Research Article
Cameroon Government Bonds: An Efficiency Analysis Using a Causal Approach, with a Focus on Financing Universal Health Coverage
Albert Ze*
,
Barnabe Okouda
Issue:
Volume 11, Issue 3, September 2026
Pages:
131-147
Received:
29 June 2026
Accepted:
8 July 2026
Published:
6 August 2026
Abstract: The traditional model of health financing in sub-Saharan Africa, reliant on fiscally constrained state budgets, volatile aid flows, and substantial out-of-pocket household expenditures, has reached its limits. While recourse to local and regional financial markets through bond issuances offers a new source of capital, their impact on UHC remains negligible. This reflects the low responsiveness of the health sector to such inflows, compounded by a historically entrenched bias toward heavy infrastructure investment over direct care delivery. This study aims to assess the impact of Cameroon’s bond issues on the health sector. More specifically, it seeks, on the one hand, to conduct an in-depth analysis of the efficiency and effectiveness of these issuances in light of the set objectives. On the other hand, it examines the extent to which the rollout of universal health coverage has benefited from these resources. To this end, the research relies on a causal analysis that demonstrates the urgent need to break away from the traditional model of financing healthcare investments. The analysis covers the bond issues launched over the 2010-2023 period. The data was sourced from the Ministry of Finance alongside other market participants. The results demonstrate that Cameroon’s multiple bond issuances have not meaningfully benefited the health sector. To effectively advance UHC, Cameroon must urgently reform its health service purchasing mechanisms and adopt a strategic earmarking of its sovereign debt. To this end, this study proposes an innovative “social bonds” architecture to finance UHC mechanisms in Cameroon specifically, and across Africa more broadly.
Abstract: The traditional model of health financing in sub-Saharan Africa, reliant on fiscally constrained state budgets, volatile aid flows, and substantial out-of-pocket household expenditures, has reached its limits. While recourse to local and regional financial markets through bond issuances offers a new source of capital, their impact on UHC remains ne...
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Research Article
Healthcare Utilization in the Context of the Implementation of Universal Health Coverage and COVID 19: Evidence from the Household Living Standards Survey, Côte d’Ivoire
Issue:
Volume 11, Issue 3, September 2026
Pages:
148-158
Received:
18 August 2026
Accepted:
2 September 2026
Published:
24 September 2026
Abstract: Universal Health Coverage was established to reduce financial barriers to healthcare. Nevertheless, inequalities in access—including cases of forgoing care—persist. This study analyzes the determinants of healthcare utilization in Côte d'Ivoire using data from the 2021 Harmonized Survey on Household Living Conditions. This study aims to analyse healthcare utilization in Côte d'Ivoire in the dual context of Universal health coverage scheme (CMU in Côte d’Ivoire) and the COVID-19 pandemic. The individual was taken as the unit of analysis. The analytical sample comprised 64,491 individuals drawn from 12,965 households. Analyses of healthcare utilization were restricted to the 17,220 individuals who reported a health problem in the preceding 30 days. Both the type of care sought and instances of forgone care were recorded. Logistic regression was used to assess associations between sociodemographic, socioeconomic and health-related characteristics and healthcare utilization. Among respondents, 11,017 (64.0%) had sought medical care, whereas 6,203 (36.0%) had renounced despite reporting a health problem. Self-medication was the principal reason for forgoing care. Healthcare utilization was positively associated with younger age (AOR = 2.50; 95% CI [2.03-3.08]), the presence of a chronic condition (AOR = 2.14; 95% CI [1.88-2.45]) and health insurance enrolment, particularly under the UHC scheme (AOR = 2.93; 95% CI [1.86-4.61]). Conversely, primary school education (AOR = 0.83; 95% CI [0.76-0.90]) and living in a household size with one person (AOR = 0.78; 95% CI [0.63-0.96]) were associated with lower odds of seeking care. Neither self-reported COVID-19 infection nor area of residence (rural versus urban) was significantly associated with healthcare utilization. Inequalities in access to care persist despite the introduction of CMU. Strengthening universal access will require both a broader benefit package for people living with chronic conditions and sustained action on health literacy.
Abstract: Universal Health Coverage was established to reduce financial barriers to healthcare. Nevertheless, inequalities in access—including cases of forgoing care—persist. This study analyzes the determinants of healthcare utilization in Côte d'Ivoire using data from the 2021 Harmonized Survey on Household Living Conditions. This study aims to analyse hea...
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