Research Article
Cameroon Government Bonds: An Efficiency Analysis Using a Causal Approach, with a Focus on Financing Universal Health Coverage
Albert Ze*
,
Barnabe Okouda
Issue:
Volume 11, Issue 3, September 2026
Pages:
131-147
Received:
29 June 2026
Accepted:
8 July 2026
Published:
6 August 2026
DOI:
10.11648/j.hep.20261103.11
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Abstract: The traditional model of health financing in sub-Saharan Africa, reliant on fiscally constrained state budgets, volatile aid flows, and substantial out-of-pocket household expenditures, has reached its limits. While recourse to local and regional financial markets through bond issuances offers a new source of capital, their impact on UHC remains negligible. This reflects the low responsiveness of the health sector to such inflows, compounded by a historically entrenched bias toward heavy infrastructure investment over direct care delivery. This study aims to assess the impact of Cameroon’s bond issues on the health sector. More specifically, it seeks, on the one hand, to conduct an in-depth analysis of the efficiency and effectiveness of these issuances in light of the set objectives. On the other hand, it examines the extent to which the rollout of universal health coverage has benefited from these resources. To this end, the research relies on a causal analysis that demonstrates the urgent need to break away from the traditional model of financing healthcare investments. The analysis covers the bond issues launched over the 2010-2023 period. The data was sourced from the Ministry of Finance alongside other market participants. The results demonstrate that Cameroon’s multiple bond issuances have not meaningfully benefited the health sector. To effectively advance UHC, Cameroon must urgently reform its health service purchasing mechanisms and adopt a strategic earmarking of its sovereign debt. To this end, this study proposes an innovative “social bonds” architecture to finance UHC mechanisms in Cameroon specifically, and across Africa more broadly.
Abstract: The traditional model of health financing in sub-Saharan Africa, reliant on fiscally constrained state budgets, volatile aid flows, and substantial out-of-pocket household expenditures, has reached its limits. While recourse to local and regional financial markets through bond issuances offers a new source of capital, their impact on UHC remains ne...
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