BD LogoHeart to Heart International, BD & Dr. John Nkengasong, PhD (CDC) are working in Fotabong, Cameroon to improve access to health care by strengthening the Fotabong sub-district hospital through community commitment and partnerships.




Fotabong, Cameroon – Partnering with Becton Dickinson to improve hospital and community access to health care. The Lovely Mothers women’s group is singing and dancing about the improvements to their hospital.


Dr. John Nkengasong

Dr. John Nkengasong (CDC)

Cameroon, a central African country, has set its sights on becoming an emerging economy by 2035. [1]  As such, prioritizing health care access for the poorest segments of the population is key to making solid progress toward lasting economic growth. Although Cameroon’s proportion of doctors (1.9 per 1,000 inhabitants) 1 is twice the minimum recommended by the World Health Organization, the country’s health statistics are paradoxically behind the curve.

Life expectancy for Cameroonians has decreased by about two years since 1990, while it has increased by an average of five years in the rest of sub-Saharan Africa.1,[2]  Worldwide, Cameroon is among the countries where the mortality rate for children under five years of age (122 deaths per 1,000 live births) has decreased the least.2,[3] The implications of these statistics, is that the more money a woman has, the more likely she is to have qualified professional assistance during childbirth, whereas in poor and rural communities, women and children will have a much higher risk of dying.




Access to Health Care

Cameroon has 10 regions and within these, the geographic disparities are striking: 40% of the country’s doctors practice    in the Centre region (which includes Yaoundé, the capital), where only 18% of the population lives. On the other hand, the Far North region, which also holds 18% of the population, employs only 8% of Cameroon’s doctors.

The health system in Cameroon has three levels:

  1. Peripheral or operational level – Health District
  2. Intermediate level – Health Region
  3. Central level – National

The Cameroon government is currently implementing several measures aimed at improving access to health care in the country that include results based financing and dialogue structures (health committees).



Health Care System in Fotabong, Lebialem:

Cameroon-West-01Lebialem, with a population of 180,000 inhabitants, is an administrative division within the South West Region of Cameroon. It is composed of three administrative sub-divisions—Fontem, Alou, and Wabane.  The administrative divisional headquarters is situated in Menji in the Fontem sub-division. The neighboring divisions to Lebialem are Menoua in the West Region to the East, Manyu Division in the South West Region to the West, the North West Region to the North and the Kupe Manenguba Division in the South West Region to the South (figure 2). Each sub-division in Lebialem has a government hospital.

The Fotabong hospital is a government owned sub-divisional hospital in Alou sub-division and is part of the health care network in Lebialem. A physician who serves as a Medical Officer runs the Fotabong hospital, and reports to the divisional Chief Medical Officer (CMO) who is based in Menji, the Divisional headquarters. The CMO in turn reports to the Regional Delegate of Health in Buea. The Fotabong hospital was created in 1982, initially as an integrated health center and later on became a sub-divisional hospital. It serves a catchment area of about 21,000 individuals and until four years ago saw an estimated 80-100 patients daily. The various functional units of the hospital include: a pharmacy, laboratory, surgery room, maternity, male and female wards, and a cold chain storage room. The hospital also serves as the hub for vaccination campaigns for the entire sub-division.

The hospital has two main buildings: the old facility where the hospital currently functions and a newer building that was constructed by the government of Cameroon to serve as a maternity unit; however it is incomplete and non-functional.

Since 2011, the government of Cameroon has assigned a medical officer to the hospital. However, because the doctor did not reside at Fotabong and rarely visited the facility, the quality of medical care deteriorated significantly leading to a lack of confidence in the hospital within the community, resulting in a loss of access to basic health care to the estimated 21,000 potential users.



  1. To improve the physical infrastructure of the Fotabong district hospital in order to provide quality health care.
  2. To strengthen the human resource capacity of the Fotabong hospital to enable provision of quality health care to the population.
  3. To strengthen maternal child health care of the Fotabong hospital by improving its services, infrastructure, and referral systems.
  4. Strengthen community leadership and engagement.


Project Work Plan:

Objective 1. Renovation / improvement of the physical infrastructure of the Fotabong district hospital in order to provide quality health care


Current Electrical Wiring

39.04 PTDC0180

Current Water System

The following activities will be conducted to achieve this goal:

  1. Assessment and renovation of the old bloc of the Fotabong hospital in order to enable it meet minimum standards of care.
  2. Specific renovation of the old block will include:
    • Repair of the roof
    • Water supply
    • Electricity
    • Proper flooring
    • Replace/repair damaged ceiling tiles
    • Doors
    • Bring operating theater to an acceptable standard for procedures
    • Patching and Painting
  3. Renovation of the doctor’s house to be completed by the community.

Objective 2. Strengthen the human resource capacity of the Fotabong hospital to enable it to provide quality health care to the population.

Activities to meet this objective include:

  1. Provision of a resident doctor and a nurse to compliment the government’s effort of the assigned district medical officer.Creation and training of a community health care volunteer workforce to provide community support for efforts such as WASH, breastfeeding and infant and child care.Training in additional skills for pharmacy attendant, community nurses and laboratory technicians.
  2. Provision of new salaried positions including laboratory technicians, cleaner and security.

Objective 3.  Strengthen maternal child health care of the Fotabong hospital by improving its services, infrastructure, and referral systems. 

The following activities will be conducted to achieve this goal: IMG_0177-1

  1. Renovation of the new maternity block in order to enable it to function and provide maternal child services.
  2. Specific renovation of the maternity block will include:
    • Repair of the roof
    • Water supply
    • Electricity
    • Proper flooring
    • Doors and windows
    • Beds
    • Delivery rooms
  3. Develop a referral system for pregnant women including an emergency plan for every expected delivery.
  4. Support an ambulance transportation vehicle to refer emergency cases to the Mary of Health of Africa hospital.
  5. Develop a community health care program to support maternal health care.

Objective 4: Strengthen the dialogue structure via community leadership and engagement

In order to achieve the mission of the “H4H Serving the Community” the Fotabong community will need to be actively engaged in order to fully own the process. Activities aimed at strengthening the leadership of the health committee will include:

  1. Training of leadership skills to the health committee

Engaging community to strengthen relationship with and ownership of the health of the community.


Measuring Improvement: Quality of Care Indicators:


To measure the progression of the H4H project the following indicators will be assessed quarterly during the first year of this project.

Quality of Care Indicators

  1. Number of health care visits at the maternal and child care clinic
  2. Average number of prenatal doctor visits for pregnant women
  3. Number of live births at the maternal and child care clinic and ratio of live births to total births.
  4. Number of people who have had a Primary Care Provider checkup in the past 12 months.



[1] Better Access to Health Care for all Cameroonians. The World Bank Cameroon Economic Update, 2013 issue 6. Available at

[2] Cameroon: WHO Statistical Profile. Available at

[3] Millennium Development Goals (MDGs) Visualization: Cameroon.  Institute for Health Metrics and Evaluation. Available at