Human resources for health in the Centre Region remain well below the WHO standard of 23-25 qualified health workers per 10,000 inhabitants to respond more effectively to people’s health problems [13,15]. This observation was highlighted in a national assessment of Cameroon in 2013 [16]. Key challenges in the country’s human resource management system include the absence of a recruitment plan, low investment from the private sector, and a disconnect between health worker training and employment opportunities [17].

The Region’s inpatient mortality rates were evenly distributed across the areas. The approach to reducing hospital deaths is based on aspects such as the density of qualified human resources for health and the pricing of care. In a context of lack of health insurance, the cost of care is often a barrier to patients’ access to quality care in both public and private HFs, especially in emergency situations. In addition, improving the safety of hospital care and reducing hospital deaths is a clear goal that is well supported by clinicians, managers and patients. Good leadership and information, a quality improvement strategy based on good local evidence and a community-wide approach can be effective in improving the quality of care processes and reducing hospital mortality [18].

A higher risk of perioperative mortality was observed in rural areas compared with urban areas. The quality of care in the management of emergencies, especially surgical emergencies, hospital hygiene and the level of postoperative follow-up may explain these findings. Urban areas have a greater number of specialists and a better standard of care than rural areas [16]. The humanization of hospital care includes high quality care and better management of patients and their families, especially in emergency situations. It is therefore necessary to carry out surveys in rural district HFs to ensure that these care meet hygiene standards. However, the lack of use of a surgical checklist, patient comorbidities, blood transfusions and the use of general anesthesia are predictors of death in healthcare settings [19].

Neonatal mortality was higher than the regional average in most urban HDs, and maternal mortality remained a major problem in remote rural HDs. This situation can be explained, on the one hand, by the inadequate implementation of public health policies on maternal and neonatal health in some of the region’s health districts and, on the other, by the poor compliance of the population with these general measures. In fact, it is possible to improve neonatal survival and health and eliminate avoidable stillbirths by achieving high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and child, and care for small and sick newborns [20].

The death cases observed in the Region may be attributed to various factors. The rate of use of hospital care was 10 times lower than the recommended standard (Table 1). This low level of use results in delayed treatment, thereby increasing the risk of mortality. In addition, self-medication, exacerbated by the illicit sale of street drugs, financial constraints linked to the unfavorable economic context and the absence of a universal health coverage mechanism at that period, can have varying degrees of impact on patient survival [21,22].

Most urban HDs did not comply with the national malaria treatment policy for children under five. The high demand for drugs compared to supply in urban HFs may explain this poor performance. Indeed, these HFs are constantly experiencing stock-outs of inputs such as artemether-lumefantrine and injectable artesunate, which are needed to implement this health coverage. However, the introduction of universal health coverage in the country could help to address this health issue, by ensuring a better monitoring of hospital supplies of free malaria treatment inputs [23–25].