Warmer weather, low bed nets use and heavy rains have been blamed for a recent upsurge in malaria in northern Cameroon, but public health in this region has also been undermined by weak medical services and widespread poverty.
Between January and September of this year, 182,402 cases of malaria were recorded in the Far North Region. Nearly a third of those patients died. Over the same period last year, a reported 166,261 people contracted malaria, with 30 percent of them succumbing to the illness.
“The increase in the number of cases and deaths is observed every year between July and October, a period conducive for malaria transmission resulting from heavy rains and standing waters. Women and children are the most affected and child mortality in the region has increased,” said Etienne Fondjo, the permanent secretary of the country’s National Malaria Control Programme.
Fondjo explained that high temperatures in September made people stay outdoors, exposing themselves to mosquitoes. Additionally, many do not visit health centres when they have early signs of malaria, resorting instead to self-medication. The use of counterfeit drugs is also common, he added.
“There is low use of treated mosquito nets by the people of this region, despite its availability to about 85 percent of the people,” said Fondjo. “Following the floods of 2012 in Maroua [in the Far North Region] and heavy rains this year, the environment has also become more favourable to the proliferation of breeding sites for mosquitoes.”
Doctors in the cities
Although Cameroon has nearly twice the minimum health worker-to-patient ratio recommended by the World Health Organization, at 1.9 health workers per 10,000 people (the sub-Saharan average is 1.3:10,000), the majority of doctors and nurses work in urban areas, according to a recent World Bank report.
More than half of the country’s health workers are in the Central, Coastal and Western regions, which host the three largest cities of Yaoundé, Douala and Bafoussam, the report says.
The Central Region, which includes Yaoundé and is home to 18 percent of the population, has 40 percent of the physicians, while the Far North Region, which is also home to 18 percent of the population, has only 8 percent of the physicians, said the report.
“Public hospitals in the Far North Region don’t have any capacity to receive the large number of patients that come in every day. Most of the patients who come in are even more exposed to mosquito bites on hospitals premises because they sleep under trees… because they lack the means to pay for the ward [fee], or the rooms are not sufficient for all the patients,” Maria Enjema, a nurse at Maroua District Hospital, told IRIN.
Healthcare costs in Cameroon are principally borne by individuals. In 2011, households shouldered 94.5 percent of their medical costs, the highest figure among the Economic Community of Central Africa States (ECCAS). According to the World Bank, Cameroon has for the last decade allocated the least amount of its public expenditure to health compared to the other countries in ECCAS.
“With the current healthcare system, it is more profitable for doctors and healthcare personnel to work in urban areas, where their clients have higher salaries and their own chances for professional advancement are greater than in rural areas,” said Fanga Ndi, an economist and analyst.
Cameroon’s northern regions are also the most deprived, with dire health indicators such as high malnutrition and low vaccination rates. Affording quality healthcare is therefore difficult due to costs. Around 40 percent of Cameroon’s 22 million people live in poverty.
“The general health facility level is deplorable in the north of Cameroon,” said Martine Kemaju, a doctor in Yaoundé. “This is due to the economic and socio-cultural circumstances of the region. It is a place where few have high-paying jobs and medical health investments are less profitable.”
“The few equipped public hospitals like the Garoua Central Hospital might not have the capacity to receive the large number of malaria and HIV/AIDS patients flocking the hospital,” Kemaju added.
Fondjo said the government had increased the supply of anti-malaria drugs and furnished hospitals with equipment for rapid diagnostic tests (RDT) of malaria, and is freely distributing insecticide-treated nets. Children under age five and pregnant women were also being treated for free, but he noted that health centres and hospitals needed sufficient personnel.
“The government seeks urgent consultation with partners and experts for the introduction of prevention [measures] for children between three and 59 months in the three northern regions during the high malaria transmission period. This strategy is expected to significantly reduce the number of cases during the period,” Fondjo said