Financing Oral Health Care in Yaoundé Cameroon: Policy Strategy for Universal Health Coverage

Abstract

Introduction: Oral diseases affect 3.5 billion people (45%), mainly in low- and middle-income countries. The high prevalence of oral diseases represents a substantial economic and financial burden for individuals, households and societies in Africa. Their costly management requires specialized interventions and mobilizes significant, often inaccessible resources, leading to catastrophic expenditures for dental patients. This study aimed to analyze the financing of oral health care in Yaoundé Cameroon with emphasis on policy strategy for universal health coverage. Methods: A descriptive cross-sectional study was conducted in Yaoundé, with data collected in five dental clinics namely: laboratory of implantology and periodontology (LIP), Social and Health Animation Center (CASS), Dental Clinic of the Presbyterian Church Hospital (PCH), and District Hospital (HD) of Biyem Assi. Data were collected using a questionnaire administered to patents. Data were analyzed using the statistical computer software IBM® SPSS® version 24, with the results presented the forms of frequencies, tables and graphs. A confidence interval of 95% and a p value <5% were used for assessing the level of statistically significance. Results: The sex ratio was 0.69 in favor of female, which is explained by the fact that, in case of dental illness, women are more likely to go to dental clinics than men, with a mean age of 35.43 years. The predominant dental health problems were: dental caries (73.91%), pulpopathy and periapical diseases (71.73%), edentulism (43.47%) and periodontal disease (26.08%) in the study settings. Dental care pricing depends on each hospital financial management system and Direct payments by patients for dental care and services represent the largest source of funding, on average more than half (51%) of total dental care spending in study settings comes from out-of-pocket payments. At the end of the consultation, only 22.17% of patients had a single diagnosis, the average direct costs of which were XAF83,715, XAF855,505, XAF33,250, XAF214,785 and XAF305,000 respectively for dental caries, single tooth edentulism, periodontal disease, pulpopathies and periapical diseases, and orthodontic anomaly. Regarding financing strategies, no individual dental patient benefited from state or public financing as the payments for oral health care came mainly from private expenditure, notably through direct out of pocket payment associated with social safety network and savings for about 98.3% of dental patients, with the participation of health insurance for about 3% of dental patients. Indeed, oral health care is not integrated into the package of universal health coverage. The use of oral health services increases with income, rather than need for care, where the predominant form of remuneration, fee for-service, rewards providers for delivering services to clients as opposed to meeting the needs of populations. Conclusion: In Cameroon, oral health care ranks among the costliest health interventions in the country where financing strategies are heavily influenced by out-of-pocket payments, with little private health insurance coverage for individuals. Public health financing is non-existent for private dental health care and no oral health policy is yet effective to ensure the financial health protection desired by the WHO by 2030. Therefore, the policy strategy for universal health coverage should improve access to high quality and affordable dental care services that remains a major public health challenge.