title: How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon.
abstract: Direct out-of-pocket payments for healthcare continue to be a major source of health financing in low-income and middle-income countries. Some of these direct payments take the form of informal charges paid by patients to access the needed healthcare services. Remarkably, however, little is known about the extent to which these payments are exercised and their determinants in the context of Sub-Saharan Africa. This study attempts therefore to shed light on the role of supply-side factors in the occurrence of informal payments while accounting for the demand-side factors. The study relies on data taken from a nationally representative survey conducted among people living with HIV/AIDS in Cameroon. A multilevel mixed-effect logistic model is employed to identify the factors associated with the incidence of informal payments. Results reveal that circa 3.05% of the surveyed patients incurred informal payments for the consultations made on the day of the survey. The amount paid informally represents up to four times the official tariff. Factors related to the following: (i) human resource management of the health facilities (e.g., task shifting); (ii) health professionals' perceptions vis-à-vis the remunerations of HIV care provision; and (iii) reception of patients (e.g., waiting time) significantly influence the probability of incurring informal payments. Also of note, the type of healthcare facilities is found to play a role: informal payments appear to be significantly lower in private non-profit facilities compared with those belonging to public sector. Our findings allude to some policy recommendations that can help reduce the incidence of informal payments.
authors.affiliation: Aix-Marseille University (Aix-Marseille School of Economics), CNRS and EHESS, Centre de la Vieille Charité, 13236, Marseille, Cedex 2, France.
authors.forename: Hyacinthe Tchewonpi
authors.identifier: http://orcid.org/0000-0002-9920-1106
authors.initials: HT
authors.lastname: Kankeu
authors.affiliation: INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.affiliation: National AIDS Control Committee, Yaoundé, Cameroon.
authors.forename: Raoul
authors.initials: R
authors.lastname: Fodjo Toukam
authors.affiliation: INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu-Zaineh
mesh_terms: D000328:Adult; D002163:Cameroon; D003906:Developing Countries / Q000191:economics; D005251:Fees, Medical; D005260:Female; D005382:Financing, Personal / Q000379:methods*; D015658:HIV Infections / Q000191:economics*; D061889:Healthcare Financing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cameroon; HIV care; informal payments; multilevel mixed-effect model; supply-side factors