Health in Cameroon

Last updated
Laquintinie Hospital, Douala, Littoral Region Hopital Laquintinie de Douala.JPG
Laquintinie Hospital, Douala, Littoral Region

The Human Rights Measurement Initiative [1] finds that Cameroon is fulfilling 61.0% of what it should be fulfilling for the right to health based on its level of income. [2] When looking at the right to health with respect to children, Cameroon achieves 81.7% of what is expected based on its current income. [2] In regards to the right to health amongst the adult population, the country achieves only 70.5% of what is expected based on the nation's level of income. [2] Cameroon falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 30.9% of what the nation is expected to achieve based on the resources (income) it has available. [2]

Contents

The advent of the COVID-19 pandemic brought more light to the deplorable healthcare system and saw the country venturing into Health technology.

A laboratory in Cameroon, picture by John Mbengue Au Laboratoire au Cameroun 04.jpg
A laboratory in Cameroon, picture by John Mbenguè

There is also a shortage in professional medical staff, partially caused by public service hiring quotas. Therefore the staff that works is badly paid and has too much work to do, which makes it difficult to treat patients adequately. Many doctors and nurses which were trained in Cameroon emigrate to Europe – but also to South Africa and Asia – for that reason. [3]

Health infrastructure

As of 2016, Cameroon's health map illustrates 10 regions, 189 health districts, 1800 health areas and approximately 5166 public and private health facilities spread throughout the national territory. Access to health services in Cameroon in 2016 was at 2.19 health facilities per 10,000 inhabitants. [4] The health facilities are organized into seven main categories: general hospitals, central hospitals, regional hospitals, district hospitals, district medical centers, Integrated health centers and ambulatory health centers. [5]

Health status

Demographics

Life expectancy in Cameroon Life expectancy of Cameroon.svg
Life expectancy in Cameroon

Life expectancy

The 2014 CIA estimated average life expectancy in Cameroon was 57.35 years. [8] However, in 2017, the estimates were 65.5 and 61.0 years for females and males respectively. [9]

Birth rate and population

The population is estimated as 24,053,727 in 2017 [10] and Central Bureau of Census and Population Studies gives an official projection of 24,348,251 in 2019. [6]

There has been substantial increase from 2.3 million in 1900 through 4.34, 8.66, 11.7, 15.4, 20.1 millions in the years 1950, 1980, 1990, 2000, 2010 respectively. [11]

Health Expenditure Profile

The per capita income of Cameroon in 2017 is $3,640, making it a low middle income country. [10] The current Health expenditure (CHE) per capita has been on an increase in the last 20 years; US$43, 48, 54 and 64 in the years 2000, 2005, 2010, 2016 respectively though out-of-pocket spending has been the main source of payment for health services for majority of Cameroonians throughout this period. [12] In 2016, of the health expenditure per capita of $64 spent, estimated that out-of-pocket spending accounted for 70% while domestic public spending, voluntary health insurance, aid accounted for 13%, 9% and 6% respectively and other sources just 2%. [12]

Major causes of death

From 1990 till 2018 communicable, maternal, neonatal diseases as group is the leading causes of death followed by non-communicable diseases and injuries in Cameroon and Sub-Saharan Africa. However, globally this is not the same pattern observed as the group of non-communicable diseases has been the leading cause of death followed by the group of communicable, maternal & neonatal diseases and thirdly the group of injuries in the last three decades. [9] The top ten causes of death in 2018:

HIV/AIDS

HIV/AIDS is the second cause of death in Cameroon in 2018 after malaria. Progress had been made in AIDS-related death and new infections in Cameroon; reduction in the number of deaths from 22,000 to 18,000 and the number of new infections from 36,000 to 23,000 between the years 2010 and 2018. In 2018, 540,000 people were living with HIV and the prevalence among adults (15–49 years) was 3.6%. [14] Moreover, the incidence among all people of all ages in Cameroon is 1.02% in 2018. [14] In Sub Saharan Africa, the incidence (new infections per 1,000 of population) among adults (15–49 years) declined from 3.39 in 2010, 2.49 in 2015 to 2.14 in 2017 and globally for adults it also declined from 0.44 to 0.40 between 2015 and 2017. [15]

Many organizations have been partnering with the government of Cameroon via the ministry of public health (MINSANTE) to against this disease.

Incidence of HIV in Cameroon from 1990 to 2018 Incidence of HIV in Cameroon from 1990 - 2018.jpg
Incidence of HIV in Cameroon from 1990 to 2018

Maternal and child healthcare

The under 5 mortality rate, per 1,000 births is 155 and the neonatal mortality as a percentage of under 5's mortality is 24. In Cameroon the number of midwives per 1,000 live births is 0.2 and the lifetime risk of death for pregnant women 1 in 35. [16]

As of 2017:

Maternal mortality ratio

The maternal mortality ratio is defined as the number of women who die due to causes related to pregnancy or aggravated by pregnancy and provision of care with such deaths occurring during pregnancy or delivery or within 42 days after the end of pregnancy, whatever the duration or type of pregnancy, expressed per 100,000 live births for a given period. [7] The maternal mortality ratio of Cameroon has shown decline in the last three decades from 728 per 100,000 live births in 1990 and to 596 in the year 2015. These deaths are however preventable with appropriate management and care. However, more efforts are needed so as to meet the global Sustainable Development Goals target of this indicator which is less than 70 per 100,000 lives births by 2030. [7] [17] In the world at large, it reduced significantly by almost half (44% reduction) from 385 in the year 1990 to 216 in the year 2015; as compared to Sub-Saharan Africa from 987 in 1990 from 546 in 2015. [17]

Table 1: Maternal Mortality Ratio in Cameroon from 1990 to 2015

YearsMaternal Mortality Ratio
2015596
2010676
2005729
2000750
1995749
1990728

Source: World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015

Coverage of skill birth attendants

In Cameroon, there has been a drop from 63.4% in 1990 to 56.8% in 2000 and then an increase to 67.9% in 2017. [9] However, Globally, the 81% of live births worldwide occurred with the assistance of a skilled health personnel in 2018, up from 62% in 2005 and 69% in 2012 whereas that of Sub-Saharan Africa is just 59%in 2018. [15]

This increase in the coverage of live births by skilled birth attendants from the year 2000 in Cameroon could be attributed to the increase in the number of training institutions of health owned by the government, faith-based organization and also by private individuals; and also increase in the number of skilled health personnel employed in health facilities. Moreover, possibly because of the increase in mother and child health campaigns and demand to seek health this services in health facilities though traditional birth attendants are also present. [5]

Coverage of skill birth attendants, Cameroon Coverage of skill brith attendants, Cameroon.jpg
Coverage of skill birth attendants, Cameroon

Family planning needs met

The proportion women of reproductive age (15 to 49 years) in Cameroon who have their family planning needs met with modern contraception methods increased about three folds from 14% in 1990, to 43.1% in 2015. As of 2017, still not up to half of women of reproductive age have their family planning needs as met as the percentage stands at 44.7%. [18] However, progress has been globally even though slowly from 74% in 2000 to 76% in 2019. [15]

Met need for family planning with modern contraception methods, Cameroon Met need for family planning with modern contraception methods, Cameroon.jpg
Met need for family planning with modern contraception methods, Cameroon

Under-5 mortality and neonatal mortality

Globally in the year 2000, the Under-5 mortality rate was 43 per 1,000 and neonatal mortality rate (likelihood of dying in the first 28 days of life) was 31 per 1,000. [15] Also globally, in 2017, the Under-5 morality and neonatal rates stood as 39 and 18. [18] As for Cameroon, the Under-5 and Neonatal mortality rates have shown a decline from 135.6 and 39.3 in 1990 to 73.5 and 23.4 in 2017 respectively. Many kids still die before getting celebrating their 5th birthday in Cameroon.

Table 2: Under-5 Mortality and Neonatal Mortality rates 1990–2017

YearUnder-5 Mortality RateNeonatal Mortality
201773.523.4
201677.524.3
201581.524.9
2010103.028.1
2005122.531.2
2000134.232.9
1995139.137.3
1990135.639.3

Source: [9]

Road injury

Transport injury is among the several types of injury. Pedestrian, cyclist, motorcyclist locally called "benskin" or "okada", motor vehicles, are among the most used road transport in Cameroon. As of 2014, the number of vehicles was estimated at 675,000. Recording more than 16,000 road accidents per year with more than 1000 deaths. In addition to the human loss which is dramatic, the economic loss is estimated at 100 billion FCFA (approximately US Dollars 168 million) per year. [19] The estimated number of people killed per 100 million km driven was 73, which is more than 35 times higher than on similar roads in the US and Europe.

Road traffic injury is a major cause of death in Cameroon and among the top ten causes in 2018. The estimates of the deaths per 100,000 in the year 2017 from all transport injuries was 15.88 while road injury alone was 14.79 in Cameroon. Moreover, the deaths per 100,000 were 17.96 low income countries had as opposed to 10.39 in high income countries. In 2017 in Sub Saharan Africa, the number of deaths per from road traffic injuries were estimated at 161,648. [9] Road traffic accidents are the largest cause of unintended injury in all regions, among low, middle income and high income countries. However, in developing countries, they have to deal with road accident in addition to some communicable diseases which are not a major issue in the high income countries. [20] This numbers of deaths from transport injury for Cameroon have increase from 3391 to 4408 in the last two decades with increasing number of death recorded among he males population. [9]

Percentage distribution by Sex of deaths due to Road Injury in Cameroon, 2017. Data from: https://vizhub.healthdata.org/gbd-compare/ Death (Percentage) due to Road Injury in Cameroon, 2017 - Distrbution by Sex.jpg
Percentage distribution by Sex of deaths due to Road Injury in Cameroon, 2017. Data from: https://vizhub.healthdata.org/gbd-compare/

These deaths could be as a result of several factors grouped into: transport operator (driver, cyclist, motorcyclist) factors, the state of the means of transport, the road or pavement, and also other environmental factors.

Distribution of the Death due to Road Injury in Cameroon, 2017 - Distribution by Age. Data from https://vizhub.healthdata.org/gbd-compare/ Age Distribution of the Death due to Road Injury in Cameroon,2017.jpg
Distribution of the Death due to Road Injury in Cameroon, 2017 - Distribution by Age. Data from https://vizhub.healthdata.org/gbd-compare/

The Sustainable Development Goal number 3 (Ensure healthy lives and promote well-being for all ages) has nine major targets. The target number 6 which involves road injuries states:

Table 3: Number of deaths in Cameroon, Sub-Saharan Africa and the Globe from Traffic Injury (Road traffic Injury) 1990 - 2017

YearCameroon - Deaths from

Transport Injury (Road Traffic Injury)

Sub-Saharan Region - Deaths from

Transport Injury (Road Traffic Injury)

World - Deaths from

Transport Injury (Road Traffic Injury)

20174408 (4108)172,283 (161,647)1,335,004 (1,243,068)
20164441 (4119)170,780 (160,446)1,345,442 (1,252,392)
20154317 (4074)169,377 (159,036)1,347,696 (1,252,514)
20104356 (4053)167,183 (156,985)1,394,717 (1,299,939)
20053484 (3484)166,077 (155,417)1,377,836 (1,284,407)
20003391 (3158)162,369 (151,565)1,376,105 (1,282,553)
19902680 (2535)131,216 (124,172)1,228,046 (1,150,717)

Source: [9]

Reports: Road Safety: Cameroon must redouble its effort and strengthen coordination [19]

In Cameroon, ministry of transport in collaboration with other ministries have been enforcing several methods to reduce this deaths in several sensitization campaigns (in schools, sending short messages to subscribers phones, special back to school programs), teams to do unannounced controls, alcohol test for drivers, improving on the high way signs, rehabilitation of road etc. However, she needs to redouble her effort and improve coordination, [19] cooperation with as well as human behavior in order to greatly reduce not only the number of deaths but also the Disability-adjusted life year DALYs which stands at 226,673 (157,195 for men) [9] road injury alone for Cameroon.

United Nations: Sustainable Development Goals, 2016–2030

Cameroon understands that the importance of the Sustainable Development Goals (SDGs) cannot be over emphasized as the program takes into consideration the problems of development in the dimensions of security, economy, social, human and the environment. [21] Cameroon adopted all 17 SDGs but also understands that it will be demanding for her in reporting and also in achieving the objectives. Main challenges identified were:

The SGDs are implemented in Cameroon against the backdrop of an update of development policies and strategies resulting in the facilitation of their integration. In addition, for the conclusion of an economic and financial program, with the International Monetary Fund (IMF), an interim development strategy has been prepared taking into account the contextualized SDGs. On security fronts, repeated attacks from the Boko Haram terrorist group in the Northern regions since 2014, flow of Central African refugees in the East region, and also the internal crisis in the North-West and South-West regions since 2017. These factors affect the mobilization of domestic funds which has negative impact on the achievement of SDGs. [22] Some strides have been made in the implementation of the Agenda 2030 in the areas of education, economic growth, policies and institutions but the aforementioned factors and host of other factors threaten even the little gains achieved in these areas. [22] [23]

Key factors identified to the success of the implementation of the SDGs will be their inclusion in the budget; and the enhancement of the statistical mechanism for the follow-up of the progress. [22]

Cameroon was part of the national voluntary review on the implementation of SDGs and the high level political forum on sustainable development New York in July 2019. The government has indicated that concrete actions and strategies are needed to:

Related Research Articles

<span class="mw-page-title-main">Child mortality</span> Death rate of infants and young children

Child mortality is the mortality of children under the age of five. The child mortality rate refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.

<span class="mw-page-title-main">Health in Nigeria</span> Overview of health in Nigeria

In Nigeria, there has been a major progress in the improvement of health since 1950. Although lower respiratory infections, neonatal disorders and HIV/AIDS have ranked the topmost causes of deaths in Nigeria, in the case of other diseases such as monkeypox, polio, malaria and tuberculosis, progress has been achieved. Among other threats to health are malnutrition, pollution and road traffic accidents. In 2020, Nigeria had the highest number of cases of COVID-19 in Africa.

<span class="mw-page-title-main">Health in Malaysia</span>

Malaysia is classified by The World Bank as upper middle income country and is attempting to achieve high-income status by 2020 and to move further up the value-added production chain by attracting investments in high technology, knowledge-based industries and services. Malaysia's HDI value for 2015 was recorded at 0.789 and HDI rank no 59 out of 188 countries and territories on the United Nations Development Programme's Human Development Index. In 2016, the population of Malaysia is 31 million; Total expenditure on health per capita is 1040; Total expenditure on health as % of GDP (2014) was 4.2 Gross national income (GNI) per capita was recorded at 24,620

<span class="mw-page-title-main">Health in Ethiopia</span> Overview of health in Ethiopia

Health in Ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. A central feature of the sector is the priority given to the Health Extension Programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. The development and delivery of the Health Extension Program, and its lasting success, is an example of how a low-income country can still improve access to health services with creativity and dedication.

<span class="mw-page-title-main">Health in Kenya</span> Health status and problems in Kenya

Tropical diseases, especially malaria and tuberculosis, have long been a public health problem in Kenya. In recent years, infection with the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), also has become a severe problem. Estimates of the incidence of infection differ widely.

Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards. Prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. Moreover, the country's topographical and sociological diversity results in periodic epidemics of infectious diseases, epizootics and natural hazards such as floods, forest fires, landslides, and earthquakes. But, recent surge in Non communicable diseases has emerged as the main public health concern and this accounts for more than two-thirds of total mortality in country. A large section of the population, particularly those living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition and other health-related events. Nevertheless, some improvements in health care can be witnessed; most notably, there has been significant improvement in the field of maternal health. These improvements include:

<span class="mw-page-title-main">Health in Tajikistan</span> Overview of health in Tajikistan

The Tajikistan health system is influenced by the former Soviet legacy. It is ranked as the poorest country within the WHO European region, including the lowest total health expenditure per capita. Tajikistan is ranked 129th as Human Development Index of 188 countries, with an Index of 0.627 in 2016. In 2016, the SDG Index value was 56. In Tajikistan health indicators such as infant and maternal mortality rates are among the highest of the former Soviet republics. In the post-Soviet era, life expectancy has decreased because of poor nutrition, polluted water supplies, and increased incidence of cholera, malaria, tuberculosis, and typhoid. Because the health care system has deteriorated badly and receives insufficient funding and because sanitation and water supply systems are in declining condition, Tajikistan has a high risk of epidemic disease.

<span class="mw-page-title-main">Health in Niger</span>

Niger is a landlocked country located in West Africa and has Libya, Chad, Nigeria, Benin, Mali, Burkina Faso, and Algeria as its neighboring countries. Niger was French territory that got its independence in 1960 and its official language is French. Niger has an area of 1.267 million square kilometres, nevertheless, 80% of its land area spreads through the Sahara Desert.

<span class="mw-page-title-main">Health in Bangladesh</span>

Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.

The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.

According to the World Bank income level classification, Portugal is considered to be a high income country. Its population was of 10,283,822 people, by 1 July 2019. WHO estimates that 21.7% of the population is 65 or more years of age (2018), a proportion that is higher than the estimates for the WHO European Region.

<span class="mw-page-title-main">Health in Burkina Faso</span>

A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index .Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.

<span class="mw-page-title-main">Health in Burundi</span>

Burundi is one of the poor African countries with heavy burden of both communicable, maternal, neonatal, nutritional, and non-communicable diseases. The burden of communicable diseases generally outweighs the burden of other diseases. Mothers and children are among those most vulnerable to this burden.

<span class="mw-page-title-main">Health in Tanzania</span>

The 2010 maternal mortality rate per 100,000 births for Tanzania was 790. This is compared with 449 in 2008 and 610.2 in 1990. The UN Child Mortality Report 2011 reports a decrease in under-five mortality from 155 per 1,000 live births in 1990 to 76 per 1,000 live births in 2010, and in neonatal mortality from 40 per 1,000 live births to 26 per 1,000 live births. The aim of the report The State of the World's Midwifery is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child

Malawi ranks 170th out of 174 in the World Health Organization lifespan tables; 88% of the population live on less than £2.40 per day; and 50% are below the poverty line.

<span class="mw-page-title-main">Health in Lesotho</span>

Lesotho's Human development index value for 2018 was 0.518—which put the country in the low human development category—positioning it at 164 out of 189 countries and territories. Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Access to health services is difficult for many people, especially in rural areas. The country's health system is challenged by the relentless increase of the burden of disease brought about by AIDS, and a lack of expertise and human resources. Serious emergencies are often referred to neighbouring South Africa. The largest contribution to mortality in Lesotho are communicable diseases, maternal, perinatal and nutritional conditions.

Zambia is a landlocked country in Sub Saharan Africa which experiences a burden of both communicable and non-communicable diseases. In line with WHO agenda for equity in health, it has adopted the Universal Health Coverage agenda to mitigate the challenges faced within the health sector. The Ministry of Health (MOH) provides information pertaining to Zambian health. The main focus of the Ministry of Health has been provision of uninterrupted care with emphasis on health systems strengthening and services via the primary health care approach.

Even though Panama has one of the fastest growing economies in the western hemisphere, an estimated 500,000 people are in extreme poverty. Panama has major socioeconomic and health inequalities between the country’s urban and rural populations. The indigenous population lives in more disadvantaged conditions and experiences greater vulnerability in health. In general, the population living in more marginalized areas has less service coverage and less access to health care.

<span class="mw-page-title-main">Sustainable Development Goal 3</span> Good Health and Well-Being

Sustainable Development Goal 3, regarding "Good Health and Well-being", is one of the 17 Sustainable Development Goals established by the United Nations in 2015. The official wording is: "To ensure healthy lives and promote well-being for all at all ages." The targets of SDG 3 focus on various aspects of healthy life and healthy lifestyle. Progress towards the targets is measured using twenty-one indicators.

References

  1. "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-03-13.
  2. 1 2 3 4 "Cameroon - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-13.
  3. Rose Futrih N. Njini (December 2012). "The need is so great". D+C Development and Cooperation/ dandc.eu.
  4. MINSANTE, Cameroon Health Map 2016.
  5. 1 2 Cameroon: Health Analytical Profile 2016
  6. 1 2 Central Bureau of Census and Population Studies.http://www.bucrep.cm/index.php/en/
  7. 1 2 3 "Tracking the 100 core indicators for Cameroon, 2017" (PDF). www.healthdatacollaborative.org.
  8. "CIA - The World Factbook Life Expectancy". Cia.gov. Archived from the original on 2018-12-29. Retrieved 2014-06-24.
  9. 1 2 3 4 5 6 7 8 9 10 Institute of Health Matrics and Evaluation.http://www.healthdata.org
  10. 1 2 World Bank 2018, Cameroon
  11. Gapminder Tools.https://www.gapminder.org/
  12. 1 2 WHO| Global Health Expenditure Database 2018. [ dead link ]
  13. Centers for Disease Control and Prevention (July 2019). "CDC in Cameroon" (PDF).
  14. 1 2 "UNAIDS Report" . Retrieved 19 September 2019.
  15. 1 2 3 4 "Goal 3 .:. Sustainable Development Knowledge Platform". sustainabledevelopment.un.org. Retrieved 2019-09-22.
  16. "The State Of The World's Midwifery". United Nations Population Fund. Archived from the original on 20 January 2012. Retrieved 1 August 2011.
  17. 1 2 World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.
  18. 1 2 "Levels and Trends in Child Mortality Report 2018". 13 September 2018.
  19. 1 2 3 "UNECE Cameroon Report" (PDF). www.unece.org. Retrieved 19 September 2019.
  20. Skolnik, Richard (2016). Global Health 101. Third Edition. Michel Brown.
  21. 1 2 RAPPORT DE LA SITUATION DE REFERENCE DES INDICATEURS DES OBJECTIFS DE DEVELOPPEMENT DURABLE AU CAMEROUN _version 26 novembre 2017.pdf
  22. 1 2 3 "Cameroon .:. Sustainable Development Knowledge Platform". sustainabledevelopment.un.org. Retrieved 2019-10-19.
  23. 1 2 H.E. Alamine OUSMANE MEY (2019). "Voluntary National Review on the Implementation of SDGs in Cameroon" (PDF).