Improving Basic Healthcare Service Delivery in Cameroon by Promoting Innovative Whistle-blowing Techniques

Aim

The project aimed to reinforce transparency, accountability, participation and integrity in public hospitals in Cameroon by raising awareness of healthcare rights amongst the patients and providing an independent mechanism to report instances of corruption.

Landscape

In 2010, Cameroon’s National Anti-Corruption Commission (CONAC) rated the intensity of corruption in public hospitals at 8/10, which was exceptionally high. Amongst the causes for the high score was a weak whistle-blowing mechanism.

Activities

1. A new online and SMS whistle-blowing platform was developed in collaboration with Cameroon's healthcare sector.
   System developmentTrial & implement new approach
2. A baseline survey provided insight into which are the most effective ways to raise awareness amongst patients and encourage whistleblowing. For example, patients highlighted their preference for using SMS and a digital platform/website to receive information and to submit complaints. Poor communities which have limited access to the internet stated their preference for a manual, paper-based reporting mechanism with outreach support for remote villages.
   Awareness raisingRisk assessment, vulnerability map & baseline study
3. Public sensitisation campaigns were run to raise awareness for patient rights including the right to report corruption.
   Awareness raisingMedia campaign
4. Hospital directors were trained on measures to redress corruption in hospitals.
   Awareness raisingConsultation
5. An evaluation at the end of the pilot phase involved an experience-sharing workshop with healthcare workers, patients and representatives from the Ministry of Health.
   Awareness raisingStrategic working groups & Collaboration

Achievements

1. The public sensitisation campaigns incentivised reporting on the topic of health corruption on the radio and on TV which increased public outreach.
2. Hospital directors were able to identify the most corrupt services. For example, in the Biyem-Assi District, 50% of all reports related to the Hospital’s maternity service. Across the entire project, the services receiving the most complaints included: emergency units (42% of reports), paediatrics (25%) and maternity services (17%).
3. Hospital directors were able to identify how corruption was exerted within services. For example, 61% of complaints related to fraud and 35% to bribery.
4. The project generated a total of 228 corruption reports over a six-month period.

Future Plans

Following the pilot period, TI-Cameroon is working with the Ministry of Health how to continue the project.

Lessons Learnt

1. A portion of patients were found to be illiterate and in need of support from outreach staff to submit reports. Many people in poorer communities are also unable to afford mobile phones and hence required access to a more traditional paper-based system.
2. Raising awareness for patient rights should include information on the current costs for healthcare services and medicines, as this will help to fight corruption.
3. It is important to gather case studies on the positive impacts of reporting, so that communities can see the practical difference that it can make.