Page 66 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

Table 4. Determinants of bad practices vis‑à‑vis the direct payment exemption policy according to staff knowledge: Bivariate
analysis
Explanatory Fee waiver policy practice OR (95% CI) p‑value
variables Bad Good

(n=51) (n=113)
Heard about the UFE
Yes 41 (80.39) 105 (92.92) 1
No 10 (19.61) 8 (7.08) 3.17 (1.17 – 8.85) 0.023*
Information channel
Training 36 (83.72) 95 (89.62) 1
Posters/media 7 (16.28) 11 (10.38) 1.66 (0.57 – 4.56) 0.33
Knowledge of the definition of UFE HIV
Yes 44 (86.27) 103 (91.15) 1
No 7 (13.73) 10 (8.85) 1.62 (0.55 – 4.50) 0.356
Knowledge of free medical services
Yes 48 (94.12) 112 (99.12) 1
No 3 (5.88) 1 (0.88) 1.62 (0.86 – 142.19) 0.097
Possession of guidebooks on the UFE policy
Yes 18 (35.29) 78 (69.03) 1
No 33 (64.71) 35 (30.97) 4.20 (2.11 – 8.62) <0.001***
Existence of a UFE focal point in the health facility
Yes 17 (33.33) 73 (65.18) 1
No 34 (66.67) 39 (34.82) 3.74 (1.88 – 7.67) <0.001***
Opinion on the UFE policy
Useful 46 (90.2) 113 (100) 1
Useless 5 (9.8) 0 (0.0) 3e+07 (1.6e – 41-NA) 0.987
Improved quality of care for PLHIV after UFE project implementation
Yes 35 (68.63) 105 (92.92) 1
No 16 (31.37) 8 (6.93) 6.85 (2.69 – 19.13) <0.001***
Implementation of the UFE project in the health facility
Totally 12 (23.53) 68 (60.18) 1
Partially 14 (47.06) 34 (30.09) 4.12 (1.86 – 9.50) <0.001***
Not at all 15 (29.41) 11 (9.73) 7.72 (2.92 – 21.51) <0.001***
Improved patient retention after UFE policy implementation in your health facility
Yes 31 (60.78) 99 (87.61) 1
No 20 (39.22) 14 (12.39) 4.51 (2.06 – 10.17) <0.001***
Provision of free services for patients in the health facility
Yes 48 (94.12) 112 (99.12) 1
No 3 (5.88) 1 (0.88) 1.3 (0.72 – 2.11) 0.984
Abbreviations: CI: Confidence interval; HIV: Human immunodeficiency virus; OR: Odds ratio; UFE: User fees elimination.

and have greater decision-making power about granting credibility with other staff members. Thus, it becomes
exemptions. Thus, they are favorably positioned to abuse easier for them to legitimize non-compliant practices.
the system; notably, they can grant unjustified exemptions Therefore, it is essential to target these key groups in raising
to certain patients. Moreover, their levels of training and awareness and escalating control measures to improve the
medical expertise grant them considerable influence and honest application of the exemption policy.

Volume 3 Issue 2 (2025) 58 https://doi.org/10.36922/ghes.4078