Proportion of Mothers Enrolled into Mutual
Health Organizations and its Influence on
the Effective Use of Maternal Healthcare
Services in the Kumbo East and West Health
Districts of the North West Region of Cameroon
Fortune Wainachi Ndim1,2, Okalla Abodo Raphael Therese1, Claude Ngwayu Nkfusai3,4*, Nsoh Marius1,4, Terrence Beteck Epie3,5, Fala Bede3,5 and Samuel Nambile Cumber6,7,8
1Department of Public Health, Catholic University of Central Africa, Cameroon
2Limona Foundation International, Cameroon
3Cameroon Baptist Convention Health Services (CBCHS), Cameroon
4Department of Microbiology and Parasitology, University of Buea, Cameroon
5Department of Medicine, University of Oxford, United Kingdom
6School of Health Systems and Public Health, University of Pretoria Private Bag X323, South Africa
7Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Sweden
8Faculty of Health Sciences, University of the Free State, South Africa
Submission: August 14, 2019; Published: September 10, 2019
*Corresponding author: Ngwayu Claude Nkfusai, Cameroon Baptist Convention Health Services (CBCHS), Cameroon
How to cite this article: Fortune W N, Okalla A R T, Claude N N, Nsoh M, Terrence B E, et al. Proportion of Mothers Enrolled into Mutual Health Organizations and its Influence on the Effective Use of Maternal Healthcare Services in the Kumbo East and West Health Districts of the North West Region of Cameroon. J Gynecol Women’s Health. 2019: 16(3): 555940. DOI: 10.19080/JGWH.2019.16.555940
Background: The role of a mother as a life giver and a home manager has been very important and is still very important through the generations. Women put themselves through a lot of danger during the whole process of conception, and delivery even post-delivery such that as observed over the past so many years, women have been observed to loss their lives in the process. This work therefore had as main objective to find out the influence of existing mutual health schemes on the use of maternal health care services in Kumbo East and West Health Districts of the North West Region of Cameroon
Methods: A quantitative and qualitative cross sectional analytical study was carried out with a prospective and retrospective aspect. A non-probabilistic sampling technique was applied in which a questionnaire was administered to 385 women from the ages of 16-49 who were either pregnant or had at least a child <5years. Epi info, Stata, Excel were used for data entry and analysis. Chi 2 test and the Fisher’s exact test were used in bivariate analysis. The cut off value for significance was considered at p <0.05
Results: A total of 385 women of child bearing age either pregnant or having at least a child under five years old were included in the study both for the quantitative and the qualitative aspect of the study. The proportion of women enrolled into at least a mutual health scheme to those not enrolled is 29.06 is to 70.94. 90.48% of the population said 75% of their health care bills were covered by the MHO unlike 1.9% of the population which says that only 25% of their Bills were been covered by the MHO
Conclusion: The study had as general hypothesis “Mutual health organizations have an impact on the maternal health care utilization amongst women in Kumbo East and West Health District”. From the findings made from this study, we cannot say convincingly that being registered into the mutual health organization influences the use of maternal healthcare services. In conclusion, we reject the general hypothesis (Ho), hence, mutual health organizations do not have an impact on the use of maternal healthcare services in Kumbo.
Keywords: Proportion; Mothers; Mutual health organizations; Kumbo East and West Health Districts
Abbreviations: ANC: Antenatal Care; MMR: Maternal mortality rate; MHO: Mutual Health organization; WHO: World Health organization; CDC: Center of Disease Control; UNFPA: United Nations Population Fund; KE: Kumbo East; KW: Kumbo West; KEHD: Kumbo East Health District; KWHD: Kumbo West Health District; DMO: District Medical Officer; RDPH: Regional Delegate for Public Health; GIZ: German International Cooperation; Org: Organization
The role of a mother as a life giver and a home manager
has been very important and is still very important through the
generations. Women put themselves through a lot of danger during
the whole process of conception, and delivery even post-delivery
such that as observed over the past so many years, women have
been observed to loss their lives in the process. A lot of women
have lost their lives in the process of child birth and many others
are still doing so. This has through a series of research works been
proven. This is in line with what was stipulated in the article Africa
in progress .
Most of these deaths have been observed to be caused by
poorly handled complications probably resulting from deliveries
assisted by unskilled personnel as have been observed in most
of the rural communities. This view is related to work that was
done by (McTavish and Moore.2015) who said that “Every day
approximately 1500 women worldwide die due to pregnancy
childbirth related complications. Maternal health care use is
critical in reducing maternal mortality worldwide “
Globally, there was an estimated 287,000 maternal deaths
in 2010 with 99% of those occurring in developing countries
(WHO.2010). Sub-Saharan Africa had the highest maternal
mortality ratio (MMR) in 2008 with 640 deaths per 100,000 live
births (WHO 2013).
The United Nations report on Trends in Maternal Mortality
2005-2010 categorizes the countries based on their progress
towards MDG 5 targets from 1900 to 2010 . One important
feature of this report is that it demonstrates progress by providing
the average annual percentage change in maternal mortality ratio
(MMR) between 1990 and 2010, and categorizes the countries as
being ‘on track’, ‘making progress’, ‘insufficient progress’, or ‘on
progress’ made over time. Six countries viz. Ethiopia, Madagascar,
and Uganda had <350 MMR in 2010, made sufficient progress
towards achieving their MDG 5 targets, maintained an average
annual reduction rate of >4.5,and had available Demographic and
HEALTH Surveys (DHS) data for 2010 or 2011. The other three
countries viz. Cameroon, Zambia and Zimbabwe had >550 MMR
in 2010, made insufficient or no progress towards achieving their
MDG 5 targets, maintained an average annual reduction rate of <
1.5, and DHS data available for 2010 or 2011.
Another piece of work done by Abeje G  laid emphasis
on the fact that « Pregnancy and childbirth related morbidity
and mortality are serious problems worldwide especially in the
less developed world. Globally about 287000 maternal deaths
occurred in 2010 and the less developed countries accounted
for 99% of the global maternal death . Cameroon has been
observed as well to have a high rate of maternal mortality in Africa
as compared to other African countries with a death ratio of 782
deaths per 100000 live births. (EDS MICS 2011) accessibility to
the various facilities for maternal healthcare that have been put
at the disposal of the community has been observed to be a big
problem. So many women especially women in the rural areas
have the facilities but cannot utilize them due to some constraints
one of which is financial (Gaston Sorgho 2016). Countries such as
Cameroon with the out of pocket system of healthcare purchase
has posed a very heavy financial burden on its population making
it difficult for the poor to access the available healthcare hence
most women who are pregnant decide either to use the traditional
unskilled method of delivery or come to purchase healthcare only
at term hence making it difficult for any underlying complications
which could probably show up to be identified on time.
This work therefore had as main objective to find out the
influence of existing mutual health schemes on the use of maternal
health care services in Kumbo East and West Health Districts of
the North West Region of Cameroon. The study population was
pregnant women and women with children less than 5 years who
were registered into a mutual health scheme as well as those who
were not enrolled.
A quantitative cross sectional analytical study was carried
out with a prospective aspect in the Kumbo East and West Health
Districts of the North West Region. This study was carried out in
the Kumbo East and West Health Districts which both consist of
urban and rural areas. Kumbo East Health District (KEHD) is one of
the 19 health districts in the North West Region same like Kumbo
West Health District (KWHD). KEHD covers a total population of
179932 inhabitants and a surface area of 1087km2. KWHD covers
a population of 99125 inhabitants and a surface area of 1025km2.
Data was collected using a self-administered well-structured
questionnaire which was filled by the respondents and returned.
Prior to use in the study participants, pre-testing was done at
the Biyem Assi Health District Yaoundé so as to ensure that the
questionnaire would be correctly understood by women in the
field. About twenty pregnant women and women with at least a
child less than five years were interviewed using the questionnaire
that had been designed for this study. After the pre-test, adequate
modifications were made on the questionnaires where necessary.
These corrections were made to ensure that instrument was
ready for use. It was estimated that; each questionnaire could be
administered for 30-45 minutes after the pretest.
A total of 385 questionnaires were administered to pregnant
women between the ages of 16-49 years of age and mothers with
children under five years of age. Both those who were registered
in a mutual health scheme and those not registered in any mutual
health scheme were enrolled in this study.
Computing the socio-demographic characteristics of women of
child-bearing age 16-49 such as age, level of education, occupation
and marital status, using categorical variable frequencies. For
the bivariate analysis, the dependent` variable was maternal
healthcare utilization and the independent variable mutual
health. Other independent variables include ANCI, ANC4, Tetanus
injection in pregnancy, Delivery, General healthcare utilization
were computed each with the dependent variable. Cross tables
were done, Chi square test and the Fisher’s test was used to test
for statistical significance and association. The Software that was
used to analysis the data Epi info version 3.0 and version7.0 as
well as STATA and Microsoft Excel.
Ethical clearance was obtained from the school of health science
Ethical Review Board, UCAC. An authorization letter was collected
as well from both from the Director of the catholic university of
central Africa and the Regional delegate of Northwest region to
conduct the study at the Kumbo East and West Health Districts.
Authorization forms were obtained as well from the District
chiefs of service for both Kumbo East and Kumbo West. Consent
and the information forms were also being made available for the
respondents and information gotten during the study was be kept
confidential and use for the purpose of research only. Names of
respondents were not taken for the purpose of confidentiality.
Rather codes were used in order to ensure their confidentiality.
At the end of the study, the questionnaire was burned to ensure
that there is no disclosure of the information that obtained from
A total of 385 women of child bearing age either pregnant or
having at least a child under five years old were included in the
study both for the quantitative and the qualitative aspect of the
study. The main results of the study are presented in two main
sections which are; quantitative results and qualitative results
presentation (Table 1).
The percentage of the health care service bills that are covered
by MHO From the findings gotten, 90.48% of the population said
75% of their health care bills were covered by the MHO un like
1.9% of the population which says that only 25% of their Bills
were been covered by the MHO (Table 3).
This indicates that health service use is more effective amongst
those enrolled into a scheme as its seen that out of 88.39% who
effectively use the healthcare service, only about 8.03% do not
effectively use it. While on the other hand for those who are not
enrolled, out of 87.91% that use the health service effectively, up
to about 12.09% of these women do not use the healthcare service
effectively which is a little elevated compared to the former (Table
The influence of being registered into a mutual health scheme
on the use of ANC services.
P-value (Fisher’s exact test) = 0.683
With the above P-value, it shows that there is no association
between being enrolled in the mutual health scheme and the use
of ANC services. Hence being enrolled into a Mutual health scheme
cannot be pointed out as so much of an encouraging factor for the
use of ANC services given that not many mothers on the other
hand are even enrolled (Table 5).
The influence of being registered in a MHO on the utilization
of assisted delivery services P- Value (Fisher exact test)
=0.5968608087. With the above P-value, it shows that there is not
association between been enrolled in a mutual health scheme and
the use of assisted delivery given that majority of the women are
not enrolled into the mutual health and they still use the services
well as out of 100% of those who responded to the question that
were not enrolled,95.49% were gave birth assisted by health
personnel and only 4.51% of the population did not (Table 6).
One of the objectives was to find out the proportion of women
that are enrolled into mutual health organization to those who are
not registered. From the findings gotten from the field, 29.06%
of the women were enrolled into at least a mutual health scheme
while a greater population of the women was not enrolled like
about 70.94%. A lot of factors contributed to their reason for not
being enrolled into any mutual health scheme. Out of the 70.94%
of the women who were not enrolled into any mutual health
scheme, 41.61% of them said the reason to which they were not
enrolled was because they hadn’t money to register, 36.13% of
them said that they were still to consider getting enrolled while
16.42% of the women said they hadn’t the slightest knowledge on
the existence of the mutual health organization and 2.55% said
they didn’t see the importance of being enrolled. From the above
results, the main reason to which the respondents were poverty
which has contributed greatly to their inability to get enrolled into
any scheme. This is given that a huge sum of money is needed in
order to be part of a MHO and this therefore in a way excludes the
poor community who have farming as their main source of income
and hence have very little left in their pockets for the upkeep of
their families. This finding are contradictory to the findings made
by Ranson et al. . Their findings stated that MHOs are inclusive
of the poorest. On the other hand, the findings are in line with
those made by Bennett et al. ; Jütting ; De Allegri et al. .
They found out that MHOs tend to exclude the poor.
This exclusion is through the fact that enrollment into these
schemes needs at least from the number of four to 10 people for
a start requiring a minimum amount of 20000frs for registration
and most of the time, all of the people that make up this group
are usually from the same family, making it very heavy to remove
that amount of money needed to register hence, they decide not to
register and hence it becomes harder on them when they finally
get sick and are expected to pay heavy bills.
Another factor is associated to the educational level. A P-value
of 0.044 was obtained using the Fisher exact test which indicated
that there was an association between the educational level of the
population and their enrollment into the mutual health scheme.
These findings are in line with those made by (Slavea G chankova,
Sara Sulzbach (2006) who stated that Education of household
head is also positively associated with MHO enrolment.
Given that 54,5% of the sample population was made up of
first school leavers, and 23.9% secondary school leavers this
made 78.4% of the sample population people who had no valid
educational backing that could in turn help them secure a good
job that will in turn give them a good financial state, it made them
limited to peasant farming and other menial jobs. which gave them
just enough money to put food on their table.
16.42% of the population that was not enrolled into any
scheme was made up of these women who hadn’t any idea
about the existence of the organization. This probably could be
associated to poor sensitization on the part of the technical team.
Given that GIZ withdrew their support from the HIV program
in Cameroon, their support to the Mutual health scheme was
withdrawn as well. In kumbo, it made the contributions that came
from the public the only source of revenue that they used to run the
organization. This generally made the running of the organization
very difficult as some of the members of the community started
withdrawing especially those who were on HIV treatment being
supported by GIZ, and those who felt that the organization was
not respecting the % that had been promised for the payment of bills. With the limited finance available for the running of the
organization due to no external support, payment of the field staff
became difficult so very little community mobilization was done
and the population develop cold feet.
The respondents as well said that some of them left the
organization because they felt that they gave their money and
never used it. some of the respondents in their words said that “it
feels like each time one registers into the mutual health scheme,
he stops being sick” this actually served as a discouraging factor to
a number of them considering the fact that they hadn’t been well
oriented from the start.
Additionally, a good number of the respondents 2.55% said
they did not see the importance of being enrolled. They were
positive about the fact that they will rather go straight to the
hospital and use money from their pockets to pay for their health
care bills rather than go put the money in some organization in
the name of “securing for your future”. They will as well prefer to
invest in a business rather than waste their money. This is in line
with the theory of planned behaviour Ajzen and Fishbien (1980)
which says that The best predictor of behaviour is intention.
Intention is the cognitive representation of a person’s readiness
to perform a given behaviour, and it is considered to be the
immediate antecedent of behaviour
Another group of people were the Muslims who make up
14.84% of the sample population. This group of people were not
enrolled because they said it was against their religion to save up
money for future sickness. It was actually considered a sin and
hence their faithful’s did not get enrolled and for the few that got
enrolled, ended backing out up out of fear.
In most African countries, including the low-income, poor and
rural populations have low utilization and coverage rates for key
preventive and primary curative interventions. Because of their
poverty, these populations tend to suffer more health problems;
because of their health problems, they tend to be poorer . There
are many reasons for low utilization of priority health services
in Africa, including poor physical and financial access to care,
socioeconomic factors, cultural factors and perceptions about
the quality of care . with respect to the existence of Mutual
health organizations in the community, which are out to help in
risk sharing and help in the increase of access of the community
to quality health care service, the researcher decided therefore to
find out if the existing mutual health organizations do have any
impact on the use of maternal health care services [11-15]. A
univariate and bivariate analysis was done and all the p- values
gotten but for one which was the influence of educational status
on the enrolment into mutual health was significant. There was
no clear association found between being enrolled in a mutual
health scheme and using either the ANC service, assisted delivery,
General consultation services effectively [16-20]. This is because,
it was clearly seen that regardless of the fact that very few people
were enrolled in the scheme, the fact that the others were not
enrolled did not affect the level of their healthcare service use. The
level of healthcare service use was almost the same amongst those
who were enrolled as well [21-25].
The study had as general hypothesis “Mutual health
organizations have an impact on the maternal health care
utilization amongst women in kumbo East and West Health
District”. From the findings made from this study, we cannot
say convincingly that being registered into the mutual health
organization influences the use of maternal healthcare services. In
conclusion, we reject the general hypothesis (Ho), hence, mutual
health organizations do not have an impact on the use of maternal
healthcare services in kumbo [26-30].
a) There are many reasons for low utilization of priority
health services in Africa, including poor physical and financial
access to care, socioeconomic factors, cultural factors and
perceptions about the quality of care [41-45].
b) The level of healthcare service use was almost the same
amongst those who were enrolled as well
c) Mutual health organizations have an impact on the
maternal health care utilization amongst women in kumbo
East and West Health District [46-49].
WFN, OART, CNN, NM, TBE, FB and SNC designed the study
and were involved in all aspects of the study. WFN, OART, CNN,
NM, TBE, FB and SNC contributed to scientifically reviewing
the manuscript for intellectual inputs and review. All authors
reviewed the final manuscript and agreed for submission.
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