Article
Bamenda Ecclesiastical Province Health Assistance (BEPHA) – basic health care through a mutual health organisation in rural Cameroon
Bamenda Ecclesiastical Province Health Assistance (BEPHA) – Basisgesundheitsversorgung durch eine Gemeindebasierte Krankenversicherung im ländlichen Kamerun
Search Medline for
Authors
-
M.H. Schulze
- Missionsärztliche Klinik gGmbH, Tropenmedizin, Würzburg, Germany
-
S. Bosse
- University of Applied Sciences Cologne, Faculty of Process Engineering, Energy and Mechanical Systems, Cologne, Germany
| Published: | June 2, 2010 |
|---|
Outline
Text
A mutual health organisation is considered as an appropriate means to provide basic health care to people in need in developing countries. It is a community health insurance which offers financial protection against the cost of unexpected illness. Self-sustainability of such schemes is an intended and necessary long term objective. Therefore it is essential to assess continuously the costs and performance of such schemes.
We present a first assessment of the costs and performance of BEPHA Mamfe, a voluntary, non-profit community health insurance scheme in rural Anglophone Cameroon during a 12 months period in the years 2008 and 2009.
According to the actual costs the original premiums were recalculated. We further compared the range of provided services with that of the initial benefit package. A special focus was given to the treatment protocols of the beneficiaries as treatment costs account for the major part of the expenses of the scheme.
A cost analysis of 1,467 treatment protocols from 4 health facilities working with BEPHA Mamfe was carried out in a retrospective study.
About 49% of all medical costs incurred for drugs. Therefore a more detailed investigation of the drug use was done. 357 prescriptions from the different health institutions were analysed and drug use indicators were applied. On average 3.8 drugs were prescribed per encounter, 29% of all patients received injections, 57% of all patients were given antimicrobial drugs. These results exceed WHO recommendations by far.
Since treatment costs for malaria are an important part of the expenses, the use of malaria testing and the prescription pattern for antimalarial drugs were analysed. The results show considerable differences between the health institutions.
Conclusion: The cost analysis shows that the scheme is unlikely to be sustainable with the actual benefit package and constant low premiums.
BEPHA Mamfe spends considerable money for treatments which were specifically excluded from the initial benefit package like ophthalmologic or dentistry treatment.
An adjustment of premiums or of the design of the benefit package will be essential for the future viability of BEPHA Mamfe.
There is urgent need for continuous supervision by external experts who could give advice on the management of the scheme and who could analyse the prescriptions. Continuous qualification and education of the medical personnel will ensure appropriate prescription and avoid the waste of money.
