Bridging The Doctor-Patient Gap

Last month, members of the Cameroon Medical Council (CMC) convened in Bertoua, in the East Region, where a sobering reality came to light: an acute shortage of medical doctors, particularly specialists. It emerged that only one paediatrician is serving the entire East Region; one of the country’s largest administrative areas. This shortfall is not confined to the East Region; it reflects a wider national crisis in the availability of doctors. The situation is further compounded by an ageing medical workforce, the suspension of direct recruitment into the public service, and the growing emigration of young physicians seeking opportunities abroad. If left unaddressed, these factors risk undermining the significant progress the government has made, and continues to make, towards building a resilient health sector. The matter demands an urgent response from policymakers. As matters stand, it is difficult for Cameroon’s health system to fulfil its commitment to universal health coverage. This is because thousands of communities live without a single doctor. The figures are stark: the country has fewer than one doctor per 10,000 people, well below the World Health Organisation’s (WHO) target of 4.45 health workers per 1,000 populations. Yet the deeper crisis lies not only in the shortage, but in the distribution of those doctors. Urban hospitals in Yaounde and Douala are reasonably staffed, whereas facilities in rural areas located in regions like the Far North, East, Adamawa, and the conflict-affected North West and South West regions- operate with skeleton staff, if they function at all. If the country is to make meaningful progress on maternal mortality, child health and non-communicable diseases, the human resource gap must be treated as a policy priority, not an afterthought. The scale of the problem becomes clearer when placed in a regional context. Sub-Saharan Africa bears the heaviest disease burden globally, yet it also faces the most acute shortage of health workers. Between 2018 and 2022, 37 countries in the WHO African Region increased their total health workforce, but only 29 saw the density per 10,000 people rise. Population growth is outpacing recruitment, and outmigration continues to drain trained professionals. Cameroon mirrors this pattern. Even with the annual output from existing medical schools, the country faces a structural deficit. Complicating matters further, up to 27 per cent of trained health workers in the country are unemployed, despite a shortfall of 6.1 million at the frontline of health service delivery. The bottleneck, therefore, is not only training capacity, but also financing, deployment and retention. Until these three are aligned, medical schools will continue to produce graduates who cannot be absorbed into the parts of the system where they are needed most. At the same time, hospitals will go dry as patients die for want of doctors. A mandatory service scheme, backed by proper incentives, would extend coverage to underserved areas while making those postings viable for doctors. A two-year compulsory service period in regions with fewer than one doctor per 10,000 people would generate roughly 2,000 doctor-years of service from just two graduating cohorts. The key to making this effective lies in what happens after the service period ends. Rwanda paired mandatory deployment with housing allowances, hardship pay and fast-tracked access to specialist training slots, and saw rural retention rise from 22 per cent to 61 per cent between 2005 and 2015. Beyond coverage, mandatory service gives junior doctors the supervised clinical experience they are currently missing while waiting for public sector posts. For the policy to succeed, the incentives need to be tangible. A hardship allowance of 15 to 20 per cent of salary, guaranteed housing, and a clear pathway to further training are essential. If the programme is perceived as punitive without compensation, it will accelerate brain drain rather than reduce it. Scaling up public-private clinic financing would also create employment outside the State wage bill and bring services closer to the population. The current Cameroon Medical Council programme of 10 clinics per year cannot absorb 1,000 graduates annually, but scaling it up to 150 clinics per year would create immediate posts for 150 doctors, plus additional positions for nurses, laboratory technicians and administrative staff. Financing would naturally push clinics into district areas where there is demand and little competition, helping to correct the geographic misdistribution. Tying finan...