Co-financing and Co-management of healthcare begins to thrive in Bafut Health District
By Clementina Njang Yong
The Bafut Health District faces a shortage of healthcare staff in their health centers. The District Management Committee (DMC), in collaboration with the Bafut Council, has been advocating local government for additional healthcare service providers in their health facilities. Five health facilities have seen positive results from these efforts and the district is continuing to recruit 20 additional staff across 13 health facilities. With the increased availability of healthcare staff, Bafut Health District has seen an increase in the utilization of the health services.
The Bafut Health District case study is part of the Local Capacity Initiative’s (LCI’s) ongoing effort to document the impact of the LCI project to revitalize dialogue structures and strengthen community ownership of and participation in local health systems. LCI is implementing similar work in ten health districts across Cameroon: five in the Northwest and five in the Southwest.
A Shortage of Health Care Providers
The Bafut Health District is in the Northwest region of Cameroon. The district covers 420 square kilometers and has a population of around 120,000 people spread across 54 villages. It is vast and remote. Healthcare service delivery is therefore quite difficult in this area.
Access to health is always very difficult because of the means of movement because some of the health facilities are found in very remote areas like Mundum II.
– Mayor of Bafut, Langsi Abel Ngwasoh
In addition to the geographical challenges, Bafut faces an acute shortage of human resources for health. A total of six medical doctors and about 20 nurses serve the entire district’s health care needs at 15 health centers and one hospital in 14 health areas. The doctor to population ratio in Bafut is one doctor to more than 20,000 people. This is significantly lower than the nationwide average of one doctor per 10,000 people according to the District Medical Officer (DMO) for Bafut, Dr Fozao Adolph.
In addition, there is a pattern of healthcare personnel refusing to report to work in Bafut’s remote health facilities. This greatly limits the availability of health services in these areas, and contributes to challenges in providing quality health care to the people of the Bafut Health District. According to the District Medical Officer (DMO):
The district lacks staff both in quality and quantity, a situation that affects both healthcare service delivery and uptake. We realized that lack of personnel contributed to low consultations in some health units.
Some health centers only have one healthcare professional. This results to low utilization of facilities within the health district: ….especially in those remote areas…At times when people are posted here, everybody wants to work around the center where he/she can easily move up to town. People hardly want to go to the suburbs to work there. Even when a health institution is operating in an area, you find that it is difficult to find people who really attend to patients in those areas. –Mayor Langsi
The Bafut Council, through the support of LCI, has been working to address this provider shortage as part of its efforts to improve maternal and child health in the district.
Supporting Bafut to Identify Local Solutions for Community Led Health Care
In order to support the Bafut Health District to plan and advocate for appropriate staffing of the heath facilities in their community, the LCI project has provided technical support to community leaders to take responsibility for, address, and champion the health needs of their people.
LCI was launched in Bafut on 12 August 2014. The project conducted a training of trainers to empower community stakeholders to take ownership of and manage healthcare in their communities on 7-9 November 2014. A total of eleven stakeholders, including the Divisional Officer (DO), District Management Committee (DMC) members, the Mayor, and religious leaders participated in the training. The training focused on the importance of co-financing and co-managing district healthcare services. Each district was asked to develop strategic plans based on their needs.
The Bafut district’s strategic action plan initially aimed to raise awareness on the importance of seeking antenatal care (ANC). To this end, the DMC visited each of the quarters in the health district to encourage women to attend ANC. However, during this exercise, the DMC realized that pregnant women would go to some health units only to find that there were no providers available to see them. The DMC found that this shortage of health personnel was a common problem during these visits. These findings have forced the district to rethink the focus of their action plan: not only were women failing to attend ANC visits, but those who attempted to were unable to receive services due to shortages of health personnel.
To address these challenges, LCI highlighted these critical human resources for health shortages during a district strategic planning meeting. LCI facilitated a conversation about reorienting the Bafut district action plan to address the root causes of these shortages. The DMC brainstormed strategies to address this problem. In conversation with LCI, they unanimously agreed to compose an appeal addressed to the Mayor of Bafut Council stating the need expressed by some health units:
We, the District Management Team of the Bafut Health District are soliciting for assistance from the council following the need expressed by some of the health units and following our strategic plan for 2015 that we should endeavor to appeal to the council to assist the health units through the District in this aspect which is so demanding in the whole district.
A total of five key stakeholders signed this appeal, including the DMO overseeing the four LCI Supervisors and executive members of the District Health Management Team. The appeal letter was submitted to the mayor’s office on 28 January 2015.
Results of LCI Support
In a letter dated 23 February 2015, Mayor Abel Ngwasoh Langsi of Bafut council responded to the DMC’s appeal. The mayor requested a list of health centers facing staffing shortages as well as their actual staffing needs. Demonstrating their firm resolve to address this issue, the DMC responded two days later on 25 February 2015. They prepared a letter to the mayor detailing the staffing situation of 13 health centers, which need a total of 20 additional staff — five lab technicians, eight nurses, six cleaners and a yardman.
On 28 May 2015, five of the requested staff were posted to Bafut: a lab technician, three nurses and a nurse assistant. These staff were all selected through a competitive process.
The DMC, the health centers, and the communities served by the engaged staff are pleased with the services of these new personnel. The DMC plans to continue advocating through the council for the other 15 staff; as well as for the extension of contracts of the five newly-engaged staff. Healthcare provision in the Mbakong, Tingoh, Mankwi, Mundum II and Nchum Integrated Health Centers have been upgraded thanks to the input of these additional healthcare professionals; who are occasionally called up when there are any emergencies even on nonworking days.
According to the Chief of Center for Mbakong Integrated Health Center (IHC) Mr Fon Hardy, the lab technician is available to provide needed services thereby increasing access and the uptake of health services by the population. The chart below shows the increased uptake in general consultations and lab test by August 2015-three months after Mr Ngwankongnwi Cletus started working at Mbakong IHC.
The chart shows a marked increase in the number of consultations and lab tests conducted Mbakong IHC after the employment in June of Mr Ngwankongnwi as lab technician. Patients and pregnant women who used to be referred to other far away facilities for lab tests can now undergo testing and receive treatment within their local facility
….the way they attend to us now is very good. We succeed to have all our lab test here now….
-Ubrin Kaah, a pregnant woman in labour who trekked for two days to arrive at the hospital.
The lab technician and four nurses have been employed under a salary category of grade 4 echelon 1 and 2. They all receive a monthly remuneration of about 50,000 CFA each, an amount above the 36,000 CFA minimum wage. This amount can sustain the livelihood of the workers.
I am very satisfied with this job and the salary from the start. With the job I am able to send my wife back to school which is my greatest priority.
– Mr Ngwankongnwi Cletus, Lab Technician
The DMO for Bafut has used this initiative to applaud the services of the Local Capacity Initiative. He has noted LCI activities have also gone a long way to increase ANC uptake with more and more women turning up for services. The integrated ANC outreach organized by the LCI was also a means of resolving the problem of shortage of staff at facilities and reaching out to these women, with the resulting consequence of increased ANC uptake as demonstrated in the table below.
As more pregnant women turn up to facilities, human resource gaps are being filled to give them quality attention.
Comparative analysis for activities in the health center since the employment of the nurse by the council are good. It has really improved the utilization rate of the center by the whole health area in general especially in the aspect of consultations…For ANC, the outreach activities sponsored by the CBC Health Board has brought about an improvement in the number of pregnant women who turn up for ANC and we now have many ANC women to attend to.
– Mr Fon Hardy, Chief of Center, Mbakong Integrated Health Center (IHC)
At Tingoh IHC, where women lacked post-natal beds, has as a result, mobilized funds from the community and purchased two beds to accommodate their women after delivery. It should be noted that the women used to lie on the floor when there were no beds in the facility.
The example of Bafut has been appraised and shared with other LCI stakeholders as a promising practice that other District Management Committees can emulate.