Page 61 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

vulnerable population. Access to free healthcare in the care services. An initiative labeled “user fees elimination”
context of HIV denotes a success of the political, ethical, (UFE) has been effectively implemented nationwide with
and medical fight against acquired immunodeficiency the support of numerous partners since January 2020
syndrome (AIDS) (Gilks et al., 2006; Souteyrand et al., (Minister of Public Health, 2021).
2008). However, PLHIV is sometimes required to make The Far North region of Cameroon is characterized
direct payments, especially in sub-Saharan African by high levels of poverty, poor infrastructure, and limited
countries, for publicly provided healthcare services such access to health services and presents unique challenges that
as consultations, laboratory tests, and drugs to treat can exacerbate the problems associated with the effective
opportunistic infections (Boyer et al., 2009).
application of this policy (Minister of Public Health, 2020).
Many developing countries have introduced cost- Indeed, unlike other regions of Cameroon with more
recovery policies since the Bamako Initiative of 1987, favorable socioeconomic conditions and infrastructure, the
charging patients new fees at points of delivery. Indeed, Far North confronts specific obstacles that complicate the
this initiative was recommended as a means of increasing exemption of user fees. Thus, analyzing the shortcomings
healthcare financing and improving access to primary in this region can highlight local particularities, help us
healthcare and public health services (Chabot, 1988). adapt policies accordingly, and deliver valuable lessons to
Notably, more than half of the total healthcare expenditures ameliorate implementation in similar contexts.
of households in most low- and middle-income countries This study aims to determine the causes of faulty
are out-of-pocket payments. Nations in sub-Saharan Africa practices in the implementation of the policy of exemption
that bear the heaviest burden of the HIV/AIDS pandemic from direct payments by providers influencing the care of
are included among these countries (Langenbrunner & PLHIV in the Far North region. The results of this study
Alexander, 2005).
represent a part of a larger plan to raise awareness among
However, the introduction of out-of-pocket payments healthcare providers in the Far North region vis-à-vis the
positively affects healthcare utilization when it is importance of offering the service package under the free-
accompanied by measures to ameliorate the supply of care of-charge policy. In addition, the UFE policy marks the
and allow for greater provider autonomy. The decentralized first step toward universal health coverage; thus, we hope
management of direct payments at the provider level that this study will provide a basis for reflection on how
constructively influences staff motivation and results in best this initiative can be executed.
better quality of care (Mathauer et al., 2017). Nevertheless,
numerous studies show that the need for direct payment by 1.1. Theoretical framework
patients reduces access to care and treatment for the poorest Analysis of the social relevance of selective free healthcare
individuals (Mehdi, 2015) and decreases their compliance highlights the crucial importance of values, such as equity,
with treatment (Mills et al., 2006). In the context of HIV, solidarity, and access to health, in the evaluation of public
late treatment or the lack of adherence to antiretroviral policies. This analysis reveals how values are used to justify
(ARV) treatment can deteriorate individuals’ health and the behaviors of social actors and how they affect their
lead to an increased risk of virus transmission. Thus, the perceptions of the stated policy. This study’s examination
demand for direct payments from PLHIV for certain of values to understand the reception of this public policy
treatments represents a major public health issue that can instrument illustrates how values can represent powerful
exert deleterious effects on the health of the population. indicators of the social representations of actors. This
Therefore, it is imperative to remove financial barriers approach is based on the theory of ideational processes,
if we desire to achieve, albeit much belatedly, the goal of which postulates that people’s values and ideas exert a
“universal access to comprehensive prevention programs, significant causal influence on public policy formulation
treatment, care and support” for HIV/AIDS by 2010, as processes (Béland, 2009). This theory posits that the social
adopted by the 192 member states of the United Nations representations and personal beliefs of actors influence
General Assembly (United Nations, 2006). Thus, many their policy choices and affect instituted reforms by
African countries have developed free healthcare policies shaping the way policies are perceived and implemented.
aimed at increasing access to care and improving the overall The theoretical framework of this research aligns with
health of their most vulnerable populations. Cameroon this conception and is based on the analysis of social
has also adopted the policy of exempting PLHIV from representations to examine how the beliefs and values
making out-of-pocket payments. This policy was instituted of actors influence their interpretations of policies and
by the Ministry of Public Health on January 1, 2020, to reforms. Hence, this study offers an in-depth understanding
ensure free healthcare to strengthen public access to HIV of the impact of values on public policy.

Volume 3 Issue 2 (2025) 53 https://doi.org/10.36922/ghes.4078