Cameroon is a country with an approximate area of 475 thousand sq. km. (UNO, 2001). Its population is 16.296 million, and the sex ratio (men per hundred women) is 99 (UNO, 2004). The proportion of population under the age of 15 years is 42% (UNO, 2004), and the proportion of population above the age of 60 years is 6% (WHO, 2004). The literacy rate is 77% for men and 59.8% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 3.3%. The per capita total expenditure on health is 42 international $, and the per capita government expenditure on health is 16 international $ (WHO, 2004). The main language(s) used in the country is (are) French and English (official). The largest ethnic group(s) is (are) Cameroon Highlanders, and the other ethnic group(s) are (is) Equatorial Bantu, Kirdi, Fulani, Baka/Pygmees, Northwest Bantu and other African groups. The largest religious group(s) is (are) indigenous groups and Christian, and the other religious group(s) are (is) Muslim. The life expectancy at birth is 47.2 years for males and 49 years for females (WHO, 2004). The healthy life expectancy at birth is 41 years for males and 42 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Cameroon in internationally accessible literature. A rapid assessment study revealed that the use of cannabis, heroin and cocaine was common. Solvents were mainly used by street children (Wansi et al, 1996). Studies suggest that child sexual abuse may require public health attention (Mabassa et al, 1999; Menick, 2002).
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. The policy was initially formulated in 1998. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. Formation and legislation are also a component of the policy. The process of drafting began in 1992, but the mechanism for its implementation is still being worked out.
Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1992. The mechanism for its implementation is still being worked out.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1999. It is included in the National Sectorial Strategy for Health.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1999.
Mental Health Legislation Activities related to a mental health legislation have been issued in the draft form.
Details about the year of enactment of the mental health legislation are not available.
Mental Health Financing There are budget allocations for mental health. The country spends 0.1% of the total health budget on mental health. The primary sources of mental health financing in descending order are tax based, out of pocket expenditure by the patient or family and private insurances. Mental health has been included as a public health priority since 1989 with a designation of a mental health national coordinator, but greater priority was given to family planning and hospital medicine. In 2003, the mental health sub-directorate was cancelled with a risk of rolling back of financing for mental health. For example, the 2000-2001 budget addressed mental health programme activities with particular regard to the development of community-based mental health and with a plan to implement it over the next three years, but these activities could not be implemented. The country has disability benefits for persons with mental disorders. It is available only for public servants who have mental illness.
Mental Health Facilities Mental health is not a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Mental health care in the primary health set-up is being developed as a part of the mental health action plan. Regular training of primary care professionals is carried out in the field of mental health. Training modules exist for training primary care personnel. Training of primary care workers commenced in 2004. There are no community care facilities for patients with mental disorders.
Psychiatric Beds and Professionals
Total psychiatric beds per 10 000 population
Psychiatric beds in mental hospitals per 10 000 population
Psychiatric beds in general hospitals per 10 000 population
Psychiatric beds in other settings per 10 000 population
Number of psychiatrists per 100 000 population
Number of neurosurgeons per 100 000 population
Number of psychiatric nurses per 100 000 population
Number of neurologists per 100 000 population
Number of psychologists per 100 000 population
Number of social workers per 100 000 population
Psychologists get training in clinical psychology while working (but without structured clinical supervision). Some psychologists in the private sector carry out counselling.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion, prevention and rehabilitation.
Information Gathering System There is no mental health reporting system in the country. Data collection is poor because of insufficient staff. The country has no data collection system or epidemiological study on mental health. Service reorganization (as prescribed in the existing sectorial strategy document) will allow for standardization of the epidemiological collection system. An information gathering network is not yet developed due to a lack of trained and motivated staff and a lack of infrastructure.
Programmes for Special Population The country has specific programmes for mental health for disaster affected population.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, ethosuximide, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, biperiden, carbidopa, levodopa.
Other Information Even if political and budget programmes are present, the plans in mental health are very slow to activate because of low priority, which leads to ineffective use of even existing human resources and capacities.