Human Rights Watch urges Cameroon to publish information on COVID-19 revenues and disbursements

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Cameroon’s government should immediately publish information on the revenues, disbursements, and management of its Health Solidarity Fund, Human Rights Watch said on Friday.

Healthcare facilities have made mandatory contributions to the emergency fund for over 25 years and HRW said the government should disburse funds to support healthcare facilities responding to the Covid-19 pandemic, if it has not already done so, and investigate any missing funds.

“Cameroon is the Central African country with the highest number of confirmed Covid-19 cases, yet the government appears not to have disbursed funds from a reserve that healthcare facilities have been paying into exactly for emergencies like this one,” said Lewis Mudge, Central Africa director at Human Rights Watch. “The health minister should immediately make the Health Solidarity Fund available to healthcare facilities in dire need of support, publish information about its transactions, and investigate any irregularities.”

Cameroonian law has required public primary care facilities to pay 10 percent of their monthly revenues to the Health Solidarity Fund since 1993. Hospitals are officially exempt, but medical staff told Human Rights Watch that they also pay into the fund. The fund should fall under the responsibility of the health ministry and was established to provide surge support during health emergencies. However, to the best of Human Rights Watch’s knowledge, after unsuccessfully seeking such information from the government, no information about the rules governing the fund or its activity has been published, making it vulnerable to corruption and misuse.

Human Rights Watch interviewed eight medical staff, including six doctors and two nurses, three lawyers, and several representatives from local nongovernmental organisations across Cameroon between April 6 and May 24, 2020. They all said they have no information regarding disbursements from the Health Solidarity Fund. Medical staff said that they believe that the government has never disbursed any money from it, including in response to Covid-19, and yet healthcare facilities continue to contribute 10 percent of their revenues. Human Rights Watch also wrote on May 11 to the health minister, inquiring about the rules governing the fund and its activities, but has received no response.

Cameroon had 8,681 confirmed cases of Covid-19 and 208 deaths as of June 9, the majority in the cities of Yaoundé and Douala. The actual number of cases is most likely higher because testing is limited. In late March, the government asked citizens to contribute to the Special Fund of National Solidarity, which it established to provide additional support to efforts to curb the spread of Covid-19 and treat the sick. It also received US$226 million in emergency funding from the International Monetary Fund (IMF).

Healthcare facilities lack adequate resources to respond to the Covid-19 pandemic. Healthcare workers interviewed reported shortages in basic hospital goods, including thermometers, disinfectants, and medicines, as well as ventilators and oxygen, and protective gear for doctors and nurses, such as masks, gloves, and glasses. Despite these shortages, the government has not provided any information about the revenues, balance, or disbursements of the Health Solidarity Fund, nor has it clarified any rules governing its use. The apparent lack of disbursement to support the health and economic crisis raises serious concerns that the money has been misused or lost to corruption.

As the World Health Organization has declared Covid-19 a pandemic, the health and economic crisis it has caused is sufficiently serious to trigger disbursements from the Health Solidarity Fund. A 2018 World Bank report sounded an alarm regarding the lack of rules or information on the fund, noting “it is not clear what the Solidarity Fund is used for” and “there is still no legislation about its use.” The report also raised concerns that transfers to the fund “are a key source of revenue-side inefficiency,” especially since primary care facilities are allotted a disproportionately small share of the health budget.

Healthcare workers echoed these concerns. A doctor based in the capital, Yaoundé, said:

There has always been lack of information about this fund. What is certain is that health facilities keep paying and if they don’t, they are sent reminder letters from the Ministry of Health. The use of the fund is not transparent. How much money is in there? Has it ever been used? There are all the ingredients for a slush fund.  

The lack of transparency is especially problematic because the fund’s revenues largely come from patient fees that drive up the cost of health care. As of 2018, 70 percent of the total health expenditure for the country was borne by households. Cameroonian households’ contributions to healthcare costs are the third highest in Sub-Saharan Africa, where the average is 34 percent.

Studies have shown that about 64 percent of households in Cameroon do not seek health care because they perceive the cost to be high. This poses unique dangers in the context of the ongoing pandemic because while the government has made testing free, people still need to pay for everything associated with treatment, which can be expensive. These costs could act as a disincentive to seeking care and lead to further poverty and an inability to access health services. While there are some insurance providers in the country, many are bankrupt and cannot pay the health facilities for the services offered to their members.

The government has retaliated against political opposition efforts to address shortcomings in official responses to Covid-19. On May 11, police arrested six volunteers from the Survival Initiative, a fundraising initiative by the opposition leader Maurice Kamto to respond to the health emergency, while they were handing out protective masks and sanitizing gel in Yaoundé. They were charged with rebellion, then released on May 15. But on May 23, security forces arrested three other volunteers from the group in Sangmelina, a city in the South Province. They were released on May 29.

Through the minister of territorial administration, the government has blocked fundraising initiatives sponsored by the opposition, as well as donations of protective masks and Covid-19 tests. The government refused to accept donated equipment from Survival Initiative, sparking criticism, particularly from health professionals, who complained about the lack of material to protect themselves and treat affected patients.

Corruption is prohibited under section 134 of the Cameroonian Penal Code, yet the country has a long, well-documented, and consistent problem with corruption. In recent years, the government has established ad hoc institutions to fight corruption, including the National Anti-Corruption Commission, the office of Supreme State Audit, and a Special Criminal Court. However, analysts, critics, and nongovernmental organizations have questioned whether these bodies have been effective and raised concerns that the government may be using anti-corruption bodies to crack down on political dissent.

“The government of Cameroon should urgently clarify whether money from the fund has been lost to corruption or misuse and establish clear rules and transparency requirements to prevent it from happening in the future” Mudge said. “For nearly 30 years Cameroonians paid dearly for the fund, and they should be able to rely on it to help them through this global pandemic.”

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