Stephen Eyong Njang Ayongi
I am a young ambitious physician and researcher. My goal is to impact my community far beyond the scope of health. I am seeking to acquire a lot of skills to permit me empower myself and community.
Location Cameroon
Activity
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My special appreciations to FutureLearn, UNICEF, and Prof McPake and colleagues for this very informative and engaging course. The best online course and resource I have come across so far.
Many thanks again!
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Stephen Eyong Njang Ayongi made a comment
A mix of the above. Either of both will undermine the potential health benefits of the other. A mix will create a balance and potential for flexibility, considering the HS is a complex and adaptive system.
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Many donors with poor coordination, weak or unavailable data, geographical challenges.
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Stephen Eyong Njang Ayongi made a comment
I think the community nurse in this context is already motivated as highlighted. The social prestige counts a lot, and this task-shifting increases their prospect of specialization and career advancement.
Both community and hospital-based nurses are already equally enumerated. Any financial incentive will cause disequilibrium in the wage structure in my...
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Stephen Eyong Njang Ayongi made a comment
In my setting, the private sector personnel is more motivated, and efficient as compared to those in the public sector. In the private sector, productivity is easily objectivized and hence easily rewarded.
Moreover as rightly stated above, in the public sector reward comes solely from longevity (irrespective of productivity) and even worst as a favor.
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Stephen Eyong Njang Ayongi made a comment
Task shifting does a whole lot of good in LMICs settings with limited specialized personnel closer at the community level. For example, in a rural setting in Cameroon, short intensive training of Nurse assistant in midwifery has shown to significantly reduce perinatal and maternal mortality from open observation.
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Stephen Eyong Njang Ayongi made a comment
Good for any LMICs, especially as the policy blind spot is so significant in such settings. Yet the informal, lay, private, non-allopathic workforce always closer to their communities, thereby determining the type and quality of healthcare they get.
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The actual number of health workforce represented by WHO is much lower than the real-time actual numbers in Cameroon. This is because of the gross unavailability of data.
First and foremost this means Health system strengthening strategies, in Cameroon, should focus initially on training quality public health personnel to improve research endeavors in the...
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Stephen Eyong Njang Ayongi made a comment
Hello,
I am a M.D, working at DHS, Cameroon. Looking forward to more evidence on COVID-19.
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Stephen Eyong Njang Ayongi made a comment
Great!
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What are the advantages of repurposing medicines compared to using a new investigational product?
Basically, an already otherwise good safety profile for pre-existing drugs compared to experimental drugs. serves the urgency too in an emergency situation like the pandemic we have now.
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, poor adherence to preventive measures which is secondary to limited resources such as mask and sanitizers, money, etc. At national level, delayed or no implementation of effective policies such as lockdown and adopting physical policies to help citizens with lockdown challenges.
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Hi Dominic, can we have videos in 480p. Videos take forever to load with my 3G connection over here. Many thanks
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Self-isolation personally causes me a lot of boredom and potential mild depression, especially given no football games. I think it is really extreme and will drive a lot of people into mental breakdowns, especially those with past history of mental disorders.
To conclude, I think even at individual level these interventions should be contextualized. Data on...
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Much courage @MargaretFranklin
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Stephen Eyong Njang Ayongi made a comment
@annaSeale I would have loved to hear about the response in Italy.
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@SeanKnowles Slippery terrain here. A lot of emotions rising and for the record Dr. Mira's comments and assumptions were inflammatory. Publicly assuming no mask or treatment/resuscitation is available in an entire continent is not only naive and reckless but provocative. Maybe she should apologize, publicly.
However, I think for future endeavors and for the...
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Well said. The ensuing economic deep is the main source of anxiety and stress in my country people, even more than the disease itself. This greatly reduces the effectiveness of PH interventions such as physical distancing. #StayHome is trending, yet minimal impact in curbing the spread of COVID 19.
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Stephen Eyong Njang Ayongi made a comment
Great response here by Singapore.
In my setting, contact tracing is being used. Hence the continuous rise in active cases mainly in the capital and economic cities which saw a huge influx of individuals from Europe mainly.
However, this approach has yielded less results in controlling the spread of COVID-19 because most of these individuals feel...
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Stephen Eyong Njang Ayongi made a comment
How can mental health wellbeing be supported in individuals, and society as a whole?
In my context, Cameroon, the type of information sharing should also be positive in order to lower anxiety and encourage community engagement. For example, focus can be shifted a little to the number of recovered cases, which will tend to promote hope, positive behaviors...
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Stephen Eyong Njang Ayongi made a comment
Great talk, thanks!
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Stephen Eyong Njang Ayongi made a comment
Infectious diseases with very short incubation periods and, or diseases with very specific symptoms/syndromes as viral hemorrhagic diseases.
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Country-level coordination is in shambles in some countries, evident by their epidemiological curve amongst others. How does WHO and its allied multilateral agencies see to this loophole in this current pandemic?
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, we are in a containment phase. Clusters of cases were identified, all coming in from Europe with high Covid-19 burden. Presently, contact tracing, isolation and screening is focused on those who recently entered the country from abroad.
However due to poor initial response, possibly due to limited resources, cases are on a geometric rise, which...
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@SherryNRN(non-practicing) Thank you very much for this insight!
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I am still concerned the source of SARs CoV-2 have not yet been objectively identified.
It seems closing the Huanan wholesale seafood market early in the course of the outbreak in Wuhan did not curb transmission rates in and out of China. Why is that??
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Case fatality initially at 2% will eventually rise to unprecedented levels. This is because of other infectious diseases and especially Non-communicable diseases (NCDs) which continues to rise, basically constituting comorbid conditions.
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aerosols are smaller than droplets (<5ug).. travel greater than 1metre
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Stephen Eyong Njang Ayongi made a comment
Great start already.
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Stephen Eyong Njang Ayongi made a comment
NHA to me can serve as a great accountability tool. I think all HS should adopt one.
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Stephen Eyong Njang Ayongi made a comment
Well to begin, evidence shows total government expenditure to constitute the major contributor to Total Health Expenditure (THE) for countries with strong HS. Thus overemphasizing the government's role in the health sector. Evidence also revealed countries with greater government expenditure had very few out-of-pocket payments, reduced inequity, and had better...
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Stephen Eyong Njang Ayongi replied to Anam Arshad
@KennedyOseiMensah In theory, yes. However not true in reality. In my country like most LMICs, top government officials do not truly buy their supposed luxury goods. It's being given to them as bonuses, hence they do not pay any indirect taxes.
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Totally agree with you.
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Stephen Eyong Njang Ayongi made a comment
Health revenue from indirect taxes is more or less proportional, if not regressive, hence inequitable. Taxes like VAT (for example from public electricity consumption) are usually a flat rate for a vast proportion of the population.
Usually in reality, especially in LMICs, the "rich" by virtue of their social status are exempted from indirect taxes. For...
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Stephen Eyong Njang Ayongi made a comment
Out of pocket payment will cause impoverishment for the poor and not the rich. Ripple effects are the poor would not be able to readily access or afford healthcare. Hence increasing inequity.
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Mandatory social health insurance. This can be used to pool a fraction of funds from the entire informal sector workers to finance health. I can't really tell if it's progressive, however since the informal sector is large, much funds can be pooled to address service delivery for the entire population.
Voluntary health insurance would be ineffective in...
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Stephen Eyong Njang Ayongi made a comment
Increase societal inequity across many sectors.
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Stephen Eyong Njang Ayongi made a comment
Intense week three!
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All strategies were not integrated with that of the government and provinces, so there were overlaps or gaps in responsibilities and service delivery.
However, it was evident the learning approach in implementation allowed for innovation which had a positive impact.
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In my context, poor mental health coverage. One of the major 'bottlenecks' would be poor awareness and neglect of service delivery across all levels of the health system.
Now information technology strategies can increase population awareness on mental health-related conditions. Meanwhile, health workforce and finance interventions can increase the...
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Stephen Eyong Njang Ayongi made a comment
The way I see it CHWs will increase health care coverage when community-based/less integrated. Most importantly, they help bridge that equity gap when they are more community-oriented.
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Integration to formal HS will increase their supplies and support, and permit a better and more steady remuneration.
However, increase integration will take them away from the community. CHWs might start to fancy working in facilities than within the community. Also, they will be vulnerable to the huge ego of formal health system staff, who will view them...
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Bangladesh devoted adequate resources, training, and supervision to the CHW program.
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A mix of both. Maybe most should start as volunteers, gain their communities' trust, then be formally trained, allocated duties, compensated in monetary terms, and grow in the system.
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, our health system isn't decentralized, though official documents will always make reference to "services déconcentrés" when referring to district facilities.
However, I think decentralization will increase equity in services and outcomes. This is because the country is very diverse in culture, background, education, heritage, and overall ideas....
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Decentralization will promote the development of a contextualize health system, which is an efficient system.
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Stephen Eyong Njang Ayongi made a comment
Ruritania's DHO has narrow decision space across all 3 indices. For Elbonia the RHO/DHO has got moderate decision space for determining finances and the services to be providing for its region. Elbonia also does have a wide decision space as per the management of human resources, as they could effect transfers and promotions, and pay salaries regionally.
In...
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Stephen Eyong Njang Ayongi made a comment
In my context Cameroon, decision space is always variable with respect to who is in office as the Minister of Public Health. with the previous minister of health decision space for the management of human resources and finances was very wide as the Regional Delegate could effect transfers of personnel within his/her region and re-allocate budgets according to...
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By involving the District Health Manager/team or seek their opinion in planning processes that involve them.
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Stephen Eyong Njang Ayongi made a comment
Inclusion of the county hospital staff (a cohort) in the policy planning, who would have raised challenges and realities on the ground.
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, I think a lot of policy plannings follow global or WHO regional agendas. Rarely have there been a health policy designed de novo from the affected communities' needs.
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In my nation Cameroon, I find that most policy plannings are not inclusive. The affected community/individual almost always never have a say. Interventions are being designed for them without their knowledge or opinion, which I think will lead to failure.
So taking a situation analysis per WHO policy planning framework will permit policymakers to be...
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Poor coordination and cooperation to begin. Lack of qualified human, financial and material/infrastructural resources.
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Well not entirely. I think a community-based scheme should be developed, by each community, to set up its own criteria to identify deprived and vulnerable groups.
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Firstly, it is systematic and integrated. It is designed to follow and operate in a complex adaptive system fashion. Hence very responsive and adaptive.
This system requires a lot of resources. Allocation and distribution of adequate resources, promptly, have always proven to be a challenge.
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Stephen Eyong Njang Ayongi made a comment
THE Rwandan CBHI scheme was truly community-based. The community developed its criteria for the poor and vulnerable. They were flexible about it, and they did the social groupings themselves.
This way equity was truly addressed since they mastered their own demographic profile better. Comparative to a central program that will be assuming common barriers...
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Both models did a great job addressing equity. Especially the Rwanda CBHI which allowed the community itself to come up with criteria to identify the most vulnerable and stratify people in their community. This for me ensured equity and resulted in high coverage.
Also, there was great political will as evidently seen by the new reforms from the government.
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Informal charges cutting across many sectors were not fully addressed by the HEF scheme. A non-financial barrier such as population targeting affected the scheme. Child care was neglected which in turn had a negative feedback loop effect on the care of other sub-groups within the scheme.
To assess the Cambodia equity goals, we need robust information on...
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Love this idea. It Looks revolutionary.
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In my Health district in Cameroon, we have a church-based, non-profit, health assistance scheme called BEPHA (Bamenda Ecclesiastical Province Health Assistance). It is a general scheme for all though with specific commitments to the poor and vulnerable. However, it was developed as a geographically targeted scheme for the population of the North West Region of...
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Corruption is that one social determinant of ill health and poverty which seems to be ravaging all low-income countries, especially in Africa.
Maybe our politicians should be actively taking courses on health. It might help shape their perspectives and commitment.
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Stephen Eyong Njang Ayongi made a comment
Cameroon HS shows waving commitments to equity. It is a conscious notion here, though its realization is hampered by constraint resources amongst other logistics. The government has shown tangible efforts towards equity in the RMNCH sphere with encouraging outcomes. Yet a lot still needs to be done to address other vulnerable groups and populations.
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Same here in Cameroon. Seeking healthcare in urban cities, tertiary settings, and from specialist have proven to be a nightmare.
Then again, this is all part of a much bigger problem stemming from obsolete health policies and poor governance across all societal sectors.
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Formally the most important will be low socio-economic status (low income). Informally, poor road networks, lack of basic infrastructures and social amenities in patient communities, et cetera.
Reducing or eliminating formal charges will definitely improve financial access to healthcare. However, it doesn't look sustainable and does not address other...
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Stephen Eyong Njang Ayongi made a comment
Of course not. Great lecture here. Eye-opener!
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In Cameroon, it's a mixed pattern I will say - comprising of both regressive and a little bid of proportional model depending on the sector, health institution, and community involved. Government financing is definitely right of the Lorenz curve.
However, with the work of some non-profit NGOs, INGOs, and confessional institutions, we can observe a...
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Stephen Eyong Njang Ayongi made a comment
Great week1
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Clearly out-of-pocket spending is not the way to go. In itself, it affects access and affordability of quality healthcare. I am guessing UHC is the answer.
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, the Regional level is the most over-utilized and ironically under-resourced, closed followed by District hospitals. Tertiary settings are under-utilized principally because of high costs and financial risk. Generally, individuals who approach the tertiary settings directly are corporate workers from huge companies who offer their employees full...
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Stephen Eyong Njang Ayongi made a comment
In Cameroon, theoretically, the health system works as depicted in the video. However, the reality is, it is inverted due to some of the reasons highlighted by prof McPake.
Another big reality is, there might be no pyramid at all, to begin with. There are a lot of clandestine structures and services across the entire system from the community level to...
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Stephen Eyong Njang Ayongi made a comment
By default simplicity denotes mastery. Not so much on the other hand.
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Stephen Eyong Njang Ayongi made a comment
Cameroon like most other countries will traditionally follow the WHO HS building blocks. This country already faces a lot of challenges effectively running the HS with this model, which truth be told is a simplified framework.
Personally I think the conceptualize HSS framework is far more complex and will pose great difficulties in LMICs. I think each...
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True.. and also how they interact with the patient at the centre in a mutual fashion.
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Whilst all 3 dimensions are important and interdependent, I think cost coverage will benefit the population better. It will eventually increase population and service coverage.
Moreover I think most population directly view UHC as a framework to mitigate health cost. So cost coverage directly serves their interest ina tangeable way.
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Stephen Eyong Njang Ayongi made a comment
Thanks a lot lshtm, Flearn, educators and peers.
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Grand access and healthcare through humanitarian principles framework. Continuous Impact evaluation (IE) to identify early fragility and potential future failures in the interventions/response.
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Capacity building for the index communities. Communities in crisis settings should always have essential personnels and materials readily available to rapidly conduct research to help inform response.
Deployment of personnel from cities and or abroad (as humanitarian actors) may cause delays that can increase adverse outcomes of the crisis.
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Great talk!
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In my setting Cameroon, access to mental health care and service is so limited. This is because the few expert personnel and facilities are most located in urban/semi urban areas.
Also as pointed by Dr Bayard, in most low income countries, there's a cultural barrier to mental health care. Mentally ill individuals often face alot of stigma partly because it...
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The challenges of the Health System (HS) in my setting comes in a mixed pattern. The HS is almost invariably considered solely the health sector. So the magnitude of inter-dependency is very poor which compromises the strength of the HS.
I love Frenk et al's idea of re-conceptualizing global health which basically means everyone depends on everyone for...
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Stephen Eyong Njang Ayongi made a comment
Hello, I am a medical doctor working in Cameroon's ministry of public health. My nation is on verge of engaging UHC, and of course this requires a strong and functional health system. I am interested in gaining a lot of knowledge and skills on HSS in order help my nation and community achieve its UHC objectives as a means to sustainable development.
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Stephen Eyong Njang Ayongi made a comment
Great content already. Thanks!
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Stephen Eyong Njang Ayongi made a comment
Its interesting to know in most internal conflicts and insurgencies, if not all, its the state who engages in destruction of health facilities and collateral killings of health personnels in conflict regions. Its mostly always systematic, yet before the attention of IHL community is called there must have been already significant loss of lives and destruction...
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In cameroon presently. The first challenge is insecurity, even for health care providers. Also there is damage to infrastructure/health system with subsequent poor health access. Financial and economic constraints. These are three major challenges faced in the present emergency here.
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Stephen Eyong Njang Ayongi made a comment
Adapted CBS. With Community health workers (CHWs) playing a vital role in informing unusual events in their community.
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Same here.
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Stephen Eyong Njang Ayongi made a comment
Hello, I am a physician. Happy to learn more on this course.
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Stephen Eyong Njang Ayongi made a comment
Thanks for the terminology etiquette.
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Great summary of the module. Thumbs up!
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Stephen Eyong Njang Ayongi made a comment
Great initiatives by UK public health RST.
Would love to hear more on how national humanitarian cluster approach networking and coordination is being carried out in a typically fragile health system. Thanks.
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Great insight into the complexities of humanitarian emergencies.
I still wonder why some crisis never seems to get better or end. Atleast this lecture points out the fact that some politicians/leaders operate with limited oversight from International regulatory bodies during emergencies.
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Have clinicians, labs and microbiologist on camp do their thing. After which my intervention will coordinate a meeting including the above, logisticians, social scientist, a WASH specialists, community leaders and local stakeholders to formulate a response that will control the outbreak and prepare effectively for future ones. Particular priority will be to...
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Great lecture here!
I think humanitarian staffs are always protected in crisis settings. However as Dr Abubakr mentioned, situation , context, people change a lot in such settings. So 100% cannot be guaranteed. Also he mentioned targeting of such staffs, which is especially true in arm conflict settings. Outlaw militia can target a staff for ransom...
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Stephen Eyong Njang Ayongi made a comment
I think of the social, economic minorities. Statistics show most humanitarian emergencies often happen in low income settings. Most of these economically disabled individuals are at risk of diverse direct and indirect impacts of emergencies. Particular health challenges will be malnutrition and limited access to health care.
Sometimes the humanitarian...
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Stephen Eyong Njang Ayongi made a comment
I am a M.D from Cameroon, presently in a complex humanitarian crisis for about 3 years and counting. I will tell you what the health system is doing, sadly very little. Major challenges to the degrading health system being gross insecurity which has seen the shutting down of many health structures in the restive regions. A lot of health personnels have fled...
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@LharaWaby Agreed on mental support for this population. "Surviving" in a refugee camp can be mentally exhaustive. Social and psychological support should be continuously rendered.
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Generally the camp is well structured and organised. Basic social facilities are provided. The only disturbing statistics is the fact that the camp has outgrown its potential of 27,000 refugees.
Apparently the basic health needs of the camp are met through the 02 available hospitals. Though no statistics are mentioned on immunization status of the camp...
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Stephen Eyong Njang Ayongi made a comment
Once more thanks to organisers and fellow participants for their respective insight. I have gained alot of knowledge.
Now as a clinician I am capable and plan to volunteer in outbreak surveillance and response in the near future. This will help to consolidate knowledge and improve my commitment in the field. Thanks!
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Stephen Eyong Njang Ayongi made a comment
Thanks for this course LSHTM. Sincere appreciation to all developers, course instructors and facilitators
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Stephen Eyong Njang Ayongi made a comment
In a nutshell; improving health system capacity and subsequently outbreak prevetion and control in LMICs, then gobally, lies in political will. This is a very sensitive issue in LMICs which are typically characterised by bad governance and poor leadership.
I think until the world governing and regulatory bodies are ready to see and address this head-on, we...
