Keywords
Agricultural households
Healthcare utilisation
Rural Cameroon
Income volatility
Health economics
Logistic regression
How to Cite
Share
Abstract
In agrarian economies, income does not arrive smoothly across the year. It comes in waves, often tied to the harvest calendar. Yet illness does not wait for harvest. This study examines the effect of seasonal agricultural income fluctuations on healthcare utilisation in rural Cameroon using nationally representative secondary data. The main objective is to determine whether variability in farm income across seasons significantly influences the likelihood that rural households seek formal healthcare when faced with illness. Specifically, the study seeks to estimate the effect of seasonal income variability on outpatient visits, use of public and private health facilities, and health expenditure patterns. The analysis draws on data from the Fourth Cameroon Household Survey, employing a logistic regression framework and robustness checks using probit and instrumental variable specifications. The findings reveal that households experiencing higher seasonal income volatility are significantly less likely to utilise formal healthcare services during lean seasons. The negative effect is more pronounced among smallholder households without access to savings or credit. The results suggest that income smoothing mechanisms play a critical role in protecting health-seeking behaviour. The study recommends that the Ministry of Public Health, in collaboration with the Ministry of Agriculture and Rural Development and the Ministry of Finance, design seasonal health financing schemes and agricultural income stabilisation policies to reduce vulnerability in rural communities.
References
African Development Bank. (2024). Central Africa economic outlook 2024: Strengthening rural resilience and food systems. African Development Bank Group.
Agarwal, B. (1997). Bargaining and gender relations: Within and beyond the household. Feminist Economics, 3(1), 1–51. https://doi.org/10.1080/135457097338799
Beegle, K., Coudouel, A., & Monsalve, E. (2016). Going universal: How 25 years of World Bank social protection experience can help today. World Bank Publications.
Blom, S., O’Connor, M., & Walsemann, K. (2020). Income variability and preventive health care use among seasonal workers. Health Economics Review, 10(1), 17. https://doi.org/10.1186/s13561-020-00267-4
Central African Economic and Monetary Community Commission. (2023). Annual report on rural economies in the CEMAC region. CEMAC.
Deaton, A. (1997). The analysis of household surveys: A microeconomic approach to development policy. World Bank.
Dercon, S. (2002). Income risk, coping strategies, and safety nets. The World Bank Research Observer, 17(2), 141–166. https://doi.org/10.1093/wbro/17.2.141
Eurostat. (2021). Seasonal employment and health outcomes in European agricultural regions. European Union.
Friedman, M. (1957). A theory of the consumption function. Princeton University Press.
Food and Agriculture Organization of the United Nations. (2023). The state of food security and nutrition in the world 2023: Towards sustainable food systems.
Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255. https://doi.org/10.1086/259880
INS. (2017). Fourth Cameroon Household Survey (ECAM4). National Institute of Statistics.
Johnston, D., Stevano, S., Malapit, H., Hull, E., & Kadiyala, S. (2018). Time use as explanation for agri nutrition disconnect: Evidence from rural areas in low income countries. Food Policy, 76, 8–18. https://doi.org/10.1016/j.foodpol.2018.02.002
Kabeer, N. (1999). Resources, agency, achievements: Reflection on measurement of women’s empowerment. Development and Change, 30(3), 435–464. https://doi.org/10.1111/1467-7660.00125
Kassie, M., Fisher, M., Muricho, G., & Diiro, G. (2020). Women empowerment boosts dietary diversity gains from agricultural technology adoption in rural Ethiopia. Food Policy, 95, 101957. https://doi.org/10.1016/j.foodpol.2020.101957
Lundberg, S., Luciano, E., & Tchernis, R. (2019). Seasonal income and health investment in the United States. Journal of Health Economics, 65, 101–113. https://doi.org/10.1016/j.jhealeco.2019.02.003
Malapit, H. J., Kadiyala, S., Quisumbing, A. R., Cunningham, K., & Tyagi, P. (2017). Women’s empowerment mitigates effects of low production diversity on nutrition outcomes in Nepal. Journal of Development Studies, 53(8), 1194–1212. https://doi.org/10.1080/00220388.2016.1226904
Ministry of Public Health. (2024). Health financing and access in rural Cameroon: Annual report. Government of Cameroon.
Morduch, J. (1995). Income smoothing and consumption smoothing. Journal of Economic Perspectives, 9(3), 103–114. https://doi.org/10.1257/jep.9.3.103
Ngome, P. I., & Tchamyou, V. S. (2022). Agricultural cooperatives and rural financial access in Cameroon. African Governance and Development Institute Working Paper Series.
OECD. (2022). Global economic outlook 2022: Health, labour, and rural resilience. Organisation for Economic Co-operation and Development.
Rosenzweig, M. R., & Wolpin, K. I. (1993). Consumption smoothing, migration, and marriage: Evidence from rural India. Journal of Political Economy, 101(4), 905–926. https://doi.org/10.1086/261904
Sraboni, E., Malapit, H. J., Quisumbing, A. R., & Ahmed, A. U. (2018). Women empowerment in agriculture and dietary diversity in Bangladesh. Food Policy, 79, 124–135. https://doi.org/10.1016/j.foodpol.2018.06.003
United States Agency for International Development. (2025). Rural health and agriculture linkage study. USAID.
World Bank. (2022). World development indicators 2022. World Bank.
World Bank. (2023). Income seasonality and resilience in rural economies. World Bank.
World Health Organization. (2022). Global health financing report 2022. WHO.
World Health Organization. (2023). Cameroon health profile review 2023.
World Food Programme. (2024). Cameroon comprehensive food security and vulnerability analysis. WFP.
