Page 68 - GHES-3-2

Global Health Economics and
Sustainability
Implementation of payment exemption in Cameroon

confidence of certain professionals in the positive impact evaluation mechanisms to ensure the effective application
exerted by the policy on the quality of care could also of the policy. These measures should be proposed to the
engender a feeling of frustration or resistance in them and government as specific strategies designed to reinforce
cause them to bypass established rules. Thus, the perception practices conducive to the success of the free healthcare
of the merits and usefulness of the exemption policy could policy and ensure its implementation to ultimately achieve
function pivotally in staff motivation and commitment to universal health coverage.
ensure its rigorous application.
Acknowledgments
However, working in a health facility in which the
exemption policy was only partially effectively implemented Our gratitude goes to the teaching staff of the Faculty of
was found to significantly increase the chances of medical Arts, Letters, and Humanities, and particularly to those of
and paramedical staff exhibiting bad practices vis-à-vis the the Department of Sociology, Anthropology, and Social
UFE direct payment exemption policy. This result can be Sciences for Development at the University of Maroua, for
explicated by the fact that in such settings, medical and their guidance. We would also like to thank the Far North
paramedical staff members could be confronted with a lack Regional Public Health Delegate, the heads of the health
of clear guidelines, monitoring, and control, leading them districts, and all the service providers for their support and
to grant exemptions based on personal interpretations and participation in the completion of this work.
arbitrary decisions. In addition, the uneven implementation
of the policy in a health facility can inculcate a sense of Funding
inequity and inconsistency among staff members, causing None.
them to deviate from established procedures.
Conflict of interest
This study has certain important limitations. The
cross-sectional methodology used in this study did not The authors declare they have no competing interests.
allow us to establish causal relationships between the
studied variables and the bad implementation of the direct Author contributions
payment exemption policy. Data were collected through a Conceptualization: All authors
digital questionnaire, which could have introduced biases Formal analysis: Godfroy Rostant Pokam Djoko
linked to the selection of respondents and the quality of Investigation: Sali Aristide Dama
the answers obtained. In addition, the sample size of the Methodology: Sali Aristide Dama, Godfroy Rostant Pokam
study (164 medical and paramedical staff) was significant Djoko
but modest, which could limit the generalizability of the Writing – original draft: All authors
results to all healthcare providers in Cameroon. Finally, Writing – review & editing: All authors
the study did not intensively explore other factors that
could influence policy implementation practices, such as Ethics approval and consent to participate
operational constraints specific to individual healthcare
facilities. In the context of this study, ethics aimed to ensure the
protection of those involved in the research, to ensure the
5. Conclusion independence of Ethics Committees, and to combat false
research. We obtained research authorization from the
This study highlights several critical factors that negatively Far North Regional Public Health Delegate [N°545/1/22/
influence the implementation of the policy instituted MISANTE/SG/DRSPEN]. Anonymity and confidentiality
in Cameroon to eliminate out-of-pocket payments for of information were safeguarded during data collection.
PLHIV. The results of this study reveal that the type of The research protocol was approved by a sub-committee of
job (physician or pharmacist), access to policy guidelines, teachers from the Faculty of Letters and Humanities of the
perceptions about the impact of the policy on the quality of University of Maroua.
care, and the context of working in a system in which the
policy is partially effective are all significant determinants of Consent for publication
bad practices adopted apropos the studied policy. Targeted
strategies must be devised to improve the compliance of Not applicable.
care providers with this crucial policy. Efforts should Availability of data
be made to create focused training programs for care
providers, improve the communication and dissemination All data used and/or analyzed for this study are available
of policy guidelines, and establish regular monitoring and from the corresponding author on reasonable request.

Volume 3 Issue 2 (2025) 60 https://doi.org/10.36922/ghes.4078