Factors influencing direct payment exemption in the user fee elimination project in the Far North of Cameroon

Abstract

On January 1, 2020, the State of Cameroon instituted a policy to eliminate direct payments by people living with human immunodeficiency virus (PLHIV). However, limited data are available on the implementation of this policy. This study aims to identify the determinants of the improper implementation of this policy by healthcare providers. To this end, a cross-sectional study was conducted with 164 medical and paramedical staff involved in the care of PLHIV. Data were collected using a Google Forms questionnaire and administered in health facility forums. Determinants were assessed using multiple logistic regression analysis. The study found that the job profile of a doctor or pharmacist (odds ratio adjusted [AOR] = 9.64 [95% confidence interval (CI): 2.32 – 44.09]; p = 0.002), access to policy guidelines (AOR = 2.81 [95% CI: 1.02 – 7.86]; p = 0.045), perception of the policy’s impact on quality of care (AOR = 4.26 [95% CI: 0.79 – 26.95]; p = 0.034), and the context of working in a system in which the policy is partially effective (AOR = 4.0 [95% CI: 1.53 – 11.08]; p = 0.005) significantly increased the chances of improper practices related to policy implementation. Awareness-raising and capacity-building strategies must be developed to policy implementation by healthcare providers in Cameroon. The policy of “user fees elimination” marks the first step toward universal health coverage, and this study also provides a basis for reflection to facilitate its optimal implementation.