The Determinants of the Evolution of Health Inequities in Cameroon: Implication for Health Policy and for the Achievement of the Health-Related MDGs

Since 1991, Cameroon’s economic progress has been mixed, with stagnation and 1990 and 1997, then a slow return to growth thereafter. During the same period progress on human development has been very modest, with better results in education than in health. Indeed, so far the country has performed poorly in term of the health-related MDGs (MDG 4: reduce child mortality; MDG 5: improve maternal health; and MDG 6: Combat HIV, AIDS, malaria, and other major diseases). Health inequities greatly contribute to this slow progress, since health outcomes among the lowest quintile of the income distribution are worse than those of other income groups. Furthermore, improvements in health status appear to have improved only marginally in this income group or to have even worsened.

Using Cameroon’s DHS data for 1991, 1998 and 2004, we analyze the evolution of health status, service use and behavior for the five quintiles, but also by rural/urban location. We then use regression analysis to link their evolution to that of the underlying determinants. Finally, policy implications are derived from the results of the study to help design the next health sector strategy (HSS). Indeed the current HSS (2001-2015) puts much emphasis on a new role for the health district, but does not really address equity at the four levels of implementation (health of the mother, the adolescent, and the child; fighting disease; promoting healthcare; and making health districts more viable). However, the results of this study show that those who need most these services still don’t have access to them and are not even aware that they are free.  Furthermore, indicators for MDGs 4 and 5 have also been disappointing among the lowest quintile and in rural populations. In this regard addressing the specific needs of these groups would also help achieve the goals.