The demand for outpatient care in a health district in the North West Province of Cameroon : an empirical investigation into the potential effects of introducing community financing in public health centres.

The aim of this study is to examine the potential impact of community financing on the utilization and accessibility of health care providers in general and the government health centres in particular. A household interview survey, Focus group discussions, in depth interviews and document reviews were undertaken in one health district in the North West Province of Cameroon. 1147 households with 6656 members were visited and their heads interviewed. Of 1093 households with 3441 adult members analyzed, only 603 indicated that they had an adult sick with in two weeks preceding the date of the household interview survey (HIS).The results indicate that people who seek health care from any of the health care providers in the district spend a substantial proportion of their incomes on treatment, even in government health units where treatment is supposed to be free. Like other studies, this one found that people in the poorest quartile spend a higher proportion of their income on treatment compared to those in the highest quartile. Transport and time costs are also higher for those in the lowest quartile compared to those in the highest quartile. Using a computer programme - A L O G IT - the demand for health care in the district if community financing were to be introduced was modelled. Community financing as used in this study refers the situation where there is mobilization and management of resources by the community to support, in part or in full, basic preventive and curative health services for its members. From the data, the introduction of community financing in government health c entre s would result in people shifting away from them towards private health care providers probably because they value highly the quality of care given by private providers. However if community financing is introduced in government health centres and combined with an improvement of the accessibility of health care services (such as by the creation and /or reactivation of village health posts leading to a reduction in travel time and distance), utilization of public health centres would still decline , though not as acutely as if community financing were introduced alone. Though the demand for health care in the district is estimated to be price inelastic, there are people in the community who need to borrow money or pawn their belongings to be able to pay for health care or are sim ply barred access to health care providers.