APPRAISAL MEETING FOR JANUARY TO APRIL 2020 VERIFICATION AND

VALIDATION OF HIV USER FEES

SWOT ANALYSIS SWR

5th June, 2020

Dr. SIMO P. Francis

PBF, CDVA Manager
CDVA Southwest, Cameroon.
OUTLINE
INTRODUCTION

OBSERVATION FROM THE FIELD

STRENGHTS

WEAKNESSES

OPPURTUNITIES

THREATS

RECOMMENDATIONS
 Introduction
 Exoneration of user fees by Decision
No.0498/D/MOH/SG/NACC/GTC/SP of 4 April 2019
 Sensitization meeting of regional actors done in December,

2019
 After validation of manual and operationalization of the

DHIS 2 platform (portal), field work started in May, 2020.

 CDVA is the verification agency
 January, February, March and April 2020 declarations were

all verified in May, 2020

 Observation from the field
Achievement rate for
Nber of HFs verified HIV User fees
SN Health District Nber of Active HFs Nber of HFs for HIV User fees HIV User fees
(Jan-Apr2020)
(Jan-Apr2020)
1.   Akwaya 6 Not Done Not Done Not Done

1.   Bakassi 7 7 6 86%

1.   Bangem 9 1 1 100%

1.   Buea 35 19 19 100%

1.   Ekondo Titi 15 10 5 50%

1.   Eyumojock 11 10 0 0%

1.   Fontem 3 1 1 100%

1.   Konye 9 6 5 83%

1.   Kumba 30 12 12 100%

1.   Limbe 35 19 19 100%

1.   Mamfe 15 4 4 100%

1.   Mbonge 9 7 7 100%

1.   Mundemba 6 3 3 100%

1.   Muyuka 5 4 3 75%

1.   Nguti 7 6 4 67%

1.   Tiko 17 15 15 100%

1.   Tombel 13 5 5 100%

1.   Wabane 6 2 2 100%

  Total 238 131 121 86%

 Observation from the field (Con’t)- AVG Monthly verification time
Average
Average
Active MPA Active CPA additional time Total Time Total time General
additional time
SN Health District HIV user fees HIV user spent in MPA MPA CPA Total Time additional time
spent in CPA HFs
HFs fees HFs HFs (Days) (Days) MPA+CPA (Days)
(in Hours)
(in Hours) (Days)

1  Akwaya ND ND ND ND ND ND   ND
2  Bakassi 7 0 1 0 7.00 0.00 7.00 0.88
3  Bangem 0 1 0 2 0.00 2.00 2.00 0.25
4  Buea 17 2 2.5 7 42.50 14.00 56.50 7.06
5  Ekondo Titi 4 1 2 4 8.00 4.00 12.00 1.50
6  Eyumojock 10 0 2 0 20.00 0.00 20.00 2.50
7  Fontem 1 0 1 0 1.00 0.00 1.00 0.13
8  Konye 6 0 3 0 18.00 0.00 18.00 2.25
9  Kumba 9 3 3 7 27.00 21.00 48.00 6.00
10  Limbe 17 2 2.5 8 42.50 16.00 58.50 7.31
11  Mamfe 3 1 2 4 6.00 4.00 10.00 1.25
12  Mbonge 8 1 2 2 16.00 2.00 18.00 2.25
13  Mundemba 2 1 2 3 4.00 3.00 7.00 0.88
14  Muyuka 2 1 2 3 4.00 3.00 7.00 0.88
Strengths
 Good project as it eliminates (promote access) the direct
payment for PLHIV, improve epidemiological response
 Majority of staff usually trained on management of PLHIV
 “Normal PBF Indicators” had prepared ground work (easy

declaration and verification)

 Integration of the verification mechanism within CDVA

activities is cost effective

 Verification revealed limited follow-up of HIV+ pregnant

women.
Weaknesses
 The policy of the management of HIV patients is not properly handle
 Staff of HF’s and CDVA have not yet trained/briefed
 Need to clarify the verification guideline (some points are not clear)
 Need to also adopt a clear validation process (type and number of
documents needed)
 Absence of medical files and booklets in some HFs
 No equity mechanism provided for HFs
 Registers for HIV user fees sometimes not available (++TB register)
 Viral load results are almost always sent late
 The DHIS 2 platform does not capture the HF that are considered as
subcontract
 No management fees allocated for the activity at the level of the CDVA
Opportunities
 Other HFs carrying out HIV activities were not
included nor verified in Q1-2020
 Continuous capacitation on HIV management

for staff in HFs

 Encourage the facility to completely update files

or records (registers and medical files) for

PLHIV
 Learning and enhancement opportunity

between “normal PBF indicators” and “User fees”

Threats 1/2
 This activity provides additional workload to Medical verificators
 Referral laboratory could not even be verified during this first
visit
 Sometimes, there is necessity to revisit the health facility
 Increase of transportation and communication fees
 Overall risk of delay in transmission of reports from field and
CDVA office
 Seasonal stockout of HIV materials (supply, transportation)
 Possibility of bias verification as some satellite HFs will not
benefit from the incentives (files not kept at their level but
transferred to the main CTA/UPEC centers).
Threats 2/2
 The portal has not been adjusted
 Many incoherence’s (absence of subcontracts on the bills)
 No bill generated (Bakassi, Fontem, Mbonge, Mundemba,

Eyumojock, Wabane).
 Risk of stigmatization of HIV patients if not properly handle
 Communication gap between the UPEC Unit and the

laboratories of the HFs

 Only 1 referring laboratory does viral load ====> delay in

transmission of results to HFs

 Ongoing socio-political crisis
Recommendations
 An explanatory session/training is needed for the field
actors (Health Facilities and their supervisory bodies)
 Commodities (registers, files, test and reagents) should

be made available for the HFs implementing the user

fees
 There should be provision for equity bonuses to HFs
 The date against the 2nd signature of the facility should

be removed
 The margin on the declaration form should be increased
THANKS FOR YOUR KIND ATTENTION