Unveiling Barriers to Universal Health Coverage: A Cross-Sectional Assessment of the Demand-Side Viewpoints in Northwest Region-Cameroon

Universal Health Coverage (UHC) aims to ensure that everyone has access to quality health services without suffering financial hardship. Health services must be culturally acceptable; otherwise, utilization will remain low despite availability. The understandings and attitudes toward UHC differ across populations, impacting its implementation. This study assessed the knowledge, attitudes, and perceptions of UHC, analyzed the factors associated with these views, and examined the users’ preferences for UHC in terms of healthcare provider choice, payment schemes, and factors predicting these choices. This study was conducted in the Northwest Region of Cameroon, with over 3 million inhabitants, in a humanitarian crisis since 2016. A cross-sectional survey included 417 respondents selected through multistage sampling from 20 health districts. Data were collected through face-to-face interviews using pretested questionnaires. Data was entered and analyzed using Excel and SPSS. The association between variables was studied using the Chi-squared test, Student’s t-test, and Analysis of Variance (ANOVA). A multiple linear regression was done to eliminate the effect of confounders influencing knowledge and attitudes toward UHC. Ethical considerations included informed consent, data confidentiality, and compliance with the Regional Ethical Committee for Human Health Research (CERSH). Most respondents (77%) had heard of UHC, but only 32.3% knew it reduces out-of-pocket costs. Three-quarters were unaware of the government's UHC goals. While 82.5% desired universal access to cost-effective healthcare, only 6.4% had a good perception of UHC. Nonetheless, 83.3% wanted a National Health Insurance Scheme (NHIS), and 70% wanted it to be compulsory. Higher knowledge scores were found in older age groups (p=0.020), urban residents (p=0.015), private-sector employees (p<0.001), and those with free healthcare access (p<0.001). Regarding UHC plan choices, 51.0% had no preference for private or public hospitals, 48.1% believed the government should cover all costs, while 38.0% wanted a mixture, with the wealthier paying more. This study shows significant gaps in knowledge and perceptions of UHC among the population. While there is a strong desire for cost-effective healthcare access, awareness of government initiatives and UHC mechanisms remains low. Policy implications include the need for targeted educational campaigns on UHC. Additionally, considering a compulsory NHIS could foster greater community participation and support backed by their strong willingness to contribute to the NHIS. This will definitely build a resilient health system.