ABSTRACT
This study aimed at presenting the relevance of project
approach adopted by the HIPC initiative. In the mean time, it will be matter
more over to show the problematic related to the funding of health care. This
problematic seems to have found a durable solution through health mutual
insurance companies. For our research, data collection was used thanks to
interview guides. Furthermore, analysis of the content and statistic further
help us to interpret data. The conceptual frame of the study was constructed
following two explanatory variables (diagram annex 6). On the theoretical point
of view, our study required the use of two grids of analysis: Systemic analysis
and critical analysis. For indebtedness of sub-Saharan African countries many
solution have been applied, among others the rescheduling, structural
adjustments (SAP). Unfortunately, they all tend out to be a failure. At the
dawn of the year 2000, these countries are in state of unsustainable
indebtedness and an extreme poverty. HIPC initiative put in plan in 1996
proposes innovating solutions. It is matter here to finance Africans economies
thanks to resources gotten from debt burden reduction. These resources are
anyway called upon to be used in development projects well identified and well
planned. It is the consecration of project approach which obliges a rigorous
preparation of tools that constitute it and brings quality in it
expenditures.
In Cameroon, the CCS/HIPC is the organ in charge of the
orientation and control of this approach. Projects from sectorial ministries
and the civil society are presented to this organ for eligibility to HIPC
funds. Unfortunately the appropriation of project approach by actors is
incomplete. On about 40 projects analyzed by this organ, only 30% has
successfully elaborated a feasibility study and has written a report of
activities meanwhile, 85% has written a fore project of execution. The problem
of access to quality health care was identified, analyzed by the Ministry of
Public health and the solution envisage is the promotion of mutual systems. It
is therefore for this reason that, the project PROMUSAP was put in place.
HIPC-initiative brings support as a matter of fact to the development of
Cameroonian financing system by facilitating the creation of non banking system
of internal saving collection.
As from 2003 we are therefore faced to a rapid development of
pilot mutual health in Cameroon. Health's mutual are fast growing and in 2008
they were already up to 90 created all over the country. Other organisms
equally bring support in the putting in place of these mutual organs in the
example of Belgian and German Cooperation (GTZ). By the way, the diffusion of
this concept in a greater scale needs an evaluation of action taken so far.
We have as a matter of fact evaluated 8 of such mutual health
organs financed on HIPCs' funds. Out come of these evaluations show some
weaknesses on the technical and financial plan. There is a weak rate of
adherence and a real lack of dynamism of populations. To perceive the
specificity of mutual health organs, evaluation tools adapted to the context
have to be elaborated. Diverse research tracks can permit to construct relevant
monitoring and evaluation indicators. Our principal recommendations go to the
building capacities of actors on project approach, improvement of procedures of
fund allocation, the search of relevant indicators for monitoring and
evaluation, the elaboration of impact study on mutual health organs on
populations, the quality of care and governance in health units.
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