1) Problématic
 Cameroon is off-track with the health related MDGs. Health indicators deteriorated dramatically during the 1990s, matching the economic crisis. In the past five years; some indicators have gradually improved but progress is very slow. The main problems are perceived as :
  • The affordability resulting in high inequities in terms of access to primary health services;
  • Poor management of human resources and financial resources;
  • Large out-of-pocket payments that represent an increasing and unsustainable burden on households;
  • Weak linkages between health spending and priority public health intervention with public spending on health care higher in large cities;
  • Lack of accountability in public budget management.
 In collaboration with its development partners the government of Cameroon has initiated the preparation of a multi-partner supported Health Sector Development Program using a Sector Wide Approach (SWAP). Within this framework, governance and corruption have been identified as critical issues in improving the efficiency and effectiveness of health service delivery in the attainment of health outcomes . The problems and causes vary greatly between different parts of the country.

 2) Impact
 Improve the health system through a better access to health care and quality service to the entire population with the community participation in the management and financing of the health care system
 3) Objectives
 Based on this context, SNV aims to contribute to achieve this by helping our clients to :   • Use of various governance tools to support the voice of health service users but also the voice of those who cannot use the services because of inability to pay ;
  • Improved district management committees and users associations to understand financial flows that will allow more effective planning and transparency ;
  • Finally; ensure that improved governance and empowerment of the service users will be translate into improved quality and sustainability of the services.

 4) Expected results
  • Improved performance of the Health Management Committees to effectively participate to the monitoring and control of the health service delivery
  • Health Management Committees are working in a more effective manner and ensure the integration of health users feedback into the health policies
  • CSOs and networks working in the health sector have the skills to undertake basic tracking of public expenditure and are using this information to advocate for more transparency and efficiency of public spending in health.
  • Health Management Committees are familiar and use tools that enable service satisfaction surveys and the voice of users to be heard,
  • Strong and sustainable partnerships between local councils (steering the process) and other health actors (hospitals, health centres, Community health micro insurances) are built up in order to improve the delivery of the health services,
  • Improved access (with quality treatment) of formally excluded groups (poorest, women, ethnic minorities etc) is evidenced through monitoring tools.
 5) Intervention zones
 North West and Extreme North
 6) Clients (types)
  • Health management committees
  • Health Districts
  • Mutual Health Organisations

 7) Partners
  o Health service providers
  o Government institutions: Lines ministries in charge of health and social insurance (MINSANTE, MIN travail et sécurité sociale)
  o Specialized Programmes under the ministry of Health or international partners: ONUSIDA, PCPA (Programme Concerté Pluri-Acteurs), Malaria Programmes, etc.
  o Development and financial institutions (Donors): GTZ (German cooperation), French Cooperation, CTB(Belgian Technical Cooperation), WHO, UNICEF, etc.
  o Technical and knowledge institutions (Platform of Mutual Health Promoters).
  o Local Capacity Buliders or Service Providers.