Pour contribuer à la performance du système de santé, l’objectif de l’article est d’analyser sur le long terme sa capacité à protéger les ménages  contre les risques financiers liés à la santé. Les deux principales variables étudiées sont l’incidence de la catastrophe financière et l’appauvrissement  des ménages dus aux dépenses de santé, mesurés à partir des données des trois dernières Enquêtes Camerounaises Auprès des Ménages (2001,  2007 et 2014) et selon plusieurs approches pour assurer la robustesse des estimations. Une nette amélioration de la protection financière s’observe  entre 2001-2007 sous la mise en oeuvre des politiques engageant de fortes dépenses sociales. Tandis qu’entre 2007-2014, la situation s’est plutôt  dégradée sous les politiques de croissance inclusives engagées. L’analyse au Cameroun et ailleurs montre que la meilleure performance en matière  de protection financière en santé est plus liée à la gouvernance et à la structure économique qu’à une politique de financement de la santé. Une  bonne combinaison de politiques de financement ciblées est suggérée. Ainsi que le développement d’une économie peu extravertie devant soutenir  un système de santé autonome, doté d’une offre suffisante et de qualité, et avec un système efficient et transparent de mise en oeuvre et  suivi-évaluation. To contribute to the performance of the health system, the objective of the article is to analyse over the long term its ability to protect households  against financial risks related to health. The two main variables studied are the incidence of the financial catastrophe and the impoverishment of  households due to health expenditure. They are measured from data from the last three Cameroonian Household Surveys (2001, 2007 and 2014)  and according to several approaches to ensure the robustness of the estimates. A marked improvement in financial protection can be observed  between 2001-2007 under the implementation of policies involving high social expenditure. While between 2007-2014, the situation rather  deteriorated under the inclusive growth policies undertaken. Analysis in Cameroon and elsewhere shows that the best performance in health  financial protection is more related to governance and economic structure than to health financing policy. A good combination of targeted financing  policies is suggested.  As well as the development of a less extroverted economy to support an autonomous health system, endowed with sufficient and quality supply. The said health system should also have an efficient and transparent system of implementation and monitoring- evaluation.

In the context of a developing country like Cameroon characterized by the scarcity of financial resources and the appearance of Covid-19, this article  shows that this pandemic was not more important than the pre-existing health problems to the point of giving it more importance in funding compared  to strengthening the health system. The theoretical elasticity model of the poverty rate to growth is used to estimate the impact of Covid-19 and the  incidence of impoverishing health expenditure is used for the impact of common diseases. It is estimated through direct health payments that common  diseases push about 340,865 people into extreme poverty annually. The Covid-19, through the loss of growth generated between 4.8 and 6.6 points  according to the optimistic or pessimistic scenarios, would impoverish between 224,193 and 398,565 people: impact on the number of poor ranging from  0.7 to 1.2 times that of all common diseases, i.e., equivalent on average, but sensitive to the speed of spread of the virus and the duration of the  crisis while the impact of common diseases is structural and linked to the poorly performing health system. The solutions proposed are endogenous and  linked to the impact mechanisms.