Reallocation of Cameroon’s Public Health Budget from the Central Administration to Regional Level: Is it Worthwhile?

Abstract

Cameroon is a “decentralized unitary State” but is financially centralized. Its health sector faces inequities in financial resource allocation from central to peripheral levels generating significant disparities in healthcare delivery at the regional, district, and health facility levels. Despite a 68.3% increase in national financial allocation and 100% budget execution, the resource allocation inequities persist, with less than 50% of the resources allocated to integrated health centers reaching the intended benefactors. The main questions analysed are: why are most of the finances allocated to the Central level, and what current structures can be adapted to effectively “decentralize” the financial resources? The advantages of decentralizing health systems include increased efficiency, quality of health services, promotion of accountability and local governance of the health system, and 'shock-absorber' effects. Recommendations on making this budget reallocation sustainable in Cameroonian will eventually come through organizational change and the use of needs-based reallocation formulae to ensure objectivity and dilute subjectivity. Central Administration to act as a regulator with an ombudsman from the National Anti-Corruption Commission or the office of the Public Independent Conciliator to prevent financial leakages at the district and regional health levels. A close-to-ground governance system will help resolve staff absenteeism, motivation, career management, and retention issues. Centralization is needed to steer national policies, but decentralization will prevent embezzlement and corruption, avoid supply delays, promote Universal Health Coverage application, local autonomy tailored to the specific needs of different health districts and assist in achieving Sustainable Development Goal 3 and other health-related SDGs.