Date of Award

Spring 5-10-2014

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Bruce Clement Perry, MD, MPH

Second Advisor

Lee Rivers Mobley, PhD

Third Advisor

Betty Armstrong-Mensah, PhD, MIA


There are complex and multisectoral interdependent relationships between health systems and economic development in Cameroon that have been barely described in literature. Since its colonial and post-independence periods, Cameroon has faced an important economic crisis, from the mid-80s to the mid-2000s, which was addressed through structural adjustment programs (SAPs). The combined effects of the economic crisis and the liberal and market based programs resulted in a significant reduction of social programs and public interventions that negatively affected the country’s social structure, including the health sector. For example, life expectancy at birth moved from 53.3 years in 1986 to 49 years in 2000.

As the country regained macroeconomic stability, and attained the completion point of the Highly Indebted Poor Countries Initiative in the mid-2000s, there was some room to improve social development, including population health status. This was the motivation for the strategic planning process that started with the elaboration of Vision 2035 (Cameroon’s national development strategy for 2010-2035) followed by the Growth and Employment Strategic Paper (the first decennial implementation phase of Vision 2035). The health sector, one of the seven development sectors identified in the 2010-2019 phase of the implementation of the national development policy, updated its 2001-2015 strategic plan to cohere with the national development strategy, as well as to align its objectives with that of the Millennium Development Goals (MDGs).

The 2001-2015 health sector strategy was aimed at strengthening health districts, reducing morbidity, decreasing maternal and child mortality, and improving intersectoral management for health. In order to achieve these objectives, the health system has to face some critical challenges that were either not efficiently addressed or simply not accounted for, mainly because of weaknesses in the baseline assessment, and the lack of formative evaluation of its theory of change and process implementation. These challenges include but are not limited to: i) a poor health information system that is highly centralized and not utilized at peripheral level where all activities are implemented; ii) structural and capacity building problems in health service administrations at peripheral and central levels; iii) the inadequacy of training of the health workforce with present and forecasted population health status.

Having analyzed these challenges, the author of this capstone proposed the following policy alternatives:

  1. The organizational chart of the Ministry of Public Health should be in accordance with that of the Health Sector Strategy programs and with the New Financial Regime Act that command results-based management and programs’ autonomy.
  2. Formative evaluation (needs assessment and process evaluation) should be conducted for any strategy or program prior to its implementation.
  3. The programs of the Health Sector Strategy should be restructured into two vertical programs (disease control and prevention and health promotion) and one horizontal program that would support the vertical programs on aspects such as governance, health workforce, infrastructures, drugs and laboratory supply, as well as strategic planning and financing.
  4. A rising portion of health districts’ revenues should originate from the results-based financing mechanism in order to accelerate their strengthening by reinforcing their economic autonomy, health information system, and quality of service delivery.
  5. Health workforce capacity (for clinicians and health district management teams) should be reinforced in accordance with present and forecasted population health status, economic environment, as well as governance challenges.