Cameroon’s health sector is one of the most underfunded in Africa. Two-thirds
of total health spending in the country comes from people seeking treatment – double the regional average – and studies have shown that the majority of families do not seek health care because the costs are too high. The country also lacks a social safety net and nine out of 10 workers are employed in the informal economy.

The COVID-19 pandemic has brought new urgency to increasing funding for health centers and supporting people who have lost their income. In April 2020, the Minister of Health announcement
a response plan of 58 billion FCFA (105 million US dollars) and on May 4, the IMF approved a US $ 256 million emergency loan to help fund it. In October, the IMF approved a second $ 156 million loan to fund a stronger three-year program of US $ 825 million to support the country’s healthcare system and help businesses and households affected by the pandemic.

Under the May loan, the Cameroonian government promised
use funds transparently and commit to publishing semi-annual reports on COVID-19-related spending; have an independent audit carried out; and publish “documents relating to the results of public contracts and [beneficial ownership information] companies awarded contracts.

Since the start, virtually no public information has been provided regarding government spending related to COVID-19. The health centers have launched an urgent appeal for support of an emergency health fund to which they have contributed 10 percent of their income since 1993, according to medical staff interviewed by Human Rights Watch from various regions in April and May, but said they received no support. The government does not release any information about the fund and has not responded to a letter from Human Rights Watch about it. President established
a second solidarity fund and called on private companies and citizens to contribute, but this fund was not transparent either.

In interviews
with Human Rights Watch, medical staff reported shortages of basic hospital supplies, including thermometers, disinfectants, and medicines, as well as ventilators and oxygen, and protective gear for doctors and nurses, such as masks, gloves and goggles. Doctor noted
his hospital received only 12 masks, 20 boxes of gloves and four full gowns for its 50 employees until the 10 medical facilities in his district finally received a combined total of 10 million CFA francs (US $ 17,000 ) in August.

People who lost their jobs or wages because of the pandemic told Human Rights Watch that they received little or nothing to fight hunger. A woman, who works as a secretary in a hotel in Douala and now earns a third of her usual salary, said in December that she struggled to pay for her children’s food, school fees and other expenses, declaring: “The state has not helped us. Another woman, an event manager at a hotel with reduced pay, said she had to ask her brother to take care of her two children because she could no longer afford them. The two women worked in hotels that the government had requisitioned between March and May to house people who may have been exposed to COVID-19.

Based on more than a dozen interviews conducted by Human Rights Watch, hotels have received very little or no compensation for their costs, which has added financial constraints at a time when the industry was already grappling with restrictions linked to the pandemic resulting in layoffs and sharp wage cuts. The government has not released any information regarding its contracts or reimbursements to these hotels.

After public pressure, the Ministry of Health, citing “the urgency of transparency”, published
a two-page statement on July 29 on how he spent about 22 billion FCA ($ 40 million), which he said was his total spending to respond to COVID-19 in the previous five months. It only included vague categories that offer no real possibility for the public to verify. In its letter, the IMF said the finance ministry was preparing a report on its spending related to COVID-19, which it expects the government to share “in the near term.”

Before the IMF approves a second emergency loan, it called on the government to change its rules to allow it to publish information on the beneficial owners of contracted companies, and to publish “the backlog of all contractors. COVID-19 related contracts awarded since May 4, including beneficial ownership. In a positive move, in October, the government issued a circular require companies to include information on beneficial owners in their contract offers and make it mandatory to add this information to a national registry once a contract is awarded.

In practice, however, the government never uploaded this information to a central database. Instead, he product a list of the names of the companies that have been awarded contracts, the beneficial owners and the amount of the contract, but there is no link to this document on any government website. The only link appears to be on page 47 of an IMF loan agreement. In addition, for almost all businesses, only one beneficial owner is listed, making it highly unlikely that the information is complete.

The government did not publish the contracts themselves, and the IMF revised – it says “clarified” – the terms of the November contract. loan agreement to no longer require the government to do so. Regarding the commitment to carry out an independent audit, the state agency, the Cameroonian State Supreme Control (CONSUPE), has would have
started an audit and the Minister of Finance called
calls for tenders for an independent audit.