CIMA Care's Empowerment Approach in Northwest Cameroon Addresses Financial Incentive Research Concerns

When Evidence Meets Innovation:
A Critical Point for Global Health

A comprehensive study published in the British Medical Journal Global Health has sent ripples through the global health community, examining 40 studies from 19 countries across Africa, Asia, and Latin America to map the evidence on incentive programs in immunization campaigns. [1] The findings reveal a problematic paradox: while financial incentives may boost short-term vaccination rates, they often create unintended consequences that undermine long-term health system sustainability. In northwest Cameroon, CIMA Care's innovative health staff and parents' empowerment approach offer a compelling alternative that addresses these research concerns.

The Research Reality:
A Global Wake-Up Call

The BMJ Global Health scoping review, published in 2025, was conducted by researchers from Médecins Sans Frontières, London, UK, and Amsterdam, Netherlands, and examined financial and non-financial incentive programs implemented between 2000 and 2024. The scope was vast. Thirty-one studies evaluated effectiveness through randomized trials and quasi-experimental designs, while nine provided qualitative insights into community perceptions and unintended consequences.

However, no studies showed sustained long-term impact, and several revealed troubling unintended consequences that should alarm global health leaders.

CIMA Care's Alternative:
Building Capacity, Not Dependency

Against this backdrop of global research concerns, CIMA Care's approach in northwest Cameroon emerges as an exemplar of sustainable innovation. Rather than offering financial incentives that create dependency, expectancy, and erosion of self-determination, CIMA Care focuses on empowering healthcare workers and parents through professional development and digital tools.

Dr. Cornelius Chebo, the Coordinator of EPI Northwest Cameroon, articulates this transformation: "CIMA Care's SMS reminder system has become a crucial lifeline in regions challenged by 'ghost town days' that disrupted regular vaccination schedules. The success is already evident in the Azire Health Area of the Bamenda Health District, where vaccination coverage rates have greatly improved. The dream of the region is to see this service extended to the whole region."

Measurable Results Without Dependency  

CIMA Care represents a complementary approach to incentive-based models by achieving a 23% improvement in vaccination uptake in Cameroon's Bamenda Region through empowerment, not payments. [2] This success came in a region challenged by conflict and infrastructure limitations, precisely the contexts where sustainable approaches matter most. 

Dr. Cornelius Chebo emphasizes the expanding impact: "Another health facility is coming on board! Welcome to the Atuakom Integrated Health Center of the Bamenda Health District. The number of family health facilities joining the CIMA project is growing. Many more families will be educated on parenting, using the UNODC and UNICEF parenting skills... Also, the health staff can access online CPD-UK-accredited courses and instantly see the list of defaulters to trace them. The implication is that more children are vaccinated, and fewer are missing out on vaccines. All this is thanks to the CIMA Project."

Global Implications:
A Model for Sustainable Change

The BMJ researchers conclude with a critical recommendation: "Future programmes should be co-designed with communities, consider locally acceptable non-monetary alternatives, incorporate strategies to maintain intrinsic motivation, and ensure sustainable implementation within existing health systems."

CIMA Care's experience in northwest Cameroon embodies exactly this vision. By focusing on empowerment over incentives, education over compensation, and capacity building over dependency creation, CIMA Care demonstrates that sustainable vaccination improvement is possible without the unintended consequences that plague incentive-based approaches.

TAssociate Professor George Ikomey Mondinde, PhD, of the Virus/Immunology Unit at the University of Yaoundé 1, affirms this impact: "The CIMA project has demonstrated the usefulness of the reminder app in improving vaccine coverage in Cameroon, particularly in the crisis-hit zones of Bamenda in the Northwest region."

The Path Forward:
Choosing Empowerment Over Dependency

As the global health community grapples with the evidence on incentive programs, CIMA Care's approach offers a roadmap for sustainable impact. The choice is clear: we can continue down the path of financial incentives that create short-term gains but long-term dependencies, or we can invest in empowerment approaches that build lasting capacity within health systems.

The question is not whether incentives work in the short term; the BMJ research confirms they often do. The question is whether we are building sustainable health systems or creating cycles of dependency that ultimately undermine the very goals we seek to achieve.

In northwest Cameroon, healthcare workers are choosing empowerment over dependency, and the outcomes reflect their decision. It Is time for the global health community to adopt this capacity-building approach instead of perpetuating dependency-creating incentive programs.