Des principes de responsabilité et de solidarité pour un accès équitable aux soins de santé : le cas des travailleurs de l'informel urbain du Cameroun en situation de vulnérabilité

Financial access to health services for socially disadvantaged groups is an important ethical stake in many low-income countries or in process of emergence. Equity achievement in the healthcare system, equal opportunities and good health are prerequisite to wellbeing. Thus, access to healthcare represents a key ethical issue for people to keep their full functional citizens status.  In Cameroon, efforts have been made by public authorities and their foreign partners to favour access to healthcare for the disadvantaged groups. However the incentives fall short to guarantee a sufficient healthcare access level. Basics medicines still are not affordable. Furthermore, the high financial costs of ambulatory and hospitals care do not help. In case of sickness, access to health service occurs unless a cash payment before the service, leading to a situation of health care non-affordability. Hence, self-medication is a direct outcome. The economy is mostly informal in the country, so it is not have the capacity to finance   welfare and social systems, which are tools usually used to reduce disparities.  This thesis analyzes the relevance of the political choice of universal health coverage in Cameroon through the principles of social responsibility and solidarity. The analysis was performed using the case of vulnerable urban workers of the informal sector, who represent 90% of all the workers in the country. The population of study is the vulnerable workers of the informal sector, who faced issues in accessing healthcare.   This thesis analyzes the conditions and modalities of distribution of social goods (access to quality care) in order to establish equity in resources redistribution. Lickewise, political, social, economic and ethical issues related to the universal problem of access to care have been assessed. The operational strategies that lead to improved quality of care and a better management of the healthcare services (good care and ethics of good governance in the system) come forward.  Furthermore, a participatory approach is advocated here under the form of the mobilisation of a sustainable local funding of universal access to care. The exploration of this perspective leads to the result that an inclusive and integrated approach to promoting the informal economy (boosting its activities and potentiating its actors) could make this sector a real social and economic development lever. A social and inclusive sustainable development over the long term, might lead to the goal of universal health coverage. This thesis recommends the accountability of the informal sector`s workers for a more involved, responsible and caring society. Hence, this approach is likely to materialize the right to health, to build the autonomy of workers in vulnerable situations and strengthen their ability to contribute through an adapted operationalization to the principles of responsibility and solidarity.

Keyphrases: Fair access to healthcare, Informal workers, Principles of accountability, Principles of solidarity, Vulnerability