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Free Care for People Living with HIV/AIDS

                                       NO USER FEE HIV PROJECT FOR THE NWR

 

 

  • Introduction

 

Cameroon together with international community is committed to improve the HIV response and reach the 90-90-90 goals for the year 2020, to eliminate HIV as a public health problem by 2030.

The Strategies put in place are, the reorganization of HIV management structures to 6th category HFs (July 2018) the adoption of the « Test and Treat » strategy (June 2016), Antiretroviral drugs (2007), early infant diagnosis of HIV, and HIV testing in the vulnerable populations. The country is far from reaching the 90-90-90 targets by the of end of 2020

To improve this situation, the Ministry of Public Health (MOPH) signed Decision No.0498/D/MOH/SG/NACC/GTC/SP of 4 April 2019 exempting payment for certain services for PLHIV in Public health facilities and affiliated Community-Based Organizations. Following a key stakeholder meeting in Yaounde, confessional health facilities were brought on board the No User Fee HIV Project. The cancellation of user fees in HIV services is an opportunity to improve coverage as far as HIV is concerned, to increase the uptake/demand and equity of services to accelerate progress towards HIV response targets, to draw useful lessons for progress towards Universal Health Coverage.

 

Following this decision, the North West Regional Fund for Health Promotion (NWRFHP) PIG signed a Memorandum of Understanding (MOU) with the MOPH as the payment agent in the North West Region. Through this, the project is fully on course in all the 19 heath districts in the region, alleviating poverty at the level of PLHIV and financially empowering health facilities involved in the project.

 

  • OBJECTIVES

 

 

General objective

To eliminate the direct payment of service fees related to the care of PLHIV in Cameroon.

Specific objectives

– To improve the epidemiological response against HIV / AIDS;

– To improve treatment indicators (screening, initiation of treatment, and viral load);

– To improve the solvency of patients living with HIV;

– To guarantee equity and access to care for PLWHIV;

– To implement the first elements of Universal Health Coverage.

 

 

  • Service Package

 

The project makes available the following services to PLHIV free of charge in any government or confessional health facilities in the North West Region.

 

S/N Services Prices
1 Routine Consultation by (HIV patient) 600
2 ANC Consultation (ANC 1) Fees 600
3 ANC Consultation (ANC 2,3,4) for PLHIV 600
4 Medical Notebook (Consultation Books for PLHIV) 500
5 Targeted HIV test for adolescents and adults that were done using the “Screening Tool 0
6 FBC for Pregnant Women (PLHIV) 4,000
7 Urine Examination (Albumin, sugar) for pregnant women (PLHIV) 1,000
8 Creatinine Pregnant Women (PLHIV) 4,000
9 Glycemia for pregnant women (PLHIV) 1,000
11 Viral load Transportation 1,500
12 Viral Load Examination (VL) (Once a year or if clinically needed) 3,500
13 CD4 Test (Twice a year or if clinically needed) 2,500

 

 

  • Reimbursements/ Services Offered

 

The services are paid through a reimbursement scheme. Thus the health facility renders the service to the client free of charge and the NWRFHP PIG pays the health facility as soon as the bills are declared and validated.

In the first semester of 2020, the following free services were provided to PLHIV in the  North West Region.

SERVICE PACKAGES T1 T2 TOTAL
QTY QTY QTY
ROUTINE CONSULTATION 6,695 6,857 13,552
ANC 1 4,435 4,456 8,891
ANC 2,3,4 430 486 916
MEDICAL BOOK FOR PLWHA 2,463 682 3,145
MEDICAL FILE 1,926 923 2,849
Targeted HIV Test using “Screening Tool” 19,187 22,961 42,148
FBC for Pregnant Women (PLWHIV) 47 76 123
Creatinine Pregnant Women (PLWHA) 122 99 221
Gylcemia Pregnant Women LWHA 80 128 208
Viral Load transportation 4,305 3,799 8,104
Viral Load Examination 4,305 3,799 8,104
CD4 Test 14 20 34
TB Test for (PLHIV) 1,213 501 1,714

 

 

  • SWOT ANALYSIS OF THE NO USER FEE HIV PROJECT

 

Like any other project, the No User Fee HIV Project for North West Region has her Strength, Weakness, Opportunities and Threats.

 

Strengths

  • The project has strong and reliable technical and financial partners like GIZ, World Bank, KFW, French Development Agency and the Government of Cameroon through the MOPH.
  • The NWRFHP PIG as a key player in the project. Existing for more than 30 years and having lots of experience with the community of NWR, her presence in the project is a major booster to the project as many health facilities believe so much in the transparency and objectivities of Fund’s decisions.
  • RTG as a technical partner has contributed so much to the success of the project. Her technical contribution and availability in trainings and workshops gives the project a big push.
  • The presence on board of CDVA and her well experienced verifiers. CDVA has verifiers in all the 19 health districts of the NWR.
  • Committed and dynamic staff working on the project at the level of the Fund. The staff are young and very committed and ready to work. This makes it possible for them to make any adjustment as concerns their leisure to see tasks executed.
  • The PBF Portal is a big asset to the project as it makes checks easy.
  • Payment of health facilities bills through bank transfers.

Weaknesses

  • The payment circuit for Viral Load Test. Which is that payment is done to health facilities that collected the sample and then to the reference laboratory that did the test. Money may be received at health facilities and not paid to the lab.
  • Other biological follow-up apart from Viral Load and CD4 Count benefits only HIV+ pregnant women. Allowing children and other PLHIV vulnerable.
  • Poor declaration at the level of the health facilities which lead to over billing.
  • Lack of equipment like the Full Blood Count Machines by most health facilities to do Full Blood Count Test.

Opportunities 

  • The presence of well-trained health personnel who have worked with HIV for long and have a good mastery of the treatment protocol of HIV.
  • The presence of public health facilities in almost all the villages of NWR.
  • Collaboration between RDPH, RTG, NWRFHP PIG and CDVA.

Threats

  • Late disbursement of funds. This is the main threat to the project as the unavailability of funds on time makes its implementation complicated. Health facilities lost interest and enthusiasm which had been stimulated through sensitization coaching.
  • The crisis affecting the region. Some data in some health facilities could not be collected because of this.
  • Bad road network in the region.
  • The availability of only one reference lab in the region to do Viral Load Examination.

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