Members of the community are gathered at the home of community health volunteer Esua Etienne for a medical consultation. South-West Cameroon © Fanwi Antoinette Buinda/MSF

Cameroon: Community-based healthcare is a lifeline for people displaced by violence

Around a dozen adults and children are waiting patiently for their check-ups. Sitting behind a small table, Etienne Esua listens to the patients, dresses wounds and pricks fingers to perform rapid malaria tests.

“When a test shows that a person has malaria but the symptoms are not severe, I treat the patients with drugs,” he says.

The consultations are taking place on the veranda of an ordinary house in a village in the South-West region of Cameroon. Mr Esua is not a medical professional, but a community volunteer trained by Doctors Without Borders/Médecins Sans Frontières (MSF) to provide primary healthcare to some of the region´s most vulnerable and hard-to-reach communities.

For the past four years, Cameroon´s North-West and South-West regions have been rocked by armed violence between government forces and non-state armed groups, which has displaced more than 700,000 people. Displaced communities face difficulties accessing basic services, including healthcare. The crisis has severely affected the public health system. Many health centres have closed or are non-functional, medical workers and facilities are being directly targeted by violence, and insecurity is hindering the supply of drugs and medical equipment.

Given this high level of insecurity, humanitarian organizations like MSF face serious problems to reach displaced communities, who often hide in the bush for their safety.

Decentralizing care to reach communities

To provide medical aid in such challenging conditions, MSF has set up a decentralized model of care in the South-West and North-West regions, which is delivered directly in the community, by the community. It relies on volunteers like Mr Esua.

“Community health volunteers are the bridge between the health facilities that we support and the vulnerable communities that don´t have access to health centres, either because they are displaced, because health structures are closed or because they can´t afford to pay for medical services,” says MSF field coordinator Yilma Werkagegnehu.

Violet Mesape, community health nurse, is receiving patients in a village in South-West Cameroon. Fanwi Antoinette Buinda/MSF

MSF currently works with 106 community volunteers in several health districts near the towns of Mamfe and Kumba in the South-West region. Similar activities were conducted in the North-West until December 2020, but have been put on hold following a decision from the authorities to suspend MSF activities in the region until further notice.

Community health volunteers have been recommended and selected by community leaders and trained by MSF to detect and treat simple diseases like uncomplicated cases of malaria and respiratory tract infections, malnutrition and diarrhea. They also learn how to carry out health promotion activities to prevent people from getting sick and how to look out for signs of sexual abuse and psychological distress. While they might not be medical professionals, these volunteers are still trained to adhere to medical ethics, and to treat those in need, regardless of background.

The positive impact of community workers

In 2020, community volunteers provided more than 150,000 free medical consultations in the South-West and North-West region.

The community health volunteers are paid incentives for their work and receive backpacks filled with medicines. They meet regularly with MSF supervisors to discuss their work, get advice and share medical data. Their backpacks are refilled before they return to visit remote communities, often walking for several hours a day.

If a treatment is beyond their capacity, community volunteers can refer patients to MSF-supported health facilities where they receive free treatment if they meet certain criteria, such as children with severe malaria, women with complicated pregnancies, survivors of sexual violence or patients with intentional injuries.

Travelling from remote villages to health facilities is a major challenge for many people, due to insecurity, bad road conditions and lack of transport. MSF offers a free, 24-hour ambulance service that operates seven days a week, collects eligible patients at designated pick-up points and takes them to MSF-supported health centres and hospitals. Where we cannot go, MSF provides money for public transport so that patients can reach health structures or pick-up-points. Managing a decentralised model of care and ambulance service is not easy in an insecure environment such as South-West and North-West Cameroon.

“Our community volunteers are sometimes harassed by armed men,” says MSF emergency coordinator for the South-West region, Paulo Milanesio.  “We are in constant dialogue with different stakeholders to guarantee their safety. We need everyone to understand that community volunteers and ambulances provide a much-needed lifeline for vulnerable communities who would otherwise be deprived of medical care.”