By Fri Delphine
In the Tubah health district, community members joined forces to improve quality of care at their local clinics. The LCI project led a training and provided capacity building with the aim of increasing community participation to build stronger local ownership of health care systems. This case study provides an example of how communities can advocate for and support sustainable health care services in resource-poor settings of Cameroon.
The Cameroon Baptist Convention Health Board (CBCHB) began implementing the HIV Free (HIVF) Project in 2011. The overall goal of this project is to expand and improve quality of HIV PMTCT services. During implementation, CBCHB observed low uptake in Antenatal Care/Prevention of Mother to Child Transmission (ANC/PMTCT) of HIV services at some health districts in the northwest and southwest regions of Cameroon. This was attributed to lack of basic equipment and inadequate infrastructure including pharmacy set up, ANC waiting room, toilets etc. In 2014, to address these challenges, CBCHB submitted a proposal for the Local Capacity Initiative (LCI) to the Centers of Disease Control/President’s Emergency Plan for AIDS Relief (CDC/PEPFAR). The LCI project is intended to respond to challenges faced by low-performing health districts.
The LCI project is working in ten health districts, five in the northwest and five in the southwest regions of Cameroon. The Tubah Health District case study is part of LCI’s ongoing efforts to document the impact of the LCI project to revitalize dialogue structures and strengthen community ownership of and participation in local health systems.
An Unengaged Community
Across the 12 health facilities within the Tubah district, annual ANC uptake stood at 39.5% in 2013. This is lower than the national average, which stood at 61.8% (World Bank, 2013). In Tubah, lack of basic equipment and inadequate infrastructural development in some health centers remain major challenges to high uptake of services. In addition, such communities lacked local support through dialogue structures which could empower these health facilities to address these challenges.
LCI conducted a baseline assessment of major stakeholders (administration, local council authorities, health dialogue structure representatives, politicians etc) in the Tubah district to assess their technical and organizational capacity. During this assessment, the LCI project identified the absence of community engagement and participation in improving the healthcare system, which is seen as the government’s responsibility.. In addition, the Tubah Council was unaware of its responsibility around dialogue structures and did not have an office or focal person for health matters.
Many health facilities in the Tubah Health District including the Finge Health Center, face challenges such as limited staff, limited, poor quality equipment, and supplies that affected its day to day ability to address the community’s health needs. The health center had only two staff, no pharmacy, and no electricity. It lacked basic equipment and supplies such as refrigerators and hospital beds. In addition, its health center building was run down and uncared for.
In 2014, the LCI project took steps to address these challenges. For example, LCI:
- Provided technical assistance in developing district-level action plans from baseline assessment findings.
- Identified one member of Tubah’s District Management Committee and one from the Tubah council to attend a training organized by CBCHB with technical support from APC. This training established the groundwork for participants to lead efforts in health improvement in their districts by providing them with applicable skills in Policy Advocacy Strategies.
- Trained selected members from each of the 12 Health Area Management Committees in community engagement. Participants began to understand their roles and responsibilities within the dialogue structure, developed tailored action plans to mobilize resources in their health area, and initiated sensitization and outreach efforts.
- Conducted monthly supervisory and capacity strengthening activities to committee members’ capacities. This included checking the status of action plan implementation and providing identified assistance during coordination meetings.
These activities served as “eye opener” to most of the dialogue structure members who were unaware of their roles and responsibilities to support local health centers.
Mr. Angong Emmanuel, the chairman of the Ntehmbang Health Center Management Committee, stated:
We were appointed to work, but I will confess that we barely knew our left from our right. We could not be effective not because we didn’t want to work, but because we did not know what to do. Thanks to these trainings and regular supervisions, we now better know what we are called to do.
Through LCI support, the district was able to envision the possibilities of community-supported and co-managed health care. In addition, they strengthened skills in resource mobilization to support health care centers.
Results of LCI Support in the Tubah District
As a result of LCI’s efforts, several health areas in the Tubah district mobilized resources and community support. LCI has provided the skills and motivation for communities to begin co-financing and co-managing their health system at the local level. The following are some examples of changes LCI has observed: In the Finge Health Area, the Health Area Management Committee has mobilized resources to create space for a pharmacy and pay the salary of a pharmacy attendant (as seen on the first page). Community members raised funds through direct donation or fundraising efforts to support renovations and monthly electricity costs. They donated iron doors to fortify the pharmacy and facility entrance and a refrigerator to preserve vaccines and other medications. In addition, other community members donated their time and expertise to paint and install the ceiling of the building to give a new face to the health center. Finally, the Tubah District Management Committee Members successfully lobbied for the supply of drugs to the health facility. Following improvements to the health facility, LCI has observed an increase in uptake of services as seen on the chart below:
- The health center in Ntehmbang Health Area was previously located in a small rented apartment. This space was intended to be temporary until the construction of a new health center was completed. Construction was abandoned for nearly two years due to lack of government funds to complete the construction. The Management Team mobilized resources from the Council, and community leaders and other members donated cash and kind contributions to complete new the building.
- The Lih Health Area Management Committee mobilized resources to build a sink in the labour room at the health center. The Chief of Center, Mrs. Yewa Monique, is proud of this initiative::
The LCI training taught us several things among which not to rely on vertical funding but for us to learn to work together with our community people to solve especially some critical health challenges that hinder us from accessing or providing quality health care to the people.
For the first time, the Tubah Council Mayor appointed a Deputy Mayor responsible for all health issues. Within this new role, the Deputy Mayor, Mrs. Ngwe Eunice, is to advise the council in budgeting and prioritizing health care activities. Mrs. Ngwe states:
When I returned from the LCI training and shared my experience to the Lord Mayor, he then saw the need for one of his Deputies to be responsible for health activities. He then appointed me to the new position to manage health related issues within the municipality.
Mrs. Ngwe Eunice worked with her team to prioritize and budget for health care during the November 2015 Council Budgetary session. As a result, for the first time in the history of Tubah Council, a budgetary head was created to handle health related issues with a budget of 3.000.000Frs.CFA. These funds will be used to support health-related activities in the Tubah Health area in the 2016 financial year.
These ongoing changes in Tubah Health District have increased the number of those utilizing the facility as well as the uptake of women who deliver in these facilities as indicated by the increase from 39.5% in 2013 to 50.8% in 2014 and 48.6% in 2015. It is therefore becoming clear that the LCI is contributing to the transformation of communities moving towards fully owning their health centers to define and support their health priorities. These initial successes recorded in Tubah Health district reflects those recorded in the nine other LCI districts in the Northwest and Southwest regions of Cameroon. These changes are a sign that access to and quality of health care could drastically improve if communities are well capacitated and engaged in co-management and co-financing of health care as envisioned by the National Health Policy on Dialogue Structures.