Page 65 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

Table 3. Sociodemographic determinants of bad practices exhibited by medical and paramedical staff vis‑à‑vis the direct
payment exemption policy: Bivariate analysis
Explanatory variables Fee waiver policy practice OR (95% CI) p‑value
Bad Good
(n=51) (n=113)
Age group (years)
20 – 29 14 (27.45) 19 (16.81) 2.33 (0.90 – 6.11) 0.079
30 – 39 25 (49.02) 56 (49.56) 1.43 (0.65 – 3.29) 0.374
40+ 12 (23.53) 38 (33.63) 1
Gender
Female 17 (33.33) 51 (45.13) 1
Male 34 (66.67) 62 (54.87) 1.61 (0.81 – 3.27) 0.175
Educational levels
Primary 1 (1.96) 2 (1.77) 1
Secondary 17 (33.33) 71 (62.83) 0.47 (0.04 – 10.65) 0.557
University 33 (64.71) 40 (35.40) 1.69 (0.15 – 37.37) 0.673
Health training
Integrated health center 15 (29.41) 40 (35.40) 2.5 (0.53 – 17.45) 0.033*
District medical center 5 (9.80) 2 (1.77) 1
District hospital 14 (27.45) 30 (26.55) 0.19 (0.02 – 1.01) 0.067
Regional hospital/Annex regional hospital 17 (33.33) 41 (36.28) 2.16 (0.02 – 7.85) 0.042*
Functions
Psychosocial assistant 24 (47.06) 73 (64.60) 1
Nurse/caregiver 8 (15.69) 23 (20.35) 1.04 (0.39 – 2.57) 0.928
Sanitary medical technician 8 (15.69) 12 (10.62) 2 (0.70 – 5.43) 0.177
Doctor/Pharmacist 11 (21.57) 5 (4.42) 6.60 (2.17 – 22.77) 0.001**
Related departments
Home/care 3 (5.88) 8 (7.08) 1
Administration 9 (17.65) 15 (13.27) 1.60 (0.35 – 8.7) 0.556
Laboratory 3 (5.88) 1 (0.88) 8 (0.70 – 203.37) 0.120
Medicine/Pharmacy 14 (27.45) 19 (16.81) 1.96 (0.47 – 10.21) 0.376
HIV care unit 22 (43.14) 70 (61.95) 0.85 (0.22 – 4.13) 0.822
Duration in the structure
≤3 years 27 (52.94) 50 (44.25) 1
4 – 6 years 11 (21.57) 35 (30.97) 0.57 (0.24 – 1.27) 0.181
≥7 years 13 (25.49) 28 (24.78) 0.84 (0.36 – 1.87) 0.677
Abbreviations: CI: Confidence interval; HIV: Human immunodeficiency virus; OR: Odds ratio.

linked to the granting of exemptions could have created This holistic corrective methodology should incorporate
perverse incentives for staff members to irregularly staff training, reinforce supervision processes, and revise
grant exemptions. Indeed, shortcomings in control and incentives.
monitoring mechanisms for program implementation, Conversely, participants working as doctors or
along with coordination and management difficulties at pharmacists were significantly associated with bad
the institutional level, may have contributed to the scale practices exhibited by medical and paramedical staff in
of the detected malpractices. A comprehensive remedial relation to the UFE direct payment exemption policy. This
approach is required to remedy this situation and ensure result can be explained by the fact that these healthcare
improved application of the rules of the UFE program. professionals generally occupy positions of responsibility

Volume 3 Issue 2 (2025) 57 https://doi.org/10.36922/ghes.4078