish a legal and institutional framework to protect health facility managers to apply the PBF best practices without being pressured by still existing Laws that advocate opposite ideas;
  • Distribute the PBF manual accompanied by an introduction signed by the Minister of Health that shows that PBF has become official policy in the PBF areas. The manual should explain PBF best practices such as that: (a) Health facilities have free access to distributors of drugs and other commodities, which operate in competition; (b) Staff can be recruited by PBF health facilities but also that they should obtain standard contracts explaining their status; (c) Hospitals and District Medical Centres should have the financial autonomy to manage their own funds through autonomous bank accounts.
  • Resolve with the Ministry of Finance that health facilities have autonomous management and that the MOF through the MOH should pay health facilities in cash for results (and not in the form of the “carton” system);
  • Decentralize human resources management towards the peripheral level: authorize health facility officials to recruit staff;
  • Stimulate competition by promoting that health facilities have access to accredited distributors of (essential) drugs, consumables and medical equipment;

Village chief of the PBF course

Recommendations for the Regional Delegations of Public Health

  • Raise awareness among regional authorities (TPG, Governor and CAPR managers) on the importance of implementing the eleven PBF best practices;
  • Give health facilities the authorization to open bank accounts
  • Clearly separate the roles of the Regional Funds and those of the Regional Delegations of Health to avoid conflicts of interest in particular concerning the issue of the pharmaceutical sector. Regional Delegations should be seen to play their role as neutral regulator of the pharmaceutical sector and not only to support the Regional Fund. This includes that the Regional Delegations promote the presence of several wholesalers and thereby improve access to good quality inputs at reasonable cost for (public and private) health facilities.

Recommendations for the Regional Funds for Health Promotion and the CDV Agency

  • Ensure that there is a clear separation of the role of the Regional Fund the sale of medicines and that of their role of CDV Agency.
  • Assure that health facilities know that they are allowed to purchase their inputs from different pharmaceutical distributors.
  • Conduct the mapping of the population of Ngaoundéré Urbain and Ngaounéré Rural

Recommendations for the NGO IRESCO

  • Assist local Health Authorities in the Extreme North Region with the mapping and rationalisation of the health facilities under contract by their CDV Agencies.

Recommendations for the District Health Management Teams

  • Improve the quality of supervision and coaching of the health facilities
  • Start evaluating the retail pharmacies in their districts and advocate with interested qualified investors where necessary also to open accredited retail pharmacies
  • Plan quarterly coordination meeting and monthly district validation meetings.

Adamaoua Region. Source of several rivers in Cameroun

NATIONAL BUREAU OF CIVIL STATUS (BUNEC)

In Cameroon, the Ministry of Territorial Administration and Decentralization is responsible for defining the Government’s civil registry policy but it is the National Civil Registry Office (BUNEC) that since 2013 ensures the supervision, control, evaluation and regulation of the civil registration system. The main civil status centre officials are the Secretaries General of the Town Halls. Moreover, important roles are also played by the secondary offices as well as health facilities and the courts.

The current civil registration system suffers from numerous dysfunctions. The current civil servants are poorly trained and poorly motivated due to poor salaries. These problems are aggravated by the fact that by Law registrations are free of any fees, while there is at the same time inadequate public funding. Registering the population in remote areas is difficult and the archives are not properly maintained. As a result, the national registration coverage rate for births is only 66%.

According to the BUNEC team, the PBF approach has a good feasibility of above 80% to help solve these problems.

Recommendations BUNEC

  • Start a Pilot PBF program in some representative areas of the country
  • Involve MINADT, BUNEC, the main and secondary civilian state centres, the health facilities, the Justice Department and the Communities.
  • A start of registration output and quality indicators is presented in paragraphs 7.7.7 – 7.7.11 of the course report.
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