Prof. Fru Angwafo III, Director General of the Yaounde Gynaeco-Obstetric and Pediatric Hospital, explains the challenges that have taken place since the introduction of a new management system.

What is Performance-based Financing all about?

In 2006, there about, the State introduced results-based management, thereby enhancing output in the Public Service. At the level of the Yaounde Gynaeco-Obstetric and Pediatric Hospital, we carried out a situation analysis and designed a work system, first, that gave autonomy to the services.

The services were then evaluated with the grill of values that give quality. For instance, hygiene, cleanliness, how fast we take to receive patients and most importantly, how many people are received, are some of the points for consideration that boost performance.

And to do this, we had to discuss with patients to understand what we were doing, so also with caregivers and health personnel. Today, staff receives bonuses for quality work through the World Bank Sector-wide Project for Health, our technical partners. So, it is a collective effort on the one hand by the personnel of the hospital and partners outside. But the key is that patients and families are at the heart of our endeavour.

And if they are satisfied, they come to the hospital and because they come, our revenue goes up. And if the revenue goes up, we can bring down our expenditure and earn bonuses to give back to the workers. In similar manner, the State gets more tax revenue.

What has Performance-based Financing brought to the functioning of your hospital?

We now have more patients. When we took over, the social situation was quiet tense for many reasons. We don’t need to come back to that. We even had strikes by workers because they were not able to get their monthly bonuses and salaries sometimes. I think the situation is very different today. We hope it continues like this.

The former management system did not permit us to have the means to work. Our expenditure was always more than what we needed, creating the tense atmosphere. If certain aspects are taken into consideration, this system can fast track Cameroon’s development in health and human development in general.

You began with some pilot services for this project. How have they been performing?

We started with two services and one unit. We started with the laboratory service that was generating about 10 million FCFA a month, but now produces 40 million FCFA a month. This is four-fold increase in revenue without a corresponding increase in expenditure. Radiology is performing, but not as well as laboratory. On the other hand, the Ophthalmology unit has seen its revenue tripled or quadrupled.

But it is not just a question of revenue because you have to look at how much expenditure goes into the process before you have that revenue. And that is why it is important to have training and good managerial skills not only at the level of the Director General, but especially at the level of the services.