Informal payments for health services are common in many transitional and developing countries. The aim of this paper is to investigate the nature of informal payments in the health sector of Tanzania and to identify mechanisms through which informal payments may affect the quality of health care. Our focus is on the effect of informal payments on health worker behaviours, in particular the interpersonal dynamics among health workers at their workplaces.
We organised eight focus groups with 58 health workers representing different cadres and levels of care in one rural and one urban district in Tanzania.
We found that health workers at all levels receive informal payments in a number of different contexts. Health workers sometimes share the payments received, but only partially, and more rarely within the cadre than across cadres. Our findings indicate that health workers are involved in ‘rent-seeking’ activities, such as creating artificial shortages and deliberately lowering the quality of service, in order to extract extra payments from patients or to bargain for a higher share of the payments received by their colleagues. The discussions revealed that many health workers think that the distribution of informal payments is grossly unfair.
The findings suggest that informal payments can impact negatively on the quality of health care through rent-seeking behaviours and through frustrations created by the unfair allocation of payments. Interestingly, the presence of corruption may also induce non-corrupt workers to reduce the quality of care. Positive impacts can occur because informal payments may induce health workers to increase their efforts, and maybe more so if there is competition among health workers about receiving the payments. Moreover, informal payments add to health workers’ incomes and might thus contribute to retention of health workers within the health sector.
Factors influencing the use of reproductive health care services among married adolescent girls in Dang District, Nepal: a qualitative study
Binita Maharjan, Poonam Rishal and Joar Svanemyr
BMC Pregnancy and Childbirth
Who benefits from increased service utilisation? Examining the distributional effects of payment for performance in Tanzania
Peter John Binyaruka, Bjarne Robberstad, Gaute Torsvik, Josephine Borghi
International Journal for Equity in Health
Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania
Iddy Mayumana, Jo Borghi, Laura Anselmi, Masuma Mamdani, Siri Lange
Social Science & Medicine
The role of ICT in property tax administration: Lessons from Tanzania
William McCluskey, Chyi-Yun Huang
Civil society’s role in petroleum sector governance: The case of Tanzania
Kendra Dupuy, Lise Rakner, Lucas Katera
Policy implementation under stress: Central-local government relations in property tax administration in Tanzania
Odd-Helge Fjeldstad, Merima Ali and Lucas Katera
Journal of Financial Management of Property and Construction
Når kan kvoteringsordninger for kvinner i politikken fjernes?
Will REDD+ safeguards mitigate corruption? Qualitative evidence from Southeast Asia
Aled Williams, Kendra Dupuy
The Journal of Development Studies
China and global integrity-building: Challenges and prospects for engagement
Comparing peer-based anti-corruption missions in Kosovo and Guatemala