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To begin a renewal of national health policy in Cameroon, a steering committee from the Cameroon Ministry of Health and its partners sought to analyze health demand through a national population survey and supply capacity through a national survey of retail drug stores. A survey of healthcare consumers was also conducted. The present publication describes the results of the consumer survey. Their socioeconomic profile of these consumers was much higher than that of the general population. This indicates that the poorest do not use health facilities or even self-medication. Within the population of healthcare consumers, women and children used private for-profit (60 %) and nonprofit (65 %) private health facilities most often, while men used mainly private pharmacies (60 %) and street drug (medication) sellers (62 %). In all, 85 % of the users of formal drug retailers had had a consultation with a healthcare provider. The average consultation cost was 1,440 CFA Francs, but the 7 % who paid the provider directly had an average cost of 1,794 CFA Francs. In all, 22 % did not pay at all, because of free consultations in some health facilities (40 %), personal relationships with prescribers, or other reasons. Hospitalization costs averaged 4,800 CFA Francs, and medical examinations 4,534 CFA Francs. These two categories had the highest percentage of insured patients (12 % and 5 %). Drug costs were 5,067 CFA Francs from pharmacies and 1,308 CFA Francs in the street. Total healthcare costs per person averaged 14,990 CFA Francs. Weighted, drugs accounted for the largest share, followed by hospitalisation, medical examinations, consultations, and transportation. In the formal sector, less than 10 % reported paying fees directly to the healthcare providers rather than to the HF cashier. Except for consultation in the public sector, paying providers was associated with a lower bill. However, 24 % purchased drugs from the healthcare workers, which indicates that drug sales are an important "sideline" in the formal sector. The average number of drugs per prescription was 4.1, and 24 % contained more than 6 drugs. The leading 50 drugs prescribed accounted for 57 % of the total and so did the top 50 purchased. The leading 40 prescribed, however, were mainly generics, while the top 40 purchased included many more brand-name drugs. Moreover, injectable drugs accounted for 40 % of the 40 most prescribed drugs, 50 % of the 40 most purchased, and 45 % of the 40 most purchased prescribed drugs. These figures show the low quality of prescription and dispensing.

During the 1980s, an economic depression and the concomitant decrease in the national health budget modified the population's health behavior. Improvement of the economy since the late 1990s makes it possible to renew the national health policy. To prepare the highly indebted and poor countries' program (HIPC), the Minister of Health and its partners commissioned a survey to measure the population's real access to health care and the factors that determine this accessibility and to propose concrete corrective actions. To fulfill these objectives, the steering committee decided to analyze health care demand, through a national population survey, and supply capacity, through a national survey of pharmacies and other drug dispensers. A survey of persons using medications will also be conducted (Fig.1). Focusing on this component of health care is justified by these findings: 95% of persons feeling ill buy drugs, whereas only 31% consult a physician or other healthcare provider, and half of the average household's health expenditures are for drugs. Financial, geographic, social and quality indicators were defined to measure accessibility and its determining factors (Table 1). The smallest administrative unit, the health area (HA), was chosen as the sampling unit, to enable us to survey together healthcare demand, supply and consumption according to different concentrations of supply and demand . It behaves as a cluster of sampling units of different populations: drug retailers of all sectors, drug users, households, and ill persons within the households. The HA samples include Yaounde and Douala, with urban and rural sub-samples, for which sampling ratios increase with the diversity of supply and demand, according to several pre-defined factors. The study includes 400 HAs, covering more than one third of the population (Table 2). Within these HAs, 900 pharmacies and other formal drug retailers, 709 street vendors, 4,505 households, 2,532 ill persons in these households, 4,121 pharmacy customers and 850 customers of street vendors were surveyed, i.e., more than 13,600 questionnaires. Assessment of data quality shows that the sample is representative of the national population for its socioeconomic characteristics. Its geographic distribution, even after correction, nonetheless favors urban areas, where both supply and demand are high. Generalizing the 3 sub-samples to the national level thus requires caution, especially for the geographic distribution. Other limitations and possible biases are described and evaluated. However, the retrospective demographic and statistic evaluation shows that the samples are representative of their population and that the data quality can be considered good. This article describes the background of this study and justifies its methodological choices. Future publications will analyze the data collected.