“Cameroonian doctors are currently poorly trained”

Dr Rodolphe Fonkoua, President of the National Order of Physicians of Cameroon (ONMC).
The President of the National Order of Physicians of Cameroon (ONMC) paints an alarming picture of the medical situation in Cameroon.
He denounces a training of doctors that is more theoretical than practical with only one University Hospital Center (CHU) for 10 medical faculties and proposes the closure of 08 faculties for better supervision.
It proposes solutions to end endemic unemployment among young doctors within three years.
In addition, Dr. Fonkoua talks about the illegal practice of medicine and proposes solutions to make Cameroon a medical tourism destination. Interview to read in your newspaper.
What is the current state of unemployment among young doctors in Cameroon?
Thank you for this fundamental question. For about three years, a real gangrene has been invited into the Cameroonian medical sphere, namely the unemployment of young doctors. Indeed, for four years, the State of Cameroon has not recruited any more doctors, yet it is the largest employer. If we have to give figures, obviously they would be approximate figures. Know that each year, we train endogenously 750 to 800 doctors. We come from outside about 250 doctors. This means that on the job market in Cameroon each year 1000 doctors are dumped. Since the State no longer recruits, the private sector can consume about 200. What happens to the rest? So it is really a very worrying situation.
In view of all this, what solutions does the National Order of Physicians have to resolve these unemployment problems?
We have been advocating since we arrived. We have met with all the authorities in our country. We have drawn their attention to the fact that training doctors is extremely expensive. The needs are enormous. But we are not recruiting because our country is under the thumb of the International Monetary Fund (IMF). So it is not a lack of will on the part of the State to hire, but unfortunately the IMF seems not to want us to recruit. It is a truly paradoxical subject. I like to use the expression paradoxical unemployment. The needs for doctors are enormous and yet we train them, we employ them. For example, the WHO recommends 2.5 doctors per 1000 inhabitants. In Cameroon we are around 0.5 to 0.6 per 1000 inhabitants. This is to say that the needs are enormous. Even if we had to train to fill at this rate, it would take us about twenty years to make up for our backlog of doctors. So in response to your question, I would say that we need to get out of this situation imposed on us by the country’s economic situation very quickly.
Recently the head of state has forced us to propose about 10,000 doctors over a period of 5 years, so I think that it is when we have perhaps completed this IMF program that things will change. Know that this problem of non-recruitment to the civil service does not only concern doctors, there are also teachers. So these are a few of the problems of adequacy in which we find ourselves.
As an Order, I have doctors, I want them to be recruited. But on the other side I am told that we cannot recruit because the economic situation of our country does not allow recruitment. The question that must be asked in light of the situation is: should we therefore continue to train so many people in order not to recruit? Training a doctor costs between 30 and 70 million. Considering what we produce each year, we are not benefiting from it. They leave and the others benefit. This is an urgent situation. We absolutely must find a solution to this situation that we are going to pay dearly for in the years to come.
What is the assessment of the President of the Order of the training of doctors in Cameroon?
This is an important question. Training is the crucible of any profession. It is not only for the doctor. A poorly trained teacher means children who will be poorly trained. And concerning the doctor, a poorly trained doctor is a danger to himself and to the nation. My assessment is simple. We decided a few years ago to increase the number of medical faculties. Before that, we had only one medical faculty, the CURSS (University Center for Health Sciences, Editor’s note) which was extremely appreciated in the sub-region. It was a renowned faculty, with very high-flying teachers, we are admired by the entire sub-region and why not Africa. Now for certainly noble reasons, we have decided to increase the number of faculties, except that we have done the opposite of what we did when the CURSS was created. When the CURSS was created, we had taken steps to establish contact with teachers before its creation. But today you have the impression that we have created faculties and we are looking for teachers. The second handicap is that medical training has two components. Theory and practice. Theory, I have nothing to say about that, but unfortunately on the practical level, there are many things to criticize. A faculty of medicine should be backed by a CHU (University Hospital Center). We have created 10 faculties against a single headquarters. So I ask myself the question: Where do our children receive their practical training? It is true, we have general hospitals, we have referral hospitals, but not intended to supervise medical students. That is my problem today. Because on the ground, we see that our children have practical gaps that must be filled in the field. So that would mean that, in the first years, they absolutely must be supervised. However, we have medical deserts that need doctors. This problem is a plea that I have made, everywhere I have been. But I think that it was taken seriously by the Minister of State, responsible for Higher Education, to the point where commissions have been set up these days to reflect on the content of the teachings provided in our medical schools. In this content also, I realize that on the ground, our children are missing an important tool, that is to say ethics and professional conduct. I think that a doctor who does not master this tool, which is the humanizing tool which is the compass which frames the profession of good medical practice, is a risk for medicine. We, at the level of the Order, we are fighting to reinstate these courses, which are lecture courses and to absolutely ensure that children understand the importance of these courses in ethics and professional conduct. To summarize, I say Yes, there was perhaps an urgency to train many doctors, but I say let’s go back to the initial idea of the CUZ,which was a training course backed by a university hospital. This is very important. Obviously there are two solutions: creating nine other university hospitals is very expensive, because a university hospital costs billions of CFA francs. Because you have to build and equip. But I think we can have the courage to reduce it to two faculties, one in Yaoundé, one in Douala, but create a university hospital in Douala. We train 700 each year, we can train 350 in Yaoundé and 350 in Douala. For example, in Côte d’Ivoire, they have two medical faculties for four university hospitals. They understood that to have a good vintage, you need university hospitals. The results are visible. This year, Côte d’Ivoire presented nearly 80 candidates for the aggregation, it obtained 77. We were at 17 and we had 3 or 4, that’s the difference. It’s glaring, it speaks for itself.
So, to sum up, the current conditions do not allow for having well-trained doctors?
Yes. I can acknowledge that peremptorily. It would be urgent that we take into account this example that a teacher at the faculty of Dschang lives in Douala and works in Douala. This is unacceptable. In principle, the teacher must work in the city where he teaches. And he must have a service in the city hospital so that the student who did not understand a lesson the day before finds him at the hospital in the morning for further explanations. It is not indicated that a teacher does not live in the city in which he teaches.
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What is the current state of the illegal practice of medicine in Cameroon?
Since I’ve been here, I’ve discovered some terrible things. It’s a real gangrene that’s weighing down medicine. Medical studies are a minimum of 7 years to become a general practitioner, if you want to be a specialist, there are some who go up to 12 years more. Do you see what kind of shortcut you can take to become a doctor in 2 years? In Cameroon, people improvise as doctors. Former medical delegates are doctors. Pharmacy salespeople in pharmacies are doctors, in short, it’s enough for someone to work in a health facility after three or four years to leave there to create their own structure in the neighborhood. So it’s a real octopus. But, who benefit from unimaginable complicity. Even health professionals. I conducted a study in Douala. We have about 3,000 illegal health facilities. So one of the solutions when you talk about youth unemployment, just by cleaning up, we can solve youth unemployment for three years, without asking anything from the State. Just by solving the problem of the illegal practice of the profession. So it is a very great evil that is to the State.
What are the main causes of this phenomenon?
We are all responsible. The public authorities who do not exercise their sovereign role of surveillance because these people do not practice in secret. They have a storefront, in all the neighborhoods we know who they are. The landlord who rents his home to someone illegal knows it. Because the landlord often does not go there to consult. He knows very well that this gentleman is dangerous, but he still rents his house to practice this medicine. The authority has the public force. Concerning the Order, we have a text that frames this scourge very well. The law gives us the possibility of seizing and closing the structures. But unfortunately, we do not have the necessary force to practice. I can say that in the defense of the guardianship, over the past year, too much work has been done. There is an inventory of all the structures on the national territory. It has been completed. Now I believe that with the guardianship, we will go down to the field and demand the opening papers of these training courses. Perhaps through this means we will be able to directly alleviate this situation.
So, what are the Order’s main projects in 2025?
I would like to do a flashback to the year that is ending, to say that we have nevertheless achieved a certain number of things. The first objective when we took office was to reconcile doctors with their house. There was a total lack of love. A total incomprehension. You know that we are coming out of a very trying electoral ordeal that has left its mark, so we had to reconcile this house. The second priority was to computerize our work tool. This is done for those who followed the election year a little, it took us a year to have an electoral register. Today you go to the Order’s website, and you can find out the number of registered doctors. For almost 20 years we had no table, today it is done. It was a priority for us. At the same time, we are concerned about the state of impoverishment of the population. We have set up a mutual insurance company for doctors that will be launched in the coming months and I believe that this was approved by the last General Assembly. We have also started online continuing education courses, these are courses that are very popular, we are at 4 or 5 courses. They will become mandatory from this year. Each doctor will have to prove a certain number of participations in continuing education and obviously, we are going to work a lot with the diaspora. We have made several tours in the diaspora. We have an extraordinarily competent diaspora, but the country does not benefit from it. So we are in discussions with this diaspora, which will participate either in face-to-face or videoconference training or also in welcoming our most deserving children into their department. They promised me. Today, the practice of medicine has evolved a lot, thanks to new technology tools. A surgeon may be in the middle of an operation, calling his colleague from the other side of the world, conversing and helping him to resolve some somewhat difficult situations. So the year 2025 is a year of realization of a certain number of projects.
How will his projects contribute to improving the quality of training for doctors and reducing youth unemployment in Cameroon?
The impact on training is obvious. And we must recognize that we are lacking professionals in medical schools. So if we have skills outside and these brothers are ready to come and lend a hand, I say the doors should be open to them. These are discussions that we have had with the Minister of Higher Education. It is a plea that we are going to make that some of our brothers who are ready to come and lend a hand, that they can do so. We need them. As for unemployment, I continue to say that in principle there should be no unemployment, even for 20 years in this country. We have a galloping population, a galloping demography. Every year there will be needs. So I think that as soon as we get out of this IMF impasse, I think that if the State starts recruiting again like every year, there will really be no unemployment problem.
Considering your various projects with the Order, is there a budget to rent for this purpose?
The Order lives off its own resources. We hardly have any subsidies. Since my predecessor, for 5 or 6 years we have not received any subsidies. Last year, it was allocated to us but we have not yet received it. But I think that if all our doctors paid we would not have this problem. Out of 12,000 doctors registered with the Order, barely 2,300 are up to date. In any case, on December 31, we will publish the list of up-to-date doctors and this list will be intended for insurance companies, the courts of our country and embassies. Because someone cannot call themselves a doctor if they do not fulfill their simple role as a doctor, that is to say, recognize that they belong to a family. So I think that these resources are very important.
How does the Order plan to measure the success of these projects?
We don’t have any feedback. When you come home with a gift and you give it to your child, when he’s happy you know it, because he shows it. So, we have feedback, the doctors are happy with what we do. They are listened to. They pose their problem and we find solutions. We have a very efficient site. Each doctor can create his doctor space. He poses his problem. We have made sure that, when a problem is posed by a colleague, as long as the problem is not resolved, there will be a beep that will prevent our secretaries from working. Until the problem is resolved. So this is to tell you that we are here for the doctors.
Do you feel that all doctors in Cameroon understand you?
You know, big projects, sometimes we are very misunderstood at the beginning. But we need relays like you (Media, editor’s note) to carry this news. But I believe that the doctor is an intelligent man. When you take action, he judges you on your actions. So, I believe that we have good feedback.
There are 12,000 Cameroonian doctors and there are about 2,300 who contribute regularly, that means there is a problem. But now among the others there are doctors, recognized specialists, according to you why do they not pay or contribute regularly?
I think there are several factors. The first factor, many doctors ask the question what the Order is for. That is why I spoke to you about training. If the child who is trained does not know what the Order is. Becoming a doctor, can he know what it is about? At school, you have to start there. The second thing, we have to explore this avenue. I had just done a tour in West Africa, I saw what is happening there. The Order was able to obtain help from the Ministry of Health and the Ministry of Finance. I take the case of Ivory Coast, on January 31 of each year on the January salary, the State debits the account of civil servant doctors, it pays it into the account of the Order. We are going to try this experiment. It is the civil servants who constitute the bulk of our troops. Among the 2300, 80% are doctors from the private sector or the religious sector, because they understand the need. But we are working more and more because civil servant doctors are starting to understand. We have put a small policy in place, we are going to go through hospital directors, in Douala I already have a few CMAs, who will help us collect these funds. I think it is a long-term job, but I believe it should pay off. The contribution is 25,000 CFA francs and it is the lowest in the sub-region.
Any additions?
Personally, I would have liked us to go back to the 70s and 80s when our country was the pride of medicine. I remember that I was a medical student in Abidjan, Cameroonian professors came on a mission to Abidjan. I don’t know if today, a single one goes on a mission somewhere to teach. If it is not them who come to us. The second wish, I have always asked myself this question: can we not also become a country of medical tourism if only for the sub-region. We spend a lot of money every year to go and get treatment abroad, it is a scandal. This money can be capitalized. We have very good doctors. In India for example, 30-40 years ago, these people experienced a large migration to the United States. They trained. But they returned to their country. And the results are visible. India is today the leading destination for medical tourism. I say that we can do it with the diaspora that we have. It is a question of vision, it is a question of will. And I can assure you that we have a diaspora that wants to come and do something with us. We have to welcome them. Unfortunately, it is always in terms of competition that we are afraid. So I have two dreams: to give weight back to our medicine, to its training, we are capable of it and then to make Cameroon a priority destination at least for the sub-region of medical tourism.
Interview by Joseph MBENG BOUM and Ghislaine DEUDJUI