Page 60 - GHES-3-2

Global Health Economics and
Sustainability

ORIGINAL RESEARCH ARTICLE
Factors influencing direct payment exemption in

the user fee elimination project in the Far North
of Cameroon

3
Sali Aristide Dama , Alice Ketchaji , Dorcas Kamguem Keng ,
2
1
Laura Ladouce Yanguem , and Godfroy Rostant Pokam Djoko *
4
4
1 Department of Sociology, Anthropology, and Social Sciences for Development, Faculty of Arts,
Letters and Humanities, University of Maroua, Maruoa, Cameroon
2 Department for the Control of Diseases, Epidemics and Pandemics, Ministry of Public Health,
Yaoundé, Cameroon
3 Department of Public Health, School of Health Sciences of the Catholic University of Central Africa,
Yaoundé, Cameroon
4 Research Unit of Applied Biology and Ecology, Department of Animal Biology, Faculty of Science,
University of Dschang, Dschang, Cameroon

Abstract
Academic editor:
Mihajlo Jakovljevic M.D. Ph.D. MAE On January 1, 2020, the State of Cameroon instituted a policy to eliminate direct
payments by people living with human immunodeficiency virus (PLHIV). However,
*Corresponding author:
Godfroy Rostant Pokam Djoko limited data are available on the implementation of this policy. This study aims to
(godfroydjoko@gmail.com) identify the determinants of the improper implementation of this policy by healthcare
providers. To this end, a cross-sectional study was conducted with 164 medical and
Citation: Dama, S.A., Ketchaji, A.,
Keng, D.K., Yanguem, L.L. & Djoko, paramedical staff involved in the care of PLHIV. Data were collected using a Google
G.R.P. (2025). Factors influencing Forms questionnaire and administered in health facility forums. Determinants were
direct payment exemption in the user assessed using multiple logistic regression analysis. The study found that the job profile
fee elimination project in the Far
North of Cameroon. Global Health of a doctor or pharmacist (odds ratio adjusted [AOR] = 9.64 [95% confidence interval
Econ Sustain, 3(2):52-61. (CI): 2.32 – 44.09]; p = 0.002), access to policy guidelines (AOR = 2.81 [95% CI: 1.02 –
https://doi.org/10.36922/ghes.4078 7.86]; p = 0.045), perception of the policy’s impact on quality of care (AOR = 4.26 [95%
Received: June 29, 2024 CI: 0.79 – 26.95]; p = 0.034), and the context of working in a system in which the policy
1st revised: August 14, 2024 is partially effective (AOR = 4.0 [95% CI: 1.53 – 11.08]; p = 0.005) significantly increased
the chances of improper practices related to policy implementation. Awareness-
2nd revised: August 31, 2024 raising and capacity-building strategies must be developed to policy implementation
Accepted: October 8, 2024 by healthcare providers in Cameroon. The policy of “user fees elimination” marks the
Published online: November 8, first step toward universal health coverage, and this study also provides a basis for
2024 reflection to facilitate its optimal implementation.
Copyright: © 2024 Author(s).
This is an Open-Access article Keywords: Policy; Free; User fees elimination; Human immunodeficiency virus/acquired
distributed under the terms of the
Creative Commons Attribution immunodeficiency syndrome; Far North; Cameroon
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience
Publishing remains neutral with Living with human immunodeficiency virus (HIV) entails particularly high disease-
regard to jurisdictional claims in
published maps and institutional related healthcare costs that can seriously affect individuals’ health and well-being
affiliations. (Whiteside, 2002). Thus, people living with HIV (PLHIV) represent a particularly

Volume 3 Issue 2 (2025) 52 https://doi.org/10.36922/ghes.4078