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Pertinence de l'approche projet adoptée par l'Initiative PPTE au Cameroun: Cas de la promotion des mutuelles de santé ou micro assurances santé

Institut de Formation pour le Développement (IFD) Yaoundé rue CEPER - Expert en Planification et Gestion de Projets 2007

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This study aimed at presenting the relevance of project approach adopted by the HIPC initiative. In the mean time, it will be matter more over to show the problematic related to the funding of health care. This problematic seems to have found a durable solution through health mutual insurance companies. For our research, data collection was used thanks to interview guides. Furthermore, analysis of the content and statistic further help us to interpret data. The conceptual frame of the study was constructed following two explanatory variables (diagram annex 6). On the theoretical point of view, our study required the use of two grids of analysis: Systemic analysis and critical analysis. For indebtedness of sub-Saharan African countries many solution have been applied, among others the rescheduling, structural adjustments (SAP). Unfortunately, they all tend out to be a failure. At the dawn of the year 2000, these countries are in state of unsustainable indebtedness and an extreme poverty. HIPC initiative put in plan in 1996 proposes innovating solutions. It is matter here to finance Africans economies thanks to resources gotten from debt burden reduction. These resources are anyway called upon to be used in development projects well identified and well planned. It is the consecration of project approach which obliges a rigorous preparation of tools that constitute it and brings quality in it expenditures.

In Cameroon, the CCS/HIPC is the organ in charge of the orientation and control of this approach. Projects from sectorial ministries and the civil society are presented to this organ for eligibility to HIPC funds. Unfortunately the appropriation of project approach by actors is incomplete. On about 40 projects analyzed by this organ, only 30% has successfully elaborated a feasibility study and has written a report of activities meanwhile, 85% has written a fore project of execution. The problem of access to quality health care was identified, analyzed by the Ministry of Public health and the solution envisage is the promotion of mutual systems. It is therefore for this reason that, the project PROMUSAP was put in place. HIPC-initiative brings support as a matter of fact to the development of Cameroonian financing system by facilitating the creation of non banking system of internal saving collection.

As from 2003 we are therefore faced to a rapid development of pilot mutual health in Cameroon. Health's mutual are fast growing and in 2008 they were already up to 90 created all over the country. Other organisms equally bring support in the putting in place of these mutual organs in the example of Belgian and German Cooperation (GTZ). By the way, the diffusion of this concept in a greater scale needs an evaluation of action taken so far.

We have as a matter of fact evaluated 8 of such mutual health organs financed on HIPCs' funds. Out come of these evaluations show some weaknesses on the technical and financial plan. There is a weak rate of adherence and a real lack of dynamism of populations. To perceive the specificity of mutual health organs, evaluation tools adapted to the context have to be elaborated. Diverse research tracks can permit to construct relevant monitoring and evaluation indicators. Our principal recommendations go to the building capacities of actors on project approach, improvement of procedures of fund allocation, the search of relevant indicators for monitoring and evaluation, the elaboration of impact study on mutual health organs on populations, the quality of care and governance in health units.

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