Page 64 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

Table 2. Direct payment exemption policy practices under
the user fees elimination project
Variables Absolute frequency Relative frequency (%)
Free prenatal consultation for pregnant women
No 28 17.07
Yes 136 82.93
Free medical booklet for PLHIV
No 31 18.90
Yes 133 81.10
Free targeted screening test for adolescents and adults
No 9 5.49 Figure 1. Direct payment exemption policy practices undertaken by
Yes 155 94.51 medical and paramedical staff
Free CBC in HIV+pregnant women
No 65 39.63 at the health facility (OR = 4.51 [95% CI: 22.06 – 10.17];
Yes 99 60.37 p < 0.001).
Free urine testing in HIV+pregnant women 3.5. Multivariate analysis of independent predictors
No 44 26.83 of bad practices adopted by staff members vis-à-vis
Yes 120 73.17 the direct payment exemption policy
Free creatinemia in HIV+pregnant women Table 5 displays the results of the multivariate analyses
No 77 46.95 performed on the previously significant variables to
Yes 87 53.05 control for confounding factors and identify independent
Free blood glucose testing for HIV+pregnant women predictors of bad practices adopted by medical and
No 45 27.44 paramedical staff in the Far North region apropos the direct
payment exemption policy. The table illuminates that being
Yes 119 72.56 a doctor or pharmacist (Odds ratio adjusted [AOR] = 9.64
Offer free viral load [95% CI: 2.32 – 44.09]; p = 0.002), not possessing policy
No 18 10.98 guidelines (AOR = 2.81 [95% CI: 1.02 – 7.86]; p = 0.045),
Yes 146 89.02 believing that the exemption policy did not improve the
Cytobacteriological examination of sputum free of charge for patients quality of care for HIV patients (AOR = 4.26 [95% CI: 0.79
with signs of tuberculosis impregnation – 26.95]; p = 0.034) and working in a health facility in which
No 33 20.12 the exemption policy was partially effectively implemented
(AOR = 4.0 [95% CI: 1.53 – 11.08]; p = 0.005) significantly
Yes 131 79.88
increased the chances of adopting bad practices vis-à-vis
Abbreviations: CBC: Complete blood count; HIV: Human the direct payment exemption policy of the UFE project.
immunodeficiency virus; PLHIV: People living with human
immunodeficiency virus.
4. Discussion
– 8.85]; p = 0.023), did not possess guidelines or receive The absence of equivalent studies in this area precludes
guidance on the policy (OR = 4.20 [95% CI: 2.11 – 8.62]; comparisons of our results with specific previous findings.
p < 0.001), worked in a health facility without a UFE However, the results obtained from the available and
focal point (OR = 3.74 [95% CI: 1.88 – 7.67]; p < 0.001), collected primary field data in this study allow certain
believed that the exemption policy did not improve the interpretations that are detailed in subsequent paragraphs.
quality of care for PLHIV (OR = 6.85 [95% CI: 2.69 – Our investigation revealed that overall, 31.1% of the
19.13]; p < 0.001), worked in a health facility that did not participating medical and paramedical staff members
effectively implement the exemption policy (OR = 7.72 exhibited bad practices related to the direct payment
[95% CI: 2.92 – 21.51]; p < 0.001), worked in a health exemption policy outlined under the UFE project. This
facility in which the implementation of the exemption result can be explained by the lack of training and awareness
policy was only partially effective (OR = 4.12 [95% CI: among medical and paramedical staff concerning the
1.86 – 9.50]; p < 0.001), or believed that the exemption exemption procedures and eligibility criteria. In addition,
policy did not improve the retention of patients in care the presence of financial incentives or other advantages

Volume 3 Issue 2 (2025) 56 https://doi.org/10.36922/ghes.4078