SAINT MONICA HIGHER INSTITUTE
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH
EXAMINATION QUESTIONS IN HSO 630: COMPARATIVE HEALTH CARE
PROF. SYLVESTER NDESO-ATANGA
INSTRUCTIONS: ANSWER ALL QUESTIONS
Boniface Naoussi
SHHS20PH055
April 30, 2021
1. Discuss the major challenges faced by Cameroon in delivering
health care services (10 marks)
a. Unequal distribution Health facilities and infrastructure: Many
health facilities constructed under political pressure ignoring the
real health map and needs of population. This renders health
service delivery inadequate especially in rural areas.
b. A greater portion of health service financing comes out of
community member’s pockets, most of who are poor. This limits
access to quality health services
c. Health manpower is inequitably distributed in country, in favor of
urban areas. This leaves the rural communities wanting both in
qualitative and quantitative health personnel
d. Working conditions of health personnel are below standard and
thus demotivates health personnel thereby impeding quality
health service delivery. Example is the several slashes of salaries.
This has favored absenteeism and indiscipline in the health
system.
e. Insufficient manpower, both in number and in quality. There has
been a lot of brain drain for greener pastures leaving Cameroon
wanting in trained personnel. The ratio of Doctors to Patients is
below WHO standard. This compounds health services delivery.
f. Inadequate allocation of funds to the health department by
government and misuse of the little that is allocated.
g. Inadequate and disparity in data collection tools with several
donors, each imposing their tool. This makes decision-making
difficult.
h. Corrupt practices in the health system causing impunity and other
ills
i. Inadequate and Obsolete medical equipment
j. Top-down system of governance causing stakeholders at the base
disgruntled
k. Inadequate or non-implication of the base in policy making
l. Lack consistently good planning, monitoring and evaluation of
health interventions
2. List and briefly describe the different types of health services
produced and delivered by any health care system in the world (10
marks)
a. National health Insurance: In this system, the state finances and
regulates delivery, which is provided by the private sector. It is a
national level health insurance system. Countries implanting this
include Canada, Finland, Norway, Spain and Sweden.
b. National Health Services: Here the state dominates all the aspect
related to health care delivery. Examples include Italy, Denmark,
the United Kingdom
c. Social health insurance: It is also called the traditional sickness
insurance. It involves social financing and regulation whereby
government subsidies health services, but insurance is provided
by the private sector. Example is Germany.
d. Mixed systems. It involves societal financing, state regulation, and
private service provision. It consists of components of both a and
c above.
3. Why do we study other health care systems (10 marks)
a. given the dynamics in healthcare systems development, may
changes are taking place in different countries, especially the
developed ones. For instance, European health programs are about
outpacing those of the US with more then 10-year gap. Further it is
interesting to discover the differences I programs and knowledge
emanating from the disparities in healthcare systems.
b. The US healthcare system has many gaps compared to systems of
other countries like the UK, Canada, and Germany. Knowing these
differences help us copy good examples.
c. By understanding hos systems of the other countries function, we
can be able to assess our position and identify areas for improvement
d. We are able that many developed countries provide healthcare
services either directly through the state or through health insurance
that provide comprehensive coverage with public funding.
e. Innovative ideas usually are borne when we carry out comparative
research and these, when properly implemented can drastically
reshape and modernize Cameroon’s healthcare system.
4. Discuss the financing of health care between Europe and
America (15 marks)
In the US, healthcare is the responsibility of citizen, employers,
and the government. Thru Medicaid, both the state and the
federal government partly finance healthcare. Medicaid is
responsible for the provision health services to low-wage
earners including disabled. Healthcare to the disabled and
elderly citizens are provided by Medicare with federal
government subsidies and those who are not eligible for both
schemes pay out of their pockets or through workplace
contribution.
In Europe several health insurance schemes are available. In
the UK, the NHS (or the national health service) handles the
provision of free health services to residents. The funds for this
system are exclusively from taxes collected throughout the UK.
Many countries in Europe have similar financing schemes.
In Spain, for example, the universal health care system prevails
and operates like the NHS, with the sole disparity being that
people residing in the country copay for some specific services.
The French system is the national health insurance, like that of
Norway and Sweden. It is principally financed by the
government and funds from taxes paid by residents and
business, the former usually paying less than 40% for health
care within France.
Germany has one of the oldest and entirely different schemes
based on social, solidarity and subsidiary delegated to public
and private establishments. There is self-governance of the
scheme by the establishments. The system is quasi void of
government financing and each employee paying half the cost
of while the employer covering half. Those self-employed pay
for their coverage.
The US healthcare system is the most expensive in the world
with per capita of $8,000, two times higher than that of
Luxembourg, for example. The cost of healthcare per capita in
Germany is currently at $4,800. In France it is about $4,000 and
in the UK about #3,341.
The above costs differences have an impact on health access
and on life expectancies in the countries concerned.
5. How is health care financed in Cameroon and other African
Countries? (15 marks)
Cameroon and other African countries (with very slight
variance) have the same characteristics as far as health
financing is concerned. In Cameroon the healthcare system
derives its funding from a variety of sources: households, the
state, donors, the private sector, national NGOs, miscellaneous
revenues.
According to the 2011 National Health Accounts, total funding
for the health sector amounted to FCFA728 billion, contributed
as follows:
Household financing: 70.6%. Household contribution amounted
to about 61% of the entire health expenditure in 2013. This was
the 3rd largest after Sudan and Nigeria,
State: 14.6% this is about 6% of the total state budget, below
the required 15%
Private Sector: 7.7% which is 65 billion contribution from
external partners
Donors: 6.9% coming in the form of grants and loans.
Globally in Africa, out-of-pocket funding for healthcare is still
very high and it’s the main source of funding for healthcare
systems.
