Cameroon Background Information
| Geography | People |
| Status of National Policy | Other Activities |
| Training | Restrictions |
| IEC | AIDS |
| Description of Service Delivery | |
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GEOGRAPHY
The republic of Cameroon is bounded by Nigeria to the northwest, Chad to the northeast, the Central African Republic to the east, Congo to the southeast, and Gabon and Equatorial Guinea to the south; its Atlantic coastline stretches 340 miles/200km. along the Gulf of Guinea. The relief and physical features vary considerably. The south of the country consists of a large plateau, 1,500-2,200 ft./460-670 m. in height, of igneous and metamorphic rocks; this rises northwards to the vast Adamawa massif, which is 3,000-5,000 ft/900-1,500 m. in height. The Benue River basin and the tributaries of Lake Chad lie further north. The west of the country is dominated by a range of volcanic mountains, stretching northeast from Mount Cameroon, which is 13,000 ft/4,070 m. high. The Sanaga River runs through the center of the country, entering the Atlantic near Douala.
Cameroon’s spread over 11 degrees of latitude makes for great variety of climate and natural vegetation. The far north has a hot dry Sahelian climate and is characterized by Sudan savanna; moving south the vegetation grades into Guinea savanna, and the south is covered by dense equatorial rainforest. This north-south vegetation pattern is substantially modified by the relief and human activity.
PEOPLE
Cameroon has about 200 tribes and clans speaking at least that many African languages and major dialects. It is the only African nation where both French and English have official status. In 1961, the government established the University of Yaounde, the first African university to offer courses in both French and English. Branch campuses are in Ngaoundere, Dschang, Douala, and Buea.
Traditional African religious beliefs influence both Muslims (concentrated in the north) and Christians (concentrated in the south). Four-fifths of Cameroonians live in the formerly French east; 20,000 Europeans and 900 US citizens reside in Cameroon. The main seaport and largest city is Douala; the capital Yaounde, is second largest.
STATUS OF NATIONAL POLICY
Formerly a strong pro-natalist country, in 1992 Cameroon adopted both a National Population policy and a comprehensive family planning service delivery policy. The 1920 law against contraception had been repealed in August of 1980. Since independence in 1960, the government provided no official support for integrating FP services into the national health system. This began to change in 1989 when the MOH created the "Directorate of Family and Mental Health", adopted a family planning national policy, and started to promote child spacing as part of comprehensive MCH services. During 1991, the MOH expanded access to FP services by developing a FP services policy, designing in-service and pre-service training programs, and increasing the number of FP service delivery sites. It has established a new community financed and co-managed primary health care program to finance integrated health services.
DESCRIPTION OF SERVICE DELIVERY
According to the World Health Organization, as of November, 1985, Cameroon had 244 health clinics, 134 pharmacies, 873 physicians, 51 maternities and nearly 5000 nurses.
USAID, working with the MOH (Ministry of Health), private and NGO (church) facilities, has initiated and developed the integration of FP services in health facilities. The integrated approach through primary health care and cost recovery is developed to implement FP services in defined regions, rural as well as urban. The MOH has played an important role by defining a National Program and a strategy for reorientation of PHC. It also maintains a sort of follow up and informal collaboration among donors, PVOs and NGOs. The approach has been facilitated by developing decentralized mechanisms for program management and supervision at provincial, district and community levels. Such an approach has increased the access and utilization of FP services from 50 service sites in September 1991 to 217 in March 1994, and the CYP (Couple years protection) from 50,000 to 90,000 during the same period.
Currently, there is a functional FP service delivery system through both public and the private sectors with trained providers at the referral hospital and health center levels. A wide range of contraceptive methods including VSC as well as hormonal and barrier methods are available and an expansion of long-term methods (minilap and Norplant) is planned. Contraceptive logistics and distribution systems have been set up with low cost contraceptives, group education and individual counseling given in the service sites.
OTHER ACTIVITIES
Important progress has been made during the last two years in expanding access to FP information and services particularly in the following areas:
- adoption of a national population policy that supports integration of FP into primary health care services. The impact of the policy was to increase the donor and governement commitment to FP, MCH, and demographic data collection.
- the integration of FP into provincial PHC (Primary Health Care) programs with
- training programs
- integration of contraceptives into provincial based revolving-fund drug systems so that contraceptives are now available for distribution at every community co-financed and co-managed health center
- the tracking of key FP information in the monthly activities reports of these health centers
- the design of a supervision protocol for FP activities which can be used by district health managers during integrated supervision of health centers
- the agreement by the MOH to deliver FP services in all facilities (centers and hospitals) and not just in specialized MCH centers:
- expansion of FP IEC activities by designing training modules for IEC and counseling, and information campaigns through mass media and promotion of existing services and delivery sites
- the testing of Norplant for acceptability
Other donors interested and involved in the integrated FP program include:UNFPA, GTZ, UNICEF, France, IPPF through the CAMNAFAW (affiliate), EEC and World Bank. They are adopting the USAID model and are taking steps to integrate FP into their PHC programs.
TRAINING
A 1992 study of 67 service providers indicated that one-half of service providers had received training in family planning. This was a reflection of an increase in emphasis of the medical and nursing schools on the training of doctors, nurses and midwives in family planning. FP courses were first introduced into the medical, nursing and midwifery training in 1989. Prior to this, FP trainers and providers received training from international and national workshops. Training and updating of trainers’ and providers’ knowledge and skills in various aspects of FP services has gained tremendous momentum recently (1992). (See Literature Highlights: Cameroonian Nurses’ Perceptions of Family Planning: Implications for Nursing Practice).
RESTRICTIONS
Providers perceive the IUD and injectables as the most harmful methods. Cameroonians single out the IUD as the most harmful method. Most Cameroonian service providers have not been trained in IUD insertion which may influence perception of the IUD as harmful.
Although family planning was becoming important in the late 1980's, the government at the time did not feel that it was yet appropriate to start providing services all over the country. The approach was to first focus on IEC. If IEC generated demand, then thought could be given to the provision of services. In 1990, an IEC consensus-building seminar was organized, with JHU/PCS assistance. All IEC activities were based on the national stategy and the results of research carried out since 1990.
In 1991 a survey conducted in Cameroon highlighted negative images of contraceptive methods, users, service providers, and images of social disapproval of modern contraceptive methods. As a result, a multi-media campaign was designed and implemented in five urban towns: Yaounde, Duala, Bafoussam, Bamenda and Buea for a period of two years to address some of the image problems. The campaign included the training of service providers, the development and launching of a national family planning logo, and the production and dissemination of family planning IEC materials. As a result of the campaign, images of methods, users, provider and social approval improved.
June 30, 1994 marked the conclusion of the three-phase Cameroon Child Spacing Promotion Project, conducted by the Ministry of Health, Directorate of Family and Mental Health, Health Education Service with assistance from the Johns Hopkins University/Population Communication Services. This project was part of the National Family Health Project (USAID bilateral project). Under the bilateral, family planning services were integrated into the primary health care (PHC) delivery system. They were also expanded to the private sector through a social marketing program and family planning clinics operated by missionary and private commercial sectors. The Cameroon Child Spacing Promotion Project provided print, audio-visual and counseling materials to all public and private sector family planning service delivery activities under the bilateral, except the social marketing program. These materials complemented the service delivery and training components of the National Family Health Project.
(See Literature Highlights for a description of research results and qualitative information regarding IEC and knowledge and attitudes toward family planning. Also, see Country Profile Sheets for description of media resources.)
Epidemiological Situation of HIV/AIDS/STD
Cameroon’s first AIDS case was reported in 1986. As of December, 1994, the total number of AIDS cases reported was 5,375. Cameroon’s HIV/AIDS epidemic is defined as one of significant risk and low prevalence. Subtype O, a rare varient of HIV, has been detected in Cameroon, and 3% of the sexually active population is estimated to be HIV+; in some regions the prevalence has passed 7% (Bamenda). Ninety percent of HIV transmission is by heterosexual sex. Seventy-five percent of reported cases are found between 20-39 years of age. HIV seoprevalence in women age 15-24 years, (5 sites) range from 0.7% (Yaounde) to 8.5% (Bamenda). By the year 2005, government estimates 10,000-14,000 new AIDS cases.
National Response
National Programs: Cameroon’s second medium term plan (MTPII 1994-1998) prioritizes reduction of sexual transmission of HIV, and safe blood initiatives; target groups are CSW, military, students and pregnant women. Realistic decentralization and multisectoral coordination initiated with MTP II, along with new STD strategies.
In 1994, the government of Cameroon created a budget line within the MOH for AIDS prevention control supported by CFA 10 million.
*The WHO Global Program on AIDS, (http:gpawww.who.ch/ctryprof/cae.htm) Information current as of 27/11/1995
References: State Department Background Notes, Africa: Facts on File, REDSO Preliminary Reports
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