Mitigating Financial Barriers to Trauma Care in Cameroon Through Locally Designed Quality Improvement

In low- and middle-income countries, trauma patients frequently face delays and inequities in care due to out-of-pocket payment requirements for basic medical supplies. In Cameroon, such financial barriers may impede timely emergency treatment and worsen outcomes. We evaluated whether the introduction of a locally designed care kit that provided essential supplies to emergency department (ED) providers without upfront payment improved timeliness and perceived affordability of initial trauma care.

We conducted a pre-/post-observational cohort study using data from the Cameroon Trauma Registry at a public regional referral hospital. Injured patients presenting during the six months before emergency kit implementation (December 2021 through May 2022) were compared with those presenting during the six months after implementation (June through November 2022). Outcomes included ED treatments, time from presentation to disposition, ED disposition, and patient-reported financial interference with care. Secondary analyses examined inpatient surgical care and discharge outcomes.

A total of 399 patients were included, of whom 208 (52%) presented after kit implementation. Demographics and injury characteristics were similar between groups. Post-implementation, patients experienced shorter median time to ED disposition (13.8 vs. 15.1 h, p = 0.001) and were less likely to leave against medical advice (26.4% vs. 39.3%, p = 0.006). Although median estimated ED treatment costs increased (41,500 vs. 30,000 CFA francs, p < 0.001), the proportion of patients reporting financial interference with care decreased by more than half (22.6% vs. 47.6%, p < 0.001). Kit implementation did not reduce financial barriers to inpatient surgical care.

Provision of essential emergency supplies without upfront payment was feasible and associated with improved timeliness and perceived affordability of trauma care. Addressing acute financial barriers in emergency settings may represent a pragmatic strategy to enhance access to care in resource-limited environments.