Author: Organization of Cameroon Doctors 

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PREAMBLE

We are Cameroonian physicians practicing at home and abroad. We come together for the love of our fatherland, our profession and our patients. We have decided at this time to break the silence and discretion, which often characterizes our profession, to express our thoughts and opinions on the Cameroonian healthcare system through this manifesto.

Our aim is to contribute to the improvement of the Cameroonian healthcare system for the benefit of all.  

Our healthcare system is currently undergoing a crisis, which has impacted on our lives and the integrity and honor of our profession. Thousands of lives are lost daily in health facilities across country as a direct result of limited financial resources and lack of access to healthcare. We continue to witness the horrendous consequences of a severely flawed and dysfunctional system, a glaring sign that it is time for a complete overhaul of our country’s healthcare system.   As physicians we bear the biggest brunt of the failings of this healthcare system and are often stretched beyond the limits of our professional consciences. At this crucial time in the history of the medical profession in Cameroon:  

·         We can no longer be silent facing the sharp decline in the quality of healthcare services provided in both public and private sectors in our country.

·         We can no longer be voiceless bystanders to all the avoidable deaths, which occur in health facilities across our country due to the lack of infrastructural and financialresources crippling our healthcare system.

·         We are appalled and alarmed by the denigration and attacks faced by healthcare personnel who are easy scapegoats for the failings of a dysfunctional and flawed healthcare system.

·         We refuse to be made responsible and accountable for the policies governing healthcare in Cameroon, given that we are not the sole decision makers when it comes to healthcare strategy, especially in matters of financing and accessto healthcare.

·         We strongly refute every suggestion that a universal healthcare system with access for all is an unattainable objective for our country, when this model has been successfully implemented in countries with far less resources than ours.

·         We denounce the commercialization of healthcare for personal gain as well as the bad practices which plague our profession and will continue our fight to uphold the highest ethical standards in medical practice and theprovision of healthcare.

·         We decry the lack of technical and infrastructural resources available to healthcare providers, severelylimiting our ability to provide optimal care to populationsand perpetuating archaic and dangerous practices sub-par to international evidence-based norms.

·         We decry the insufficient involvement of populations in matters directly relating to their health and well being including: prevention, community participation and also involvement in the decision making process.

·         We denounce the insufficient regulation of noxious substances with a negative impact on the health of the population (alcohol, tobacco, sugary drinks, contaminated food products…) and locally produced traditional medicines, as well as the weakcontrol of illicit and counterfeit drugs sold freely on our streets and markets.

·         We reject our adverse working conditions and the condescensionwe face daily from institutions intended for our own defense, from government authorities, our employers and our fellow citizens.

·         We decry the weak remuneration we receive for our services and demand a just valorization for physiciansboth inpublic and private sectors, as wellas nurses andother healthcare professionals. This remuneration should be commensurate to our training, the inherent risks related to our profession and the cost of living.

·         We denounce the unfair redistribution of hospital revenue, generated for most by the services we provide as physicians and often mismanaged by the administrators of the healthcare facilitiesin which we work.

·         We protest the authoritarian approach adopted by some hospital administrators in their style of management, with complete disregard for the working conditions of healthcare providers with a direct and negative impact on our patients.

·         We decry the total disregard for the career development of the Cameroonian physician, the over-centralization and autocratic management of human resources with complete indifference to performance, unique competencies and the true needs of our health facilities.

·         We oppose the exclusion of doctors, nurses and other healthcare professionals in decision-making processes in matters relating to the healthcare provision as whole.

Our intention is to makeour voices heard and put forward a consensus proposal resulting from discussions within our organization.

Concerning

1.    The right to healthcare

It is indispensible to ensure that every Cameroonian citizen has access to healthcare according to the law on healthcare access No 96/03 of January 4th 1996. Immediate and effective healthcaremust be made available to all those in need without prior payment for services in the case of life threatening emergencies. The implementation of universal access to healthcare will have to progressive and adapted to the local context.  

2.    Healthcare financing

Health has no price but there is an associated cost to the provision of quality healthcare services, as we all know. The current budgetary allocation by the state for healthcare stands at 9% a figure, which falls below the 15% allocation recommended by the African union. Increasing financing for healthcare is in itself a way of investing in the human capital of our country, an essential prerequisite for the emergence of Cameroon. We propose the adoption and implementation of innovative strategies based on new technologies such as mobile phones to facilitate payments and secure the financing of healthcare. For example the possibility of creating a billing system linking the bills of a particular patient to their mobile phone number for ease of paymentsor to enable long distance payments by a third party of behalf of a patient. We join our voices to the call for increased investment and promotion of localpharmaceutical companies with the ability to locally produce essential medications and healthcare consumables.  

3.    The quality of healthcare provided to patients  

It is indispensible to ensure that all healthcare facilities in the healthcare pyramid are capable of providing a minimum package of care in all circumstances. For this to happen it is vital to:

·         Create a platform for coordinating the management of a referral and counter referral system between different tiers of healthcare facilities. This will prevent gaps in care, which are the main source of negative outcomes from occurring.  

·         Strive to strengthen the notion of quality of care as measured by universally accepted indicators.  

·         Ensure the comfort and security of patients in healthcare facilities.  

·         To institute and implement a unique identifier coding system for patient medical records to facilitate patient follow-up in all healthcare facilities within the healthcare system.  

·         To institute and implement an appointment based system for non-emergency consultations with the aim of reducing waiting times and to prevent overworking health service providers.  

·         Adopt a mandatory 30-60 minutes time limit for patient consultations and completion of the medical note.  

4.    Medical training  

In view of improving the quality of medical practice and upholding ethical standard in healthcare provision we propose the following:

·         Providing continued medical education at all levels of medical training and practice in matters relating to ethical practice of medicine, the code of conduct required of health professionals, as well as communication skills to interact with patients and other healthcare professionals.

·         Strengthening the institutions charged with medical training by scaling up the number of trained lecturers, improving their financial remuneration and providing more funding f or research.

·         Establishing a clear path for the career development of medical doctors as well as mandatory continued medical education of licensed healthcare providers. As well as points based system for periodic relicensing procedures implemented and supervised by the national order of medical doctors.

·         In order for the afore mentioned measures to be made possible, health providers will need to have access to the necessary resources such as online continued medical education courses, post-graduate medical training, involvement in healthcare research activities at the district, regional and national levels as well as participation at national and international conferences.

5.    Human resources in Healthcare

We strongly advocate for:

·         The coherent and equitable distribution of human resources in healthcare in proportion to the specific needs of the population with frequent, intermittent rotations of health personnel postings to avoid redundancy and stagnation.

·         The rights of specialist physicians to have private consultations in public facilities under well-defined conditions in so far as this does not disrupt the provision and access to the care provided to the general public.

·         The maintenance of healthy competition in the recruitment process of healthcare providers in the public sector by publicly advertising open positions and recruiting through an open competitive process.

·         Clearly defined employment contracts renewable on the basis of evaluation and performance on the job.

·         The creation of an independent department of human resources under the guardianship of the ministry of public health and fully dedicated to managing the deploymentand training of healthcare providers.

·         Speeding up the process of decentralization for processes relating to advancements within the civilservice andcareer development.

6.    Professional communication and information in healthcare ·        

It is vital to promote a culture of communication between healthcare providers and their patients.

·         It is essential to develop standardized tools for communication and information exchange of healthcare information within and between all public health facilities in Cameroon.

·         To this effect new technologies can and should be exploited to implement an independent and anonymous system for continuous quality control giving the patient population a way to provide feedback on the services they receive.

7.    Working conditions

Our vision for physicians and other healthcare providers within the public sector is:

·         A simplified and less expensive process for integration into the civil service.

·         A shorter waiting period between integration and assumption of duties at the designated work post and receiving a monthly salary. ·         An advanced payment of allowances during the period of integration to facilitate deployment to assigned workstations.

·         The guarantee of safety and decent facilities for accommodation especially for remote and dangerous posting stations.

·         The harmonization of the status of healthcare professionals of same grade regardless of their path of employment into the civil service (civil servants vs. HPIC recruits vs. contract workers etc.)

·         Raising the age of retirement for healthcare professionals from 55 to 60 years in order to help fill the personnel deficit facing the health sector and alsothe higher education sector where there is insufficient expertise to train healthcare professionals in newly opened medical schools.            

Our vision for all healthcare providers as a whole is:

·         The promotion of telemedicine and the creation of tools to ease communication between healthcare providers.

·         The encouragement and support of research and innovation in all healthcare sectors

·         The provision of incentive measures  (material, financial and structural) to encourage and use the medical expertise potential of the Cameroonian diaspora to strengthen the provision of healthcare services and training.  

8.    Remuneration of healthcare professionals

We want a re-evaluation of the salaries and allowances of healthcare workers in both the public and private sector commensurate to their competencies, the cost of living, the duration of training as well as the inherent risks associated with the profession.

  For doctors, nurses and paramedical healthcare workers in the private sector we envision:

·         A reevaluation of the salary scale for healthcare workers.

·         The harmonization and strict implementation of the above mentioned reevaluation following consensus guidelines adopted across the board in all private healthcare institutions. For doctors, nurses and paramedical personnel in the public sector, we envision:

·         Accommodation allowances proportionate to the basic salary.

·         Allowances for overtime work.

·         Technical allowances            

We also envision for physicians who are civil servants:

·         A regulated and harmonized system for calculating hospital based allowances in a manner proportionate to the revenue generated by hospitals of the same tier.

·         An adjustment in the pay scale for specialist physicians following t he reclassification post- specialization.

·         The institution of regulated private consultation in public hospitals outside normal working hours following a set or clearly predefined rules and to the tuneof no more than two half days per week for specialist physicians and one half day per week for generalists.

·         The institution of special allowances including:

-          A risk allowance

-          A transportation allowance

-          An allowance for overtime night duty, weekend calls and public holidays

-          A wardrobe allowance for work apparel

-          An allowance for work associated with high risk procedures

-          A distance-based accommodation allowance as incentive for remote postings and postings in dangerous stations.

9.    Hospital Administration and management

We hope for:

·         The establishment of an internal board within healthcare institutions with a role of appointing administrators from a selection of appropriately trained and qualified candidates.

·         The management of health district by public health specialists

·         The promotion of good medical and nursing practices in emergency services.

·         The establishment of an ethics committee in every healthcare institution.

·         The relicensing of healthcare professionals following continued medical education, by an independent body accredited by the national order of medical doctors.

·         The appointment of hospital management staff by a board of peers.

·         The management of hospitals by physicians with specific training in hospital management and administration by trained hospital administrators.         

Concretely we propose

·         The promotion of an evidence-based approach to the practice of medicine based on the results from clinical research, which should be supported by an annual budget.

·         That a portion of the hospital’s revenue be reserved for technical improvements and training in order to improve on output and performance.

·         The adoption of a multidisciplinary approach to medical care at all levels.

·         Ensuring a multidisciplinary and collegiate approach to medical care at all levels of the health pyramid byteams comprising at least 2 persons per care center (ideally four people, with one person for each large group of pathologies).

·         That postings of newly trained physicians to peripheral healthcare centers be preceded by a 6-12 month period of supervised work in a regional healthcare center.

10. Security at the workplace for doctors and healthcare workers   

We recommend:

·         The installation and maintenance of infrastructure and equipment in both private and public healthcare centers.

·         The installation and maintenance of appropriate workplace facilities: flowing water, electricity, toilets and changing rooms.

·         The institution of preventative measures and standardized procedures for managing work accidents related to biological exposures within the hospital setting:

-          Locally produced alcohol-based hand sanitizers made available to all health workers.

-          Free and mandatory vaccination of all hospital based healthcare personnel against recognized high-risk pathogens – Hepatitis B, poliomyelitis,and diphtheria, Tuberculosis as well as pneumococcal and meningococcal vaccines in specific high prevalence areas. These vaccinations should be extended to medical students and interns rotating through healthcare centers.

·         Upgrading the technical plateau of healthcare institutions to a standard acceptable for their level in the health pyramid.

·         The establishment of a health policy in the workplace for regular monitoring of practitioners in order to evaluate and define the impact of working conditions on their physical and mental health.  

We are deeply committed:

·         To the principle of equal healthcare standards for all andmutual social security at the national level.

·         To a relationship of trust among healthcare workers and between healthcare personnel and their patients, as required by therecommended standard of care.

·         To a duty of care to treat all patients under decent conditions.  

We

·         Praise the current government initiative to push forward healthcare reform and we appreciate its outreachto groups of physicians.

·         As physicians from Cameroon, proclaim our determination to work with within the law in order to contribute to the improvement of the healthcare system in Cameroon.      

 22th april 2016

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