[Guidelines for evaluating the viability of health care centers: test in northern Cameroon]

A working group has developed a manual of practical guidelines for evaluating the viability of health care centers (HCC). These guidelines were tested in 1996 at the HCC in Badjouma, Cameroon. Viability is assessed in three dimensions, i.e. quality of care, cost-effectiveness, and institutional efficacy on the basis of the demand for services, staff requirements, cash flow, and supply costs. Regular evaluation of these parameters allows identification of areas requiring improvement to enhance the viability of the HCC. With only 0.29 visits per year per inhabitant, the attendance rate at the Badjouma facility is low. Public appeal is adversely affected by an under-qualified staff and poor equipment. Overall operating expenses are 6.8 million CFA francs per year and depreciation costs are 1.7 million CFA francs per year. Direct proceeds related to health care services (mainly sale of medication) are 4.1 million CFA francs. The remaining sources of revenue are state subsidies (2.5 million CFA francs) and international aid (0.4 million CFA francs). The deficit is 1.5 million CFA francs corresponding mainly to depreciation costs. Evaluation of the financial viability based on service-generated revenues alone (49%) and on combined domestic revenues, i.e. service revenues and state subsidies (79%), shows that the HCC depends mainly on depreciation costs. Analysis of institutional efficacy by comparing real activity with activity defined in official texts showed that the state was the main decision-maker but also revealed a tendency to pass off responsibility due to poorly defined command structure. The results of this test validate the proposed manual as a tool for global analysis of the activity and relevance of a HCC. Findings can be used to draw conclusions on the effects of national health policies at the local level.