Page 62 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

2. Methodology 2.5. Operational definition of variables

2.1. Setting and study period The dependent variable of this study was set as the “practice
of the direct payment exemption policy” and was evaluated
The study was conducted between June 1 and August 31, on a scale of 0 – 10 based on participant responses to
2022, in 22 health districts in the Far North region, one questions on staff practices related to the implementation
of the ten regions of Cameroon. It is located in the north of the UFE service package. Participants who were found
of the country between latitudes 10° and 13° North and to implement ≤5 of the 10 UFE service packages available
longitudes 14° and 16° East, and its population of 2,721,500 in the health facilities were deemed to perform improper
inhabitants are spread over an area of 34,246 km (Minister (bad) practice, and those who implemented between six
2
of Public Health, 2020). The Far North region encompasses and 10 service packages were considered to establish a
six divisions, 47 subdivisions, and 30 health districts. It also beneficial (good) practice.
shares a long border with Chad and Nigeria. Its landscape
is characterized by wooded savanna, grassy savanna, and 2.6. Data processing and analysis
steppe depending on the season. Data collected through Google Forms were compiled and

2.2. Study design and population analyzed using the Rstudio analysis software version 4.2.4.
We used Microsoft Office Word and Excel 2013 to prepare
This quantitative, cross-sectional, descriptive, and the tables. We calculated descriptive statistics for all variables
analytical study was conducted with a population of considered in this study. We determined the associations
medical and paramedical staff members irrespective of between the dependent variable “practice of direct payment
gender and grade working in direct contact with patients exemption policy” and the independent variables using binary
for at least 6 months in a selected health facility. logistic regression analysis, and all variables with a p < 0.05 in
2.3. Sample size and procedure the bivariate analysis were deemed candidates for multivariate
analysis. The discrete indicators were estimated through a
The minimum sample size was calculated using the Lorenz significance level of alpha (α) = 0.05, and associations were
formula, assuming a precision of 5%, a 95% confidence considered significant at a p < 0.05. Notably, we used specific
interval (CI), and a value for the prevalence of the main tests adapted to the nature of the data and verified the conditions
indicator equal to 12.1% taken from the UFE 2021 of normality for the p test performed for the bivariate analysis.
regional supervision report. Thus, this study included We examined the distribution of the data to ensure conformity
164 participants recruited through the non-probability with the hypotheses of the utilized statistical tests.
convenience sampling technique. A total of 103 health
facilities across 22 health districts were selected for analysis 3. Results
based on the number of patients on ARV treatment and
the implementation of the UFE project. This selection 3.1. Participant characteristics
procedure was adopted to limit potential selection bias and Table 1 presents the distribution of the study participants
guarantee the representativeness of our sample. by age, gender, level of education, type of health training,
function, department, and length of time in the system.
2.4. Data collection techniques and tools The table shows that the participants most represented the
Data were collected through a survey administered to age group of 30 – 39 years (73.6%), with an average age
staff members employed at the selected health facilities. of (35.90 ± 8.41) years. Men were slightly more numerous
A Google Forms questionnaire was deployed in health than women (58.5% vs. 41.5%). Most respondents had
facility forums. Control measures were put in place to completed a secondary school education (53.7%), worked
guarantee data quality and avoid duplication. For instance, in a regional hospital (35.4%), were psychosocial assistants
we configured Google Forms to limit multiple responses (59.1%), were attached to the HIV/AIDS unit (56.1%), and
from the same participant by activating the option of only had worked in the facility for ≤3 years (47%).
one response per email address and activated the data
validation feature. Initially, we pretested the questionnaire 3.2. The UFE direct payment exemption policy in
on a dozen participants, after which we noted their practice
completion times and assessed their comprehension of Table 2 shows the practices adopted by medical and
the questions. The collected data primarily concerned paramedical staff in the Far North region with regard to the
sociodemographic variables and queried staff knowledge UFE policy. It shows that the majority of healthcare providers
and practices apropos the implementation of the UFE have put in place targeted measures for the management of
service package. HIV-positive pregnant women, people living with HIV

Volume 3 Issue 2 (2025) 54 https://doi.org/10.36922/ghes.4078