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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Understanding informal payments in health care: Motivation of health workers in Tanzania
Human Resources for Health, Volume 7, Article 53, Year 2009
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Description
Background: There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Methods: Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. Results: The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. Conclusion: This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic. © 2009 Stringhini et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2711965/bin/1478-4491-7-53-S1.doc
Authors & Co-Authors
Stringhini, Silvia
Ireland, Dublin
Trinity College Dublin
France, Villejuif
Hopital Paul-brousse
Thomas, Steve D.
Ireland, Dublin
Trinity College Dublin
Bidwell, Posy
Ireland, Dublin
Trinity College Dublin
Mtui, Tina
Tanzania
National Institute for Medical Research Tanzania
Mwisongo, Aziza J.
Tanzania
National Institute for Medical Research Tanzania
Statistics
Citations: 246
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1186/1478-4491-7-53
e-ISSN:
14784491
Research Areas
Health System And Policy
Study Approach
Qualitative
Study Locations
Tanzania
Participants Gender
Male
Female