Assessing the First Semester of Decentralization by Devolution in Human Resources for Health on Malaria Management in Djoungolo Health District
Keywords:
decentralization by devolution, human resources for health, malaria management, CameroonAbstract
Purpose: The goal of this study was to assess the implementation of decentralization by devolution in human resources for health on the management of malaria in the health district of Djoungolo.
Problem: Data from the Cameroon national health database (DHIS-2) shown that the number of deaths from malaria increased by 1.5 folds in this health district during the first semester of 2021; which was also the first semester of implementation of decentralization by devolution of powers to locals elected in Cameroon. Human resources for health quantity and quality attributed to a population is a real issue in health service performances and its shortage was nationwide in Cameroon until 2020, before implementation of decentralization. The General Code of Regional and Local Authorities devolved to communal council duties to recruit and manage nurses and paramedical staffs of integrated health centres and sub-divisional health centres of their communities. The main question was the effectiveness of communal council duties toward their local health facilities.
Methods: To achieve this objective, we performed a quantitative approach by carrying out a retrospective cross-sectional study with analytic aim. We had to compare admission of patients and the management of malaria cases during 2020 and the first semester of 2021.
We collected data through kobo-collect template application at the integrated health centres of Emana and Abom; and sub-divisional health centres of Elig Essono and Nkolmesseng in the health district of Djoungolo which was under the decentralized administration of Yaoundé 1 and Yaoundé 5 communal councils. Harmonized data collected had been analyzed using SPSS version 25.0 statistics software and the results presented in tables, graphs and percentages.
Results: Context-based theory (CBT) led us to discuss the results. Nurses and paramedical staffs increased from 65 to 70% at the local public health facilities of Djoungolo health district. Aggregate density of health personnel/population increased from 1.3 to 1.4 per 1000 but still below the critical threshold. There was 10% increased nurses and paramedical staffs’ work force for malaria management in the Djoungolo health district. The profile of State registered nurses’ increased to 4% and Assistant nurses’ to 10%. However, there was uneven repartition of staff profile between health facility categories and between decentralized territorial collectivity administrations.
Conclusion: Decentralization by devolution had positive impact on the management of malaria at Djoungolo health district. Devolution in human resources for health reduced the work load and positively influenced continuity and sustainability of health services. The profile of staff recruited in the local health facilities of Djoungolo health district during the first semester of decentralization by devolution gave an additional work force for the management of malaria despite an uneven repartition of staff profile. Devolution had no additional effect on malaria mortality rate (MMR) in public based health facilities of Djoungolo health district.
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