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N A D E VNkong Hill Top Association 4 Development

N A D E V

Nkong Hill Top Association 4 Development

Report of Workshop on Devolved Competences in the Health Domain in Buea

REPORT

Training Workshop on Devolved Competences and

Transferred Resources in the Health Sector for

Council Authorities and Staff in the Buea Council

27-28 May 2014

Organiser: Nkong Hill Top Association for Development (NADEV)

P.O. Box 340, Buea

Email: [email protected]

Web site: www.nadev.org

Sponsor: PADDL/GIZ

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gíz fÜrInternationaleZusammenarbeit (GIZ)GmbH

http://www.nadev.org/


Table of Content

Page

1. Introduction

- Word of welcome………………………………………………………………………3

- Workshop objective……………………………………………………………………3

- Workshop methodology……………………………………………………………….3

- Workshop participants………………………………………………………………..4

- Project Background……………………………………………………………………5

2. Module1: the Legal Framework of Decentralization in Cameroon……………………..6-7

3. Module2: Organization and functioning of the council ………………………………....8-9

4. Module3: committee systems in the council………………………………………………9

5. Module4: Understanding the Health Sector in Cameroon………………………………10-14

6. Module5: Powers Devolved To the Council In The Domain Of Health…………………15-16

7. Workshop Evaluation………………………………………………………………………..17-19

Annexes ……………………………………………………………………………………19-42

- Questions And Answers

- Committees System In Councils

- Powers Devolved To The Council In The Domain Of Health

- Understanding the Health Sector in Cameroon

- Public Health Sector Strategic Plan

-

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Opening and Introduction

Introduction

This workshop had as main objectives to:

Explain the functioning of the executive and deliberative organs of the council.

State the role of the council in the provision of quality health care for the public in the

Buea municipality;

The word of welcome

This workshop started with an opening remark from the Third and First Deputy Mayors of Buea

and Idenau councils respectively; who after welcoming participants at the workshop appreciated

the work NADEV has been carrying out with the councils, with assistance from GIZ/PADDL.

While promising effective collaboration from the council, the Deputy Mayor of Buea council

noted that the workshop will be of great value to the council, especially councilors; most of

whom are doing their first mandate in the council, to effectively carryout their roles. The 1st

Deputy Mayor for Idenau council equally promised council’s engagement to apply all that they

will learn during the workshop.

Methodology

The approach of the workshop was based on the principle of participation. This approach aims at

ensuring effective participation of all participants towards consensus building and appropriation

of workshop outputs/results by all participants. The approach was implemented through

brainstorming sessions, plenary sessions, focus group discussions, animation etc.

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Workshop Participants

The workshop was attended by 17 participants made up of the Mayor and two Deputies, the

Secretary General and Treasurer, Representatives of the Council Health Committee and the

Hygiene and Sanitation staff at the Council. (See attendance list in annex)

4


Project Background

During this session, the Coordinator of NADEV in his introductory note gave a brief background

of the project financed by PADDL, within which context the workshop was being organized.

While making reference to the 2010 Prime Ministerial Decree on the transfer of competences to

councils, he highlighted the fact that some competences were equally transferred in the domain

of health to councils, thus justifying the importance of this project, which aims at assisting

councils effectively manage the transferred competences in the health sector, for improved

service delivery.

The Coordinator equally underscored the fact that this project will help the councils to have

regular dialogues and collaboration with key stake holders in the sector, towards information

exchange and joint planning/reporting. This workshop is the third of a series of workshops held

by NADEV with the council, within the context of the project on, Enhancing Council

Participation in Health Service Delivery (ECOPaH).

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Workshop Content

1. The Legal Framework of Decentralization in Cameroon.

This session focused on improving on participants understanding of decentralization and the law

governing the process in Cameroon. This was done using brainstorming exercises and a Group

Work, which showed that about 60-70% of the participants were aware of the Law on

decentralization. The following is a restitution of participant’s Group Works on the definition of

decentralization:

Group One’s response.

- It is based on the 2004 law that decentralization was implemented which led to the creation of

Regional land boundaries, and the sharing of administrative power from Central Administration.

- The values applicable to councils.

- Councils were given the powers to look for their resources in order to generate income for the

development of the municipality and several other applications.

- The people within the municipality were given the power to elect their councilors and Mayors.

- We observed that the law of 1974 was good though the implementations were very slow. But

there are better developments now.

Group Two’s response

Educational sector

- Provision of benches and didactic materials to Government Schools

- Employment of P.T.A teachers to Government schools.

- Award of scholarships to the underprivileged and handicapped persons.

Health sector

- Employment of Nurses to Government Health Centers.

- Construction of Health Centers.

Social sector

- Taking care of the Elderly Persons, Orphans, and Widows

- Ensuring gender equality e.g via Women Empowerment Centers.

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- Provision of potable water and electricity.

- The creation of Craft Centers.

Group Three responses

- Autonomous power has been given to councils to construct schools, hospitals, markets and the

creation of job opportunities to the people.

- There have been laid down rules applicable to councils to have their autonomy in finance,

economic, social, health, sports, education and culture.

- Law No 2004/019 defining the financial system for the Regional and Local authorities.

- The method to elect councilors was elected that is via the use of a list system.

- The responsibilities of locally elected officials were increased.

Following the Group presentations, the Facilitator summarized participant’s ideas by defining

decentralization as the devolution of powers by the State to Regional and Local authorities. He

added that politically, decentralization is the sharing of powers between Central Authorities and

Local Authorities and also administrative technique that enables a human community or a service

to administer it, by providing it with resources and autonomous power, under the supervisory

authority of the State. He further presented the most recent law on decentralization in Cameroon

and the innovations ushered in by these new laws.

He then explained the reasons for Decentralization by the Central Administration, the function and

operation of decentralization, the extent of the transfer of powers to councils, the levels of

decentralization etc. While referring to and analyzing several laws, the Facilitator equally provided

explanations on the organization of council sessions (when it should be held, who convenes it,

who takes down minutes, frequency of sessions, effects of deliberations etc.) and the relationship

between the council and the representative of the state, that is, the Senior Divisional Officer.

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2. ORGANISATIONAL FUNCTIONING OF THE COUNCIL

Based on this section, under the organigram of the council operation, there are specific duties

and roles which all council staff has to effectively perform for the smooth running of the

municipality. By this, the Law has provided certain rules and regulations which entails: the

powers of councilors within and out of council sessions, their responsibilities as councilors, the

limitations to what councilors can do, the extent of their authority, the conditions for dismissal of

a councilor and their positions within the council and the municipality at large.

In another explicit section, the fundamental inevitable role and duties of the Mayor and

Deputy Mayors was elaborated. Aspects like the time of election, the peculiar activities, their

incompatibilities, their residence/remuneration, the exercise of powers; their relationship with the

higher Representatives of the State, decision making, and the conditions for their

suspension/dismissal.

3. Committee System in Council

Session objective:

Participants understand and appreciate the procedure for forming and role of Council

Committees

The Buea council is made up of 6 committees and 42 councilors with each committee having 6

members excluding the mayors and the deputies. At the Buea council the Mayor and Deputies

act as advisers to the committees, which is not in agreement with the Prime Ministerial Law of

April 2008 which requires that the committees act with some degree of autonomy.

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The Facilitator underlined that the purpose of this law was to have Councilors feel that they are

actually contributing during sessions and not just act as hand clappers. The presence of the

Mayors might intimate or sway ideas and contributions towards a particular direction.

Question from the audience:

What is the role of an adviser?

Input from Resource Person

It's good to have advisers but advisers could become omni-present and in turn want to influence

decisions whereas the purpose of having committees is to make proposals and consult.(See annex

for Power Point presentation)

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4. UNDERSTANDING THE HEALTH SECTOR

Session objective:

Understanding how the health sector operates

Determine strategies for council intervention in health care

How the Health District is organized and functions?

Health sector strategy: This strategy uses a tool known as the Systemic Quality Improvement to

improve on the quality of health. To achieve the above involves managing certain components

such as resources, processes and expected results. The basic concept of the SQM is to develop a

Health District which will help achieve the Millennium Development Goals. The 4th and 5th

clause has to do with child and maternal health unfortunately Cameroon is very far from

achieving this.

Changes in the health sector strategy

These changes have been divided in to four domains of intervention namely;

Domain 1, concerns the health of mother, adolescence and child

Domain 2, the fight against diseases ( neglected diseases such as malaria and non-neglected

diseases such as HIV/AIDS )

Domain 3, health promotion (health and the environment through integrated communication

Domain 4, the health district Development

N/B It should be noted that domain 3 cannot be achieved without community participation.

Secondly the Council should be responsible in developing the health district.

What is needed to achieve results in the health sector strategy?

Services and care

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Equipment

Human resources

Secure resources

Drugs ( promotion of local production and supply, rational use of drugs)

N/B According to statistics the facilitator said over 70% of drugs within the community are fake.

To achieve the above mentioned, it needs financing that is health financing, which helps people

to take care of their health at minimal cost.

Application of price list

Partnership with the public, private institution, traditional council and international partnership

Main components of health care

Promotion of food supply and proper nutrition

Adequate supply of safe water and basic sanitation

Maternal and Child Health Care

Immunization

Prevention against endemic diseases

Adequate treatments of injury

How the Ministry of Public Health is organized

Central

Regional

Peripheral /operational level

Communities contribute towards health through the purchase of drugs, Consultations fee etc. it is

further required that community members should make use of the Health Centres within their

community. By so doing they are contributing towards financing health. Human investment is

done by recruiting people from the community during campaigns to participate in donations for

health facilities by groups of people or individuals.

The Buea Health District.

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A health district is a geographical entity comprising of two or more health areas. The health

district is not an administrative carving.

The Buea health district is shared as follows:

Buea Road Health Area

Buea Town Health Area

Bokwoango Health Area

Bova Health Area

Molyko Health Area

Tole Health Area

Muea Health Area

Dialogue Structures

This entails local partners who for each health area should have an inventory of all the health

problems within that area and try to find solutions to them. Hence, the community determines its

health priorities according to her needs and seeks solutions in partnership with technical advice

because they are there to help achieve results towards proper health care related sectors. The

Facilitator called on each councilor to be part of the Dialogue Structures of their respective

communities. This is because the District Office has been trying without much success to have a

functional Dialogue Structure in Buea. According to the Bova Health Area the Dialogue

Structure is functional- still to be verified.

Councilors should also take the responsibility to check how the Health Centres are used so they;

Could encourage community members to make use of the facilities

Promote the spirit of partnership within the community.

Could monitor the functioning of staff at the Health Centres

What are the Functions of the dialogue structure?

Help to mobilize funds

Sensitize the population on health promotion

Mobilize resources

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Identify health problems and seek solutions

Encourage community to use the health facility

Educate the community on health policy

Promote and participate in co-financing

This is to also make sure that the health committee which is the link between the health sector

and the communities are properly functioning.

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A cross section of participants engrossed in the facilitator’s presentation on the Health System in Cameroon


What is the role of the council in promoting health?

Facilitators input: The council is a representative of the community. Councilors are members

of the community and elected by their community.

Question: What can be done to a Health Area with more than one councilor?

They are advised to work together to solve the health problems of the community

Question: What can a councilor do if he organizes a Dialogue Structure and the Chief of

Post of the Health Centre refuses to attend?

Facilitator’s input

It is necessary to call and inform the District Health Officer who is the regulator and he can

initiate those involved especially the technical service of health. Since the Health Centre belongs

to the community it is important for all the actors to come together and work towards the

common good of the community.

The non- collaborative nature of a Chief of Post is as a result of the fact that things are not

functioning the way they ought to. He stressed that it is the responsibility of all in the

community. He emphasized that the Chiefs of Posts are mere Secretaries meanwhile the

President of the Dialogue Structure or Health Committee is a member of the community, hence

they have powers. He also indicated that such attitudes could emanate because the Health

Management Committee is not functioning and the reports are not forth coming.

Contributions also came in from one of the councilors who brought up the case of a

dysfunctional health structure in Lysoka were the Health Committee members are handpicked

and is made up of very old people. Secondly the Chief of Centre is more of a money lender and

is hardly present at the Health Centre. She also refuses to liaise with traditional authorities. The

volunteer nurse present at the Centre now acts in the place of the Chief of Post. Moreover,

following records the people of Lysoka hardly use the Clinic.

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5. Transferred Competences to the Council in the Health Domain

Session objective:

Participants are able to determine their level of involvement in health care delivery

Based on Decree No 2010/0246/pm of 26th February 2010, four (4) main domains were

transferred to councils from the Ministry Of Public Health as an element of decentralization.

They entailed:

i) The right to the construction of Health Centers. By this, councils can draft a construction project,

forward it to the Ministry of Health for processing and upon positive authorization that is the

provision of technicians and Terms of Reference/plan, a Health Center can be built in that

municipality.

ii) Secondly, council can equip Health Centers. By this, they can donate medical equipments like

ward beds are more.

iii) At the level of maintenance, they can ensure the proper clean up and daily functioning of the

Health Centre at all domains possible.

iv) Lastly, as to what concerns the management of Health Centers, there must be a Council

Representative at the Health Management Committees of Health Centers as such their active

participation is of valued importance.

The Facilitator added that it should not be forgotten that the Ministry remains the head and has

its prerogatives. Hence whatever the council is doing in the domain of health, they must consult

the Ministry. There are other texts that are drawn up by the Minister of health, which is called the

cahier de text, which specifies the list of specifications for the council. These are;

Reports each semester on how the council has carried out activities in the domain of health.

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The Minister determines the conditions of the construction and equipment of these health centers

Concerning the creation of health centers the council will request to the Minister through the

representative of the state. The council constructs while the government provides the technical

staff, and council provides the auxiliary staff.

The council should liaise with the District service in relation to equipping the HC

The council is responsible for the hygiene and sanitation service of the municipality. This can be

achieved through employing workers, provide technicians, provide equipment.

Participate in Health Management Committees in taking key decisions

Management of these Health Centers.

N/B

The council should look at all the domains were they have transferred powers and allocate

budget to priority areas.

The council should also make available an inventory of council assets. With this tool the council

can mobilize other resources

Have a development plan.

Involve key stakeholders

The council should make great use of the Communal Development Plan as well as update it to

meet the needs of the community. This is because it spells out specific health challenges of the

municipality and also a list of priorities for the city. Hence it guides the council on stock taking

of what they have achieved and what is yet to be done. It is also important to note that, most

donors now depend on the communal plan of a council area before they could fund a project for

a council.

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WORKSHOP EVALUATION

What went well What didn’t go well Suggestions

Facilitators’ mastery of the

subjects.

Proper reactions and questions

from participants.

The objectives of the workshop

were good.

The content was relevant and

rich.

Good facilitation.

The venue was good.

Participatory approach was good.

Facilitation was exceptionally

good.

The content if put into practice

will help the municipality

(good).

In all, everything was good about

the workshop.

Training materials perfect.

Logistics average.

Participation was good.

Participants alert was good.

Facilitation was splendid,

because facilitators have a

mastery of subject.

Facilitators well instructed.

Participation effective.

The time for the workshop

was short.

Invitation letters should be given out

say a week before the workshop as

well as the agenda so as to help

participants prepare well for effective

participation.

Most of such workshops should be

frequently organized and that it

should not be limited to health related

matters since the council englobes as

at now.

More workshops especially on

dialogue structure.

Follow up for implementation.

Involve all counselors.

Regular workshops to be organized.

More time to be allocated.

Awareness creation on roles of

stakeholders and actors.

More stakeholders should be

involved.

Involve more participants.

Timing for modules should not be too

long.

Discuss the modalities detail with

management.

More of such workshops should be

organized in future.

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Good animation.

Entertainment was good.

Everything went well concerning

content relevance. So should

keep up in the same manner.

Good presentation and was well

explained.

Good approaches.

Workshop was adequate

Location was comfortable.

Good and excellent presentation.

Animation was good.

Enjoyed the lunch provided to

them.

Content, facilitation,

participation, animation, logistics

all went well.

The content was very good.

The facilitators did their work

very well.

Participation was very serious.

Logistics was good.

Facilitation, trainings and

logistics went well.

The selection of facilitators was

good.

The venue was good.

Participation was good.

The lectures/ presentation were

very rich.

Facilitators were professionals.

After organization of such

workshops, PADDL should prepare

to members a certificate of

participation to beef up peoples CV

Time keeper should be duty

conscious.

At least 2/3 of councilors should

participate.

Give enough time for discussion.

The participants should respect time

and that the council male exco-

members should endeavour to listen

to the facilitators.

Organizers should respect time and

agenda.

Duration of workshop; 3 days. 3rd day

for things happening in the

implementation of law.

Participants should not have a

seminar at their premises, for it

encourages in and out movements

given that they go out to do work

from time to time.

Enlarge training workshop of all

counselors on their roles and

responsibilities.

Provide a manual on council activities

each year.

Need to respect time in future.

Participants should have tables to

write on.

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Animation was excellent.

Training materials were

available.

Food was of good quality and

much.

Power point board should be

available.

Materials should be provided before

hand and also make relevant

documents available for better

applications of texts and resolution.

Time should be respected.

Provide enough materials.

Implementation should take place.

Annexes

Questions and Answers on the Legal Framework of Decentralization in Cameroon

1. FQ: How many types of councils exist in Cameroon?

FR/ PR: City Council e. g Limbe City Council, Council and Sub-divisional Council.

2. FQ: how many City Councils are there?

FR: there are 14 City Councils in Cameroon

3. FQ: what are Sub-divisional Councils?

FR: it is a council within a Sub-division.

4. FQ: How many Sub-Divisional types of councils exist in Cameroon?

FR: there are 45 Sub-Divisional Councils.

5. FQ: How many City Councils does the South West Region have?

FR: 2 which are Limbe and Kumba. The North West has 1

6. FQ: How many types of council are operating in Cameroon.

FR: there are 315 Council.

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7. FQ: how many local collectivities does Cameroon have in general?

FR: 374 all throughout the country.

8. FQ: How many councilors does the Buea council have?

PR: Bues has 42 Councilors

FQ: What is the function of municipal Councilors?

FR: they form the deliberative organ of the council that is, they vote deliberations which are

considered as local laws.

9. FQ: how many council sessions do the council usually hold?

PR: two (2)

10. FQ: Has the session to vote the council budget been done?

PR: yes, it was done in……………………………………….

11. FQ: Are the council accounts voted too?

PR: The Mayor raised a problem at the level of seating allowance wherein councilors complain

that the amount should be increased or else they will be absent.

12. FQ: What is the duration of council sessions?

PR: One day

Facilitator’s input, the law provides that sessions can last for Seven (7) days.

13. FQ: Where does council sessions?

PR: At the council hall

14. FQ: Who convenes these sessions?

FR: The S.D.O, the Mayor or 2/3 of the councilors.

15. FQ: Who chairs these sessions?

FR: the Mayor except in the session of voting the Administrative accounts wherein a Poterm

Chairperson is selected.

FQ: When and what documents are used to convene sessions?

FR: session notice should be sent 15 days before the actual comprising of the agenda, the

document to be discussed

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Question and Answers on the Health Sector

PQ: how can the Ministry intervene in a District where there are high mosquito infections?

FR; Hygiene and Sanitation talks can be organized wherein Medical Personnel’s can be invited

to assist in this community health education.

PQ: what can be done to companies like the C.D.C who because of the mis-management of their

waste and it causes some health hazards in the community?

FR: the council should fully involve.

PQ: what can be done to some religious bodies who based on their beliefs reject health care and

the impolite/unavailable behavior of medical personnel in the Sanje Health Centre?

FR: as per religious bodies, it’s a general problem that the entire ministry is observing and there

hasn’t been any resolution for it. Whereas as concerns the staff of Sanje Health Centre, measures

will be taken by the technical health services.

PQ: what can be done to improve on Community Mutual Fund?

FR: community members should continuously involved in asking and checking the proper

functioning/operation of Health Centers.

PQ: what efforts is the Ministry of Health carrying out to curb the persistent increase of child

mortality rate?

FR: the Ministry has put in place the following even though it is still insufficient:

- The creation of the Primary Health Care System.

- The change and integration of a new system in the Ministry of Health.

- the invention and provision of vaccines for about 11 diseases.

-The provision of Health unit’s e.g ensuring that every Health Area has at least One Health

Center.

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PQ: under the Minimum Package wherein a doctor has referred a severe case from a Health

center to a Hospital, what can the patient do should he/she have financial difficulties?

FR: exceptionally, the Ministry of Health has ensured to set up a Social Service at all Hospitals

wherein, a patient can explain her medical situation and show proof of financial challenges. This

organ will access the real situation and permit the patient to be treated free of charge.

PQ: how is the community involved at the pro-pharmacy level?

FR: the community is expected to be present/ available at the time inventories are taken given

that Pharmacists are elected by the community for whom they represent.

PQ: how is Hygiene and sanitation control taken care of by the government?

FR: we offer health education, hold sanitary checks with the council.

PQ: in relations to referrals, will it be wrong for a patient who is seriously ill to choose to go

straight to a Hospital instead of a Health Center within her municipality?

FR: the Health law provides that, everyone has the right to seek medical care wherever they

choose but referral cases are priorities.

PQ: what are the improvements brought about by the integrated approaches?

FR; this is has led to joint internal projects that is a combination of all activities.

PQ: why has the Ministry of Health not ensured to establish small health units within schools

like Dispensaries in Primary and Secondary Schools also in Nursery Schools, given that sick kids

need proper follow up to take their drugs in whilst in school so that the dosage will be effectively

respected?

FR: the Ministry of Health has pilot educational partnership projects with Ministry of

Basic/Secondary and Higher Education called ‘School Health’. It is the duty of the Propiator of

the school to creat a unit like that and not an extra duty that should be attributed to teachers.

Equally, parents have the sole responsible to respect prescribed dosage times when administering

the drugs to their kids.

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23


The Committee System in Councils

The Creation and Functioning of Council Committees

During its first annual meeting the council sets up committees to study matters falling

within its powers (Section 41 (1) of Law no 2004.18 of 22 July 2004.The committees are

consultative and can meet during council sessions and in between sessions.

The functioning of council committees has been further stipulated by Decree No 2008/0752/PM

of 24 April 2008. Council bye laws shall determine how the committees shall be set up

practically and state the terms of reference of each committee.

Committees are set up by council deliberation which states the membership as well as the

chairman, vice chairman and secretary of the committee. Based on the importance of a matter

that should be studied by a committee, the Mayor may submit this for deliberation by the council

session. The matter may also be tabled by the chairperson or vice of the committee. Such matter

shall be included in the agenda of the council session.

The composition of committees shall reflect, as far as possible, the make up of the council. The

maximum number for each committee shall not exceed 6 persons. No committee may be set up

within the last 12 months preceding council elections. Councillors who are not members of a

particular committee may take part in committee meetings upon the authorization of the

committee chairperson.

A committee may include in case of need, and on a consultative basis, members of the civil

society.

The number of committees that a council can create is fixed as follows:

Type of council Number of committees

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25 – 31 councillors 5 committees

35 – 41 councillors

(Exceptional 45 councillors)

6 committees

61 councillors 8 committees

City councils with 3 sub divisional

councils

5 committees

City councils with more than 3 sub

divisional councils

8 committees

Council Unions having up to 10 councils 5 committees

Council Unions having between 11 and 20

councils

6 committees

Council Unions having more than 20

councils

7 committees

The Committee is convened by its chairperson within 8 days of their establishment. Thereafter

the committee may be convened within a shorter time frame by the majority of the members.

Membership on a committee is honorary but the council budget covers the costs incurred for

running the committee.

The chairperson of a committee may invite any person on account of his expertise to advise a

committee for a fee to be decided by the council session.

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The Role of the Committees

The Committees have an opportunity to study in greater detail the issues that are assigned

to them. The Committees may invite experts on issues they have to examine. This is because

the plenary sessions of councils do not have enough time to investigate deeply into all problems

before decisions are taken.

The council executive should work with council committees to follow up on resolutions

and to oversee implementation of council projects. This becomes very necessary as council

sessions hold, except for extraordinary sessions, only four times a year and for very short

durations.

26


Transfer of Responsibilities to Councils

- Decentralisation is a political option enshrined in the constitution of 18 January 1996 which

states that: “Cameroon is a unitary decentralised State”

- Constitution provides for decentralised local authorities (Art.55)

- Since then, the Government has progressively put in place legal texts relating to the process

- The 2004 Laws on Decentralisation

Definition of Decentralisation:

Decentralisation shall consist of devolution by the State of special powers and appropriate

resources to regional and local authorities.

Decentralisation shall constitute the basic driving force for promotion of development,

democracy and good governance at the local level.

The regional and local authorities of the Republic shall be the regions and councils.

They shall carryout their activities with due respect for national unity, territorial integrity and the

primacy of the State.

See Sections 2 & 3

Local authorities receive Powers necessary for:

- Economic

- Social

- Health

- Educational

- Cultural and

- Sports development

Article 15-20 of Law No 2004/018

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First Generation Transfer of Powers to Councils as authorised by PM’s Decrees No. 0239 -

0247 of 26 February 2010

On February 26, the PM signed nine (9) Decrees dealing with the transfer of competences to

councils on the:

- Creation and maintenance of rural roads

- Maintenance and management of centres for the promotion of the woman and the family

- Promotion of agricultural activities and activities of rural development

- Attribution of aid and assistance to the poor and needy

- Promotion of farming and fishing activities

- Culture

- Public Health

- Basic Education

Competences Transferred:

A. In the area of Public Health

Decree No 2010/0246/PM of 26 February 2010

Concerned competences (Article 1)

- The construction of integrated health centres

- The equipment of health centres

- The maintenance of health centres

- The management of health centres

1. The Construction of Health Centres

- Prerogative of the state (MINSANTE)

- MINSANTE determines the conditions for the CREATION, - OPENING & FUNCTIONING of

health institutions – private and public

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- Concerning the creation of HCs, the council requests, through the Representative of the State the

ministerial authorisation to create.

- Only after obtaining the Ministerial authorisation does the council embark on the construction.

- Thus, the council constructs while the state provides the necessary financial resources

- The council provides the site negotiates the contracts

2. Equipping Health Centres

Whether constructed by the state or the council, Health centres are equipped by the latter (Article

5 of the Decree)

3. The maintenance of Health Centres

- Ensuring hygiene and cleanliness

- Guidelines (cleanliness, clearing surrounding bushes)

- Not sporadic but permanent

4. The Management of Health Centres

- The council participates in the Management of these Centres according to Articles 7 and 8 in two

areas:

- The Recruitment of auxiliary personnel

- Participating in the Management Committees in taking key decisions, strategic options and

giving guidelines on how the day-to-day Management of the centres should be done.

Decree No. 2011/0004/PM of 13 January 2011 further transfers powers on the construction,

equipping, and management of sub divisional health centres.

29


5. Construction of Sub divisional health centres

The council is the project owner for the construction of the said centres

The council is in charge of:

Constructing staff quarters

Installing and managing power back up units

Installing functional water supply systems

6. Equipment of Sub divisional health centres

The council ensures the provision of supplies and materials which are necessary for the delivery

of health care services at the centresauthorised by the Minister of Public Health.

A ministerial order defines what supplies and materials are to be provided by the council.

7. Hygiene and Sanitation of Sub divisional health centres

The council takes all measures to ensure that there is proper hygiene and sanitation in and around

the sub divisional health centres.

8. The Management of Sub Divisional Health Centres

The council participates in the Management of these Centres according to Articles 7 and 8 in two

areas:

The Recruitment and payment of auxiliary personnel

Participating in the Management Committees of sub divisional health centres found in its

territory

List of Specifications (Cahier de charges) on the Transfer of Competences in the Health

Domain

30


The above powers have been further explained by Ministerial Order No. 0821/MINSNATE of

1st April 2011 stating the list of specifications to be followed by councils in exercising the

powers transferred to them in the public health domain.

Key among the specifications are the following requirements:

Article 5: The council constructs integrated and sub divisional health centres as well as staff

quarters, following the log book of the public investment budget.

Any change of site or modification of the amount for any of the works must receive the prior

approval of the Minister of Public Health.

Article 6: The council respects the norms and sample plans for health infrastructure as laid down

by the Minister of Public Health.

The council respects the health map as defined by the Ministry of Public Health.

Personnel of the de-concentrated services of the Ministry of Public Health have to be involved in

the implementation of these activities.

Article 11: The council must include priority actions/projects in the health sector in its

communal/strategic development plan. The plan must indicate the resources to meet the primary

health care needs of the population through the services of integrated and sub divisional health

centres.

Article 15: The council can apply, where there is need for special technical expertise, through the

State representative (SDO) to the Minister of Public Health for such expertise.

31


Article: The de-concentrated services of the Ministry of Public Health carry out monitoring and

evaluation of the council implementation of the transferred competences with the authorisation

of the representative of the State.

Article 19: The de-concentrated services of the Ministry of Public Health technically assist the

council in preparing semester reports for the Minister of Public Health on the construction,

equipment and maintenance of integrated and sub divisional health centres.

This report is forwarded by the SDO to the Minister of Public Health.

Article 20: Dialogue structures comprising partners and health sector actors promote the

participatory and decentralised management of the health services through Health Area

Management Committees, Health District Committees and Management Committees.

The Health Area Management Committee assists the health centre in finding solutions to health

problems and plays a social control role in the monitoring and evaluation of the management of

competences in the health sector.

The Management Committee of the Sub divisional Health Centre ensures the management of the

said health centre.

Article 21: The Ministry of Public Health will take all necessary actions to ensure continuity of

service delivery where the council fails to perform its duties in managing the transferred

competences, especially in the construction, equipping and maintenance of health and sub

divisional centres,.

A- IN THE AREA OF SOCIAL ACTION

- The maintenance and management of Centres for the Promotion of the woman and the family

- The award of aid and assistance to the poor and needy

32


Organisation of Feasts and Ceremonies

Ensuring hygiene within and around the Centres

- The management here is similar to what obtains with health centres, i.e.:

- Recruitment of temporary personnel

- Participating in Board Meetings of the Centres

- The participation of councils here – unlike in the case of health centres – is widespread because,

on 12 May, 2010, the Minister of MINPROFF signed the guidelines giving powers to the council

to:

- Organise Board Meetings

- Follow up and evaluate projects carried out in the Centres

- Promote the training and retraining of personnel posted to the Centres

- Makes the Mayor the authorising officer for expenses in the Centres (Articles 5, 7 and 11(3) the

guarantor of equipment at the Centres as well as the overseer of their bank accounts (Article 13).

2. The Award of Aid and Assistance to the Poor and Needy

Decree No 2010/0243/PM of 26 February 2010 lays down:

The procedure for assistance

Prior social investigation (Article 4)

Two Objectives:

- Ensure good management of public funds so as not to behave in an arbitrary manner

- Respect the principles of equity and justice

- Identification of beneficiaries (Art 4 (2).

- The handicapped: mental, physical, visual, phonic, hearing

- Minors (-21) born of handicapped, poor or indigent parents

33


- Those unable to participate in income-generating activities (aged or sick people)

- Temporarily invalid people as a result of unforeseen circumstances

Types of aid or assistance to be given

- Arts 5 and 6 of the Decree

Assistance in kind – gifts or services

Instruments and appropriate Equipment

School needs and didactic material

Food and dresses

Legal assistance

Financial assistance to enable economic insertion or reinsertion (exceptional)

C. Powers Transferred for the Maintenance and Management of Women’s Empowerment

Centres

Care and maintenance of buildings, equipment and special halls

Provision of materials and supplies

The organisation of feasts and ceremonies

Ensuring hygiene and sanitation within and around the said centres

D Powers Transferred for the Promotion of Culture

The organisation of cultural days as adopted by council Deliberation

Support to cultural associations

E. Powers Transferred for the Promotion of Basic Education

The building, equipment, management and maintenance of council nursery and primary schools

and pre – school establishments

Purchase of school materials and supplies

34


Recruitment and taking charge of support personnel forroutinetasks

F. The Powers Transferred for the Promotion Of Agricultural Production Activities And

Rural Development

Participation in the acquisition of seeds and pesticides

Identification of producers by sector and production.

Mapping of the surface area and an estimate of input requirements.

A follow – up of organized producers

The financing and acquisition of inputs and tools for treatment by producer’s organizations.

Information on the activities undertaken by the producers’ organizations.

Monitoring and the fight against plant diseases (phyto sanitary control)

The development of rural mini infrastructure

Mobilization of the community for local development

G.Powers transferred by the State with regards to the promotion of livestock and fish

farming activities

The organization of livestock fairs

The support for income generating and job creation micro projects

The construction and the maintenance of zoo technical and veterinary health controlcentres

The creation and setting up of livestock breeding infrastructure as well as the control of cattle

circulation

The creation and the management of cattle markets

The creation and the management of agro-pastoral perimeters

The fight against animal diseases (zoo noses ) in urban centers

The construction, equipment and the management of infrastructures for the support of livestock,

fishing and the aquaculture

35


The protection of the underground and surface water resources through participatory monitoring

H.The powers transferred with regards to the creation and maintenance of unclassified

roads as well as the construction, maintenance and management of ferries

The creation and the maintenance of unclassified rural roads

Construction, maintenance and management of ferries

I. The powers transferred by the State as regards potable water supply in the zones not

covered by the public network for the distribution of water conceded by the State

Studies, construction and management of wells and springs

Conservation, protection and sustainable use of water

The maintenance of wells and bore holes are under the control of Councils

The putting in place of every measure necessary to ensure hygiene and sanitation around of the

aforesaid wells and bore holes

The maintenance of potable water supply structures

The establishment of a council list of potable water schemes

II. MODALITIES FOR THE EXERCISE OF TRANSFERRED RESPONSIBILITIES

1. Assist in improving the people’s lifestyle

2. Confirm activities already performed by councils

3. Provide the people at the grassroots with quality services

4. Necessary resources are provided for in the yearly budget of the State

5. These resources cannot be used for other purposes than those for which they are meant

6. They figure in the council budget

7. As public funds, they are submitted to budgetary and accounting principles in force.

8. In addition to the resources transferred by the State, Councils can benefit from aid given by

partners

36


Operational techniques to enhance effectiveness of the transfer of powers

The creation of data bases e.g. on CIGs, co-operatives, will be used to promote intra and inter

communal activities

Staff recruitment/redeployment and delegation of leadership to reinforce role of council as lead

agent for the promotion of local development

Using the budget as a tool for steering local economic development – effective respect of 40%

allocation for investment

Establishing a proper inventory of council assets

Drawing up of a strategic development plan for the council

Ensuring good governance practices of accountability and transparency in council management

Managing relations with all key stakeholders in the municipality

Effectively communicating and marketing the council and its municipality

Building strategic alliances with neighbouring and other partner councils

Leveraging resources by collaborating with civil society actors

CHALLENGES OF TRANSFERRED RESPONSIBILITIES

1. Local Development

Developing the infrastructure and ensuring the improvement of the people’s lifestyle

2. In local governance

Involve all stakeholders (participatory management)

Respect rules and regulations of financial management

Good management of human, material and financial resources

FOLLOW-UP, CONTROL AND EVALUATION OF TRANSFERRED

RESPONSIBILITIES

1. By the Supervisory Authority

37


2. By the concerned ministerial departments. Reporting every six months to the line Ministry. Duty

Specifications ‘Caheirs de charges” prepared by the line ministries will spell out the terms and

technical specifications as well as the use of corresponding resources by councils.

3. By the organs charged with the follow up and the implementation of decentralisation: the

National Council for Decentralisation (CND) and the Inter- ministerial Committee for Local

Services (CISL)

CONCLUSION

With the transfer of responsibilities in February 2010, we can say that the process of

decentralisation has entered its operational phase.

The transfer of responsibilities should not be viewed as the State abandoning its responsibilities

nor as a trap for local authorities

Rather, councils are only expected to:

- Show a high sense of responsibility

- Ensure frank collaboration with the different local stakeholders involved in the decentralisation

process

- Master the legal instruments

UNDERSTANDING THE HEALTH SECTOR IN CAMEROON

1. PUBLIC HEALTH

Strategy Indicators Sources of Assumptions

38


Verification

Level Formulation

Overall

Objectiv

e

Health status

improved

By 2015, at least 40% of the

population spend less on

drugs and increase their

economic activities

-Hospital and

Health Centre

reports

-Testimonies

- Epidemics

reduced

- Pandemic

Diseases reduces

Specific

Objectiv

e

Access to

quality

Healthcare

increased


population have access to

Quality Health services

-Hospital and

Health Centre

records

-Administrative

Reports

Enabling economic

conditions

-Favorable policy

framework

Results 1 Qualified

Medical

Personnel

increased

By 2015, at least 3 Doctors

and 24 Staff are functional in

Molyko, Muea, Bojongo,

Bolifamba and Lysoka

Integrated Health Centres

-Transfer

Decisions

-Administrative

Reports

Favorable policy

framework

2 Equipment in

the Hospital and

Health Centres

increased

By 2015, all Hospitals and

Health Centres have at least

80% of Basic equipment and

are used

-Inventory

report

-Administrative

reports

Enabling economic

conditions

3 Access to

essential Drugs

increased


population have access to

affordable essential drugs

-Testimonies

-Health

Centres/Hospital

records

-Administrative

Enabling economic

conditions

39


reports

4 Coverage of

Health

Programmes in

the

Municipality

increased

By 2014, Health Programs

cover at least 80% of the

communities

-visits

-Administrative

Reports

Favorable policy

framework

5 Health

Infrastructure

increased

By 2014, wards , water

system toilets, and Residence

for staff are constructed in

Buea, Bojongo, Bolifamba,

Lysoka and Bokwaongo

Integrated Health Centres

-Visits

-Administrative

reports

Enabling economic

Environment

ACTIVITIES QUANTITY PLACE COST(FCFA)

R1 Qualified Medical Personnel increased

1.1 Request for the

transfer of Medical

Staff

3 Doctors-Molyko,

Bojongo, Bolifamba

28 Nurses-Molyko,

Muea, Buea,

Bojongo, Bolifamba,

Lysoka

Contact Regional

Delegate for Public

Health, Buea

10,000

R2 Equipment in Hospital and Health Centres increased

2.1 Supply equipment Lab-5 Molyko, Muea, Buea,

Bojongo, Bokwaongo

Health Centre 75,000,000

40


Beds - 18

Muea – 12 Beds

Bokwaongo – 6 Beds

810,000

R3 Access to essential drugs increased

3.1 supply essential

Drugs to all Integrated

Health Centres

1 contact visit Regional Drug

Program, Buea

10,000

R4 Coverage of Health Programs in the Municipality increased

4.1 Design an outreach

program & Train staff

on patient centered

ethics

-4 Workshops. Buea 40,000,000

4.2 Support for

Community Mutual

health insurance

scheme

-Support Community

Mutual Health

insurance program

Mutual Health

Organization, Buea

50,000,000

R5 Health Infrastructure increased

5.1 construct wards 4 wards Muea-2

Bokwango-2

80,000,000

41


5.2 Construct water

system Toilets

3 -Bojongo

-Bolifamba

-Bokwaongo

Integrated Health

Centres

15,000,000

5.3 Rehabilitate road to

Health Centre

1 km Integrated Health

Centre, Bokwaongo

5,000,000

5.4 Construct

Residence for Chief

Nurse

1 Integrated Health

Centre, Lysoka

25,000,000

5.5 Rehabilitate

Integrated Health

Centre

1 Buea 15,000,000

42

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