Institutions and Leakage of Public Funds in the Cameroonian Healthcare Delivery Chain

ABSTRACT This study attempts to examine the extent of leakage in the Cameroonian health sector and identify its sources. The analyses in the study are based on the Public Expenditure Tracking Survey data collected in Cameroon in 2004. The findings reveal that 18.8% of the actual budget allocations of decentralized health services in the Ministry of Public Health do not reach them. Health centers, which are the frontline healthcare providers, receive only 26.4% of their actual budgets contained in the recurrent expenditures of the decentralized health services. We investigate the institutional factors that correlate with the leakage rates and identified the factors that affect the likelihood of health centers receiving public funds. The study finds weak compact and voice institutional links in the Cameroonian health accountability system. The need to effectively control and monitor public funds, improve the information flow mechanism and improve the wage/allowance scale is highlighted. Finally, spending rules should be strictly respected and extra-budgetary spending restricted

Women’s dissatisfaction with inappropriate behavior by health care workers during childbirth care in France: A survey study

Background As part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey’s main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care. Methods We conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March–11 May, 2020). Results Of the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives’ form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals. Conclusions The pandemic has degraded the quality of pregnant women’s care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector