ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1602798
This article is part of the Research TopicExploring Health Disparities in Black Communities: Historical Perspectives, Present Challenges, and Future DirectionsView all 8 articles
Trapped by Debt: An Ethnographic Study of Medical Indebtedness and Hospital Detention in the Fundong Health District, Cameroon
Provisionally accepted
Ashangwa Constantine Tanywe1
Ngambouk Vitalis Pemunta2Vidarah Nimar3*Cybel Nji Angwe3*
Mathias Alubafi Fubah4Maurine Ekun Nyok5Tom Obara Bosire6Nguyen Ngoc Bich Tram7Brendabell Ebanga Njee8- 1University of Yaounde I, Yaounde, Centre, Cameroon
- 2Covenant University, Ota, Nigeria
- 3University of Gothenburg, Gothenburg, Västergötland, Sweden
- 4Human Sciences Research Council, Pretoria, South Africa
- 5Masaryk University, Brno, South Moravia, Czechia
- 6University of Glasgow, Glasgow, Scotland, United Kingdom
- 7Budapest Business School, Budapest, Hungary
- 8African Public Health Organization, Minnesota, United States
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This study investigates the structural and socio-cultural drivers of medical indebtedness and hospital detention due to unpaid healthcare bills in the Fundong Health District, Cameroon. It explores how poverty, institutional shortcomings, and cultural beliefs converge to exacerbate patients' financial vulnerability and delay access to care.A qualitative anthropological approach was employed between February and November 2022, combining 34 in-depth interviews with extended ethnographic observation in hospital wards, billing offices, and family waiting areas. Data were analyzed using iterative grounded theory methods, including open, axial, and selective coding of interview transcripts, focus group discussions, and field notes. This methodology allowed for a nuanced understanding of how debt and detention are experienced and perpetuated. All data were transcribed, manually coded, and analyzed using NVivo 14 software to identify recurring themes related to hospital detention.The findings show that medical indebtedness is driven by poverty, lack of health insurance, and limited social support. Institutional factors-including underfunded healthcare infrastructure and high user fees-compound these vulnerabilities. Cultural norms, such as beliefs discouraging financial preparation for illness, further heighten exposure to risk. The practice of hospital detention, though largely undocumented, imposes severe physical, emotional, and financial burdens, prompting some to delay care or adopt harmful coping mechanisms.Addressing medical debt and hospital detention requires a multifaceted policy response.Recommendations include eliminating maternal user fees, expanding health insurance coverage for vulnerable populations, protecting hospital-based social assistance, and replacing detention with legal safeguards and social mediation. Additionally, culturally sensitive financial literacy and mental health support programs are vital. Long-term investment in health infrastructure and governance is essential to reduce out-of-pocket spending and ensure equitable, rights-based healthcare access.
Keywords: medical indebtedness, Hospital detention, Cameroon, Universal Health Coverage, Healthcare Financing, Vulnerable Populations
Received: 30 Mar 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Tanywe, Pemunta, Nimar, Angwe, Fubah, Nyok, Bosire, Ngoc Bich Tram and Njee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Vidarah Nimar, University of Gothenburg, Gothenburg, 405 30, Västergötland, Sweden
Cybel Nji Angwe, University of Gothenburg, Gothenburg, 405 30, Västergötland, Sweden
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