title: Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel.
abstract: BACKGROUND
  Cameroon is classified by the World Health Organization (WHO) as having a critical shortage of health personnel. This is further complicated by the geographic distributional inequalities of the national health workforce. This shortfall impedes Cameroons' progress of improving the human resources for health (HRH) to meet up with the Millennium Development Goals (MDGs) by 2015. However, it is unknown whether the health workforce of Cameroon is distributed equally across geographic regions. Additionally, indicators other than population levels have not been used to measure health care needs. This study aimed to assess the adequacy, evenness of distribution and challenges faced by the health workforce across the different regions of Cameroon.
  
  
  METHODS
  National health personnel availability and distribution were assessed by use of end-of-year census data for 2011 obtained from the MoPH data base. The inequalities and distribution of the workforce were estimated using Gini coefficient and Lorenz curve and linear regression was used to determine the relation between health personnel density and selected health outcomes. Alternative indicators to determine health care needs were illustrated using concentration curves.
  
  
  RESULTS
  Significant geographic inequalities in the availability of health workforce exist in Cameroon. Some regions have a higher number of physicians (per person) than others leading to poor health outcomes across the regions. 70 % of regions have a density of health personnel-to-population per 1,000 that is less than 1.5, implying acute shortage of health personnel. Poor working and living conditions, coupled with limited opportunities for career progress accounted for some documented 232 physicians and 205 nurses that migrated from the public sector. Significant distributional inequality was noticed when under-five infant mortality and malaria prevalence rate were used as indicators to measure health care needs.
  
  
  CONCLUSIONS
  Our results show an absolute shortage of public health personnel in Cameroon that is further complicated by the geographic distributional inequalities across the regions of the nation. Cameroon aims to achieve universal health coverage by 2035; to realize this objective, policies targeting training, recruitment, retention and effective deployment of motivated and supported health workforce as well as the development and improvement of health infrastructures remain the major challenge.
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. ttandi2002@yahoo.com.|Ministry of Public Health Yaounde, Yaounde, Cameroon. ttandi2002@yahoo.com.|Department of Preventive Medicine, School of Medicine, Graduate School of Public Health, Korea University, Seoul, South Korea. ttandi2002@yahoo.com.
authors.forename: Tinyami Erick
authors.initials: TE
authors.lastname: Tandi
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. neworder@korea.ac.kr.
authors.forename: YongMin
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Ministry of Public Health Yaounde, Yaounde, Cameroon. ajean_aba@yahoo.com.
authors.forename: Aba Jean-Cluade
authors.initials: AJ
authors.lastname: Akam
authors.affiliation: Ministry of Public Health Yaounde, Yaounde, Cameroon. chickofilia@yahoo.com.
authors.forename: Chick Ofilia
authors.initials: CO
authors.lastname: Afoh
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. greenkorea@korea.ac.kr.
authors.forename: Seung Hun
authors.initials: SH
authors.lastname: Ryu
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. koreaskytall@korea.ac.kr.
authors.forename: Min Seok
authors.initials: MS
authors.lastname: Choi
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. kyonghee80@korea.ac.kr.
authors.forename: KyungHee
authors.initials: K
authors.lastname: Kim
authors.affiliation: Institute for Occupational and Environmental Health, Korea University, Seoul, South Korea. shine@korea.ac.kr.|Department of Preventive Medicine, School of Medicine, Graduate School of Public Health, Korea University, Seoul, South Korea. shine@korea.ac.kr.
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Choi
mesh_terms: D000328:Adult; D002163:Cameroon; D019352:Censuses; D005260:Female; D006280:Health Workforce / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D011634:Public Health; D019371:Topography, Medical