Performance-Based Financing and a Public-Private Partnership Pilot for Universal Health Coverage in Cameroon
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This exemplar examines Cameroon’s attempt to move toward universal health coverage through a public-private partnership pilot built on a longer performance-based financing experience. It considers both the promise of that approach and the constraints created by the absence of a full legal and fiscal framework.
Cameroon’s health system is marked by very high out-of-pocket spending, low public financing, and a long search for workable reform instruments. Private spending accounted for 71.8% of total health financing in 2022, while government health expenditure stood at only 3.9% of GDP and per-capita spending was about USD 58. Since 2011, the country’s main financing innovation has been performance-based financing, first piloted in Littoral and later expanded through the SPARK-Health project. That experience created some of the operational foundations for later UHC efforts, but it did not close the larger financing gap. Cameroon’s UHC effort goes back to a 2017 presidential declaration, but it only moved into implementation territory in 2020 when Société Santé Universelle Cameroun (SUCAM), a private contractor, was selected to manage delivery. After several delays, Phase 1 was formally launched on 12 April 2023 in the Mandjou health district of Bertoua in the East Region. Cameroon's approach combines three main instruments: 1. PBF National Scale-Up: Under SPARK-Health, PBF was integrated into the national system across all districts, incentivizing facilities based on service-delivery outputs adjusted for quality. 2. Chèque Santé: A voucher system for pregnant women enabling access to obstetric care at contracted facilities — a targeted demand-side financing mechanism. 3. UHC Phase 1 via PPP: The SUCAM PPP contract to manage UHC implementation in the East Region targets 6 million beneficiaries, including pregnant women, children under five (free malaria treatment), people living with HIV/AIDS, tuberculosis patients, onchocerciasis patients, and kidney-failure patients on dialysis.
Key Numbers
out-of-pocket spending in total health financing
beneficiaries targeted under UHC Phase 1
online registrations completed in the first year
of GDP spent on government health expenditure
Key Findings
Private spending accounted for 71.8% of total health financing in 2022, while government health expenditure was only 3.9% of GDP and per-capita spending was about USD 58.
The SUCAM PPP contract manages UHC Phase 1 implementation in the East Region, targeting 6 million beneficiaries across six priority groups.
By the end of the first year of implementation, more than 7,000 online registrations had been completed under the UHC pilot.
As of 2025, no formal UHC Bill had been deliberated or passed by the National Assembly, leaving UHC implementation in a regulatory grey zone.
PBF has led to greater availability of medical supplies, increased provider financial autonomy, and enhanced information systems.
Policy Recommendations
PPP as UHC delivery model. Cameroon's SUCAM contract is the boldest service-delivery PPP in African UHC financing. Its success or failure will shape the continental PPP debate. Early signals on enrolment uptake and governance are mixed, reinforcing that PPPs require robust regulatory frameworks as prerequisite (Egypt's three-authority model being the reference
PBF as stepping stone. Cameroon's 14-year PBF trajectory demonstrates that PBF alone is not a path to UHC but can serve as a stepping stone — improving facility-level accountability, information systems, and provider autonomy that are preconditions for an insurance-based financing architecture
Voucher systems as targeted equity tool. Chèque Santé's targeting of pregnant women for free obstetric care is a replicable demand-side intervention, particularly in contexts where full insurance coverage is fiscally infeasible in the short term
The main missing piece in Cameroon is still the legal framework. Without it, the PPP remains exposed, PBF sustainability is uncertain, and the 2017 political commitment lacks full institutional backing
Treasury–MOH coordination. Cameroon's 30-day Financial Control commitment time (vs several months previously) and the 500 million CFA weekly Treasury disbursement are concrete public-financial-management wins. The information-sharing framework between Treasury Committee, DRFP, and Specialized Paymaster is a replicable mechanism for ALM Commitment 6(vi) biennial Minister-level coordination