CAN THE DIASPORA INFLUENCE HEALTHCARE IN CAMEROON

CamDocUK

“CAN THE DIASPORA INFLUENCE HEALTHCARE IN CAMEROON?”

(IMPROVING  HEALTHCARE IN CAMEROON:  proposal for a total quality management overhaul towards effective and sustainable healthcare provision in Cameroon.)

 

A PROJECT STATUS REPORT FOR CAMDOCUK MEETING OF COVENTRY, 6 OCTOBER 2012

By the Project Team:

Dr Asa’ah Nkohkwo (aka Fuaseh Fontem), FRSPH, PRINCE2 Practitioner, Project Lead

Dr Eric Njiforfut, Ms Samira Edi-Mesumbe, Dr Shiyghan Navti, Dr Leonard Ebah

 

PROJECT BACKGROUND:  systemic failures and non-responsive provision, leading to anecdotes of appalling delivery  of healthcare in Cameroon for several decades to-date; strong calls from home and abroad for sweeping changes to endow the healthcare system with effectiveness and quality assurance; the outcome of the CamDocUK debate (AGM, 21 July 2012, Manchester, UK),  mandating a project team to appraise the situation and propose a sustainable solution for CamDocUK to take forward with Government and appropriate stakeholders.

PROJECT PRODUCT: to deliver by October 2012, a radical, yet realistic, phased implementation proposal to serve for a discussion document, which can be used by CamDocUK to engage Cameroon Government and stakeholders, including potential development partners (funders), to  improve healthcare delivery in Cameroon.

PROJECT INITIATION DOCUMENT: this outline plus other documents. (ref Project Folder)

ROLE/ COMPOSITION	RESPONSIBILITY	OUTPUT/ PRODUCT
BOARD: CamDocUK BoT, represented by: Chairman- Prof Justin Konje Secretary- Dr Osric Navti Treasurer- Dr Florence Fankam	RESPONSIBILITY for  CamDocUK  as per Articles	CONSTITUTIONAL OBJECTS as per  Articles and AGM; MANDATE to PROJECT TEAM
PROJECT TEAM: – Dr Asa’ah Nkohkwo (Chair/ Manager); – Dr Eric Njiforfut (CamDocUK); – Ms Samira Edi-Mesumbe; – Dr Shiyghan Navti; – Dr Leonard Ebah (CamDocUK);   Others including  (as nominated at AGM)	Together responsible for   BoT Mandate as delegated on 21 July 2012 for   Delivering Project Product –          Strategic proposal addressing: –          Systems overhaul –          Way forward proposals	PROJECT INITIATION DOCUMENTATION,  (PID),  then wef 30 July 2012…   Fortnightly Measures evidencing tangibles:   –          Tasks updates –          Strategic proposal addressing: –          Systems overhaul –          Patient focus –          Provider focus –          Sustainability: commissioning perspectives –          regulatory  perspectives –          Strategic Alliance update
STAGE CONTROLS:   BoT & Project Team	Examine project stage progress (sign-off by BoT)  & agreeing next stage plan with TOLERANCE setting, everysecond week wef 30 July 2012	Stage Products as per  PID, ie fortnightly tangibles
PROJECT CLOSURE:   BoT & Project Team	Review project progress against original targets & tolerances (sign-off by BoT)	October 2012: –          Wider consultation ready proposal

 

STATUS  AS  AT END SEPTEMBER 2012.

Based on the above, we can report as follows:

A) the Project Definitions (interpretation of Remit/ Scope / Approach etc) as we understood it  was captured, essentially, as per the appended email.

1. B) following from the above the project approach was summarised as follow:Discussions were envisaged would happen more efficiently if we compartmentalised these into a number of focal strands, dedicated moderated forums. Hence we now have

   B-1-ACCESS TO HEALTHCARE: teasing out issues to do with how people access services, including such issues as structure & infrastructure; state commissioning; private services; affordability, insurance  etc

   B-2- RANGE & QUALITY OF HEALTHCARE: providers, delivery professionals; service users; range of services, organisation / administration of care, chunking up the healthcare system around the human body systems,  public health,  regulatory & other avenues to  quality assurance & control.

   B-3- VALUE FOR MONEY: to state commissioning; to service customers, ie COST-BENEFIT or Health Economics AWARENESS  (forum moderator yet to be agreed)

   B-4- APPLICATION OF TECHNOLOGY: using / adapting these to serve identified needs.

   – new strands could emerge as we progress

   We had envisaged that discussions would generate weekly summaries from each strand. As things progress, we look forward to being able to synthesize the emerging key messages around the following 3 summary themes to inform policy recommendations. These policy recommendations should then serve as the eventual engagement window between CamDocUK & ONMC. This leading onto the partnership (CamDocUK/ ONMC) converging  ideas towards a common ground that could then be used to engage Cameroon Govt towards improving the presentlly abysmal public health situation in Cameroon. ONMC= Ordre National des Medecins du Cameroon (Cameroon Medical Council).

The three themes we hope would be:

1.     Proper Training of professionals (doctors, nurses etc);

2. Proper regulation of the Medical profession; and
3. Proper delivery of medical services to the masses.

Suffice to also say that  with the right product developed we could actually secure development funding (from eg the Wellcome Trust, The Commonwealth Fellowship, the Common Ground Initiative of the CR, the DFID etc) which will then facilitate the next steps in partnership with the ONMC and Cameroon Govt.

1. C) PROGRESS/ CHALLENGES
   As stated above the project definitions had progressed well.  However, we have struggled to engage minds from within and outside CamDocUK. In essence, we have not had much luck with recruiting volunteers to join the debate, despite a number of anecdotal blunders of the medical system in Cameroon provoking outrage- albeit shortlived.  We are well aware that a handful of people cannot formulate an outline document  that would be judged robust enough for CamDocUK to risk its reputation to engage the ONMC and Cameroon Government.We were hoping that we would develop a reasonable draft document, which draft would then be subject to significant/ wider consultation, eventually serving us to deliver an acceptable Project Product.

   However, even such a draft needs to arise from a cohesive effort of CamDocUK. So, we are urging that somehow CamDocUK members be encouraged to join the debating forums as structured already to simplify the project. Moderators are ready, except that they need us (CamDocUK members) to join in as pledged in Manchester last July. As discussions flow, we the project team will be capturing the key messages through the system we have put in place.

   D) we (the project team) have actively efforted in hope to recruit as many people as possible, including from outside CamDocUK. So far only CamDoc Germany have shown meaningful interest, indeed even more so than CamDocUK !

We  now look forward to your appraisal of our progress as presented above and against our Project Plan (PID) as shown above. Above all we need the wider CamDocUK membership to engage with this project if we intend to come out with a project product meaningful enough to enable our leadership then on engage with the Cameroon side, in the Spring of 2013.

Therefore, we call that people interested sign-in as agreed yesterday in Coventry and so actually stating their preferred strand (B1- B4) to facilitate their induction into the development. Simply state your willingness and  the preferred strand of discussion and we will capture-process your integration.

On an endnote of observation, Coventry was another  productive and enjoyable  periodic CamDocUK renewal day. Thank-you to the hosts, the execs and all at CamDocUK. I hope that everyone travelled back home safely. With best wishes,

Fuaseh’
Project lead 04/10/2012

 

 

 

APPENDIX

 

1) WHAT?

A key item on the agenda at the said AGM raised the perennial issue of how we in the Diaspora can contribute to addressing the burning issue of improving the health of the population in Cameroon (as timely exemplified by the case study appended here, volunteered by Dr Aloysius Mbako).

We (Dr Leonard Ebah, Ms Samira Edi-Mesumbe, Dr Eric Njiforfut, Dr Shiyghan Navti and myself) were mandated to drive CamDocUK’s response, mindful of the issues that came up at the debate.  So far, here is where we are:

2) WRT SCOPE & GOAL DEFINITIONS: what is or not included in our task.

The  source / reference question was

“CAN THE DIASPORA INFLUENCE HEALTHCARE IN CAMEROON?”

The AGM debate summed up that we undertake to develop by co-design a robust yet outline proposal to address the generic elements of a national state-led healthcare system that is fit for purpose: the responsive healthcare of the population in Cameroon.  We intend to present our findings at the next CamDocUK meeting of October 2012 in Coventry.

The following issues/ question strands emerged

– ACCESS TO HEALTHCARE: structure & infrastructure; state commissioning; private services; affordability

– RANGE & QUALITY OF HEALTHCARE: providers; users;  regulatory & other avenues to  quality assurance & control.

– VALUE FOR MONEY: to state commissioning; to service customers, ie COST-BENEFIT or Health Economics AWARENESS

Narrowing down to what have equally been summed up elsewhere (TMG/NSTechnoMed) as

1.     Proper Training of professionals (doctors, nurses etc);

2. Proper regulation of the Medical profession; and
3. Proper delivery of medical services to the masses.

3) REQUESTED

– WHAT IDEAS ARE WE SUGGESTING FROM OUR EXPERTISE/ EXPRIENCE OUT HERE NORTH OF THE GLOBE as SUSTAINABLE REMEDY, WHICH CAMDOC CAMEROON  (ONMC) SHOULD CONSIDER FOR ENGAGING WITH GOVERNMENT TOWARDS CHANGE.

– WHAT ARE THE PRIORITIES? IN OTHERWORDS HOW CAN WE PHASE THE INTRODUCTION OF OUR IDEAS, WERE THEY ACCEPTABLE TO CAMDOC-CAMEROON & CAMEROON GOVERNMENT?

4) FRAME OF ORDER: PROJECT GUIDANCE: UK-OGC PRINCE2 format (file “CamDocUK NHS Cameroon” attached), in particular note following project product/deliverables

–          Tasks updates

–          Strategic proposal addressing:

–          Systems overhaul

–          Patient focus

–          Provider focus

–          Sustainability: commissioning perspectives

–          regulatory  perspectives

Strategic Alliance update
—

5) WHO ELSE?

It is proposed that we should invite others judged resourceful to significantly enrich the initiative at this critical embryonic stage. The expectation is that by so doing the likelihood would be greater that the outcome of our project (given the time constraint) would still be acceptably responsive to the needs of the target population. Hence, while proposing nominees, I am already taking the liberty (again for want of time) to copy each one  (by bcc) with this circulation the following:

(upon responding to this email everyone of these proposed project team associates will receive subsequent individual instructions from Dr Shiyghan Navti as to how to make their contribution to the discussions more productive)

– the wider CamDocUK

– from The Millennium Group UK:

– from Cameroon:
– from the Cameroon Professionals Society / CPS USA:
– others:

Any other nominees, ie those who we believe will add value to the discussions

6) WHAT NEXT?

So far Dr Shiyghan Navti has created a platform of a number of dedicated forums. For efficiency these forums will compartmentalise the discussions into dedicated question strands as outlined above. We are looking to (with your permission) accept those associates who will reply to this email. We will then insert them into respective forums of the platform. We will also assign sub-moderators to each forum. These moderators will have cross-forum access to also ensure/police against scope creep and scope mix.  We are expecting that ALL mandated project team members will take on sub-moderator roles.

On a note of tasks, sub-moderators are expected to distill the debate in their respective forum into periodic (weekly) summary, the collation of which would have generated a running picture of the discussions under the project mandate umbrella.  Other tasks will naturally emerge as the discussions develop.

———–
Da: Aloysius mbako <maloysius2002@yahoo.co.uk>
Oggetto: [CamDocUk] Fw: mbamba woman’s X-ray [4 Attachments] A: “CamDocUk@yahoogroups.com” <CamDocUk@yahoogroups.com>, “Aloysius Mbako” <maloy17266@aol.com>, “Guy Sandjon” <sandjonguy@yahoo.fr>
Data: Lunedì 30 luglio 2012, 01:51

Case Report From Cameroon.

Patient female about 78 years old. C/o severe pain R. hip. Significant co-morbidities.
Clinical examination and X-rays confirm per-trochanteric fracture of the R. proximal femur. Initial decision to treat non-operatively because pain is tolerable and taking into consideration co-morbidities. Patient allowed to mobilise touch-weight bearing as pain allows. However a month down the line, worse pain and difficulty on walking. Seen by consultant orthopedic surgeon. Plan to operate.
Operation carried out with some significant blood loss necessitating transfusion of three units of blood.
Patient on bed rest for over 6 days and then allowed to mobilise. C/o of significant leg shortening and pain. Not seen by operating surgeon since operation for two weeks and no check X-rays requested.
Family request for further X-rays.(see above). Implant completely out of the femoral canal and into the soft tissues close to imporatant neuro-vascular structures. Peri-prosthetic fracture seen with a poorly placed cerclage wire, which indicates fracture uncured during surgery. Operating surgeon has not spoken to patient or family since procedure, neither reporting per-operative complication nor findings of a dangerously positioned implant. I want to draw your attention to the fact that this operation cost 1 million francs CFA.
I’d like to get your comments. Negligence? Incompetence? What?
Mola Mbako