Global Fight Against Informal Payments for Health Services

Abstract Background Informal payments in public health facilities act as a barrier to accessing quality health services, especially for poor people. This research aimed to investigate informal payments for health care services at Kamuzu Central Hospital (KCH), a public referral hospital in Malawi. Results of this study provide evidence on the prevalence and influencing factors of informal payments for health care so that relevant policies and strategies may be developed to address this problem. Methods This study employed a mixed methods research design. The quantitative study had a sample size of 295 patients and guardians. The qualitative study had 7 key informant interviews (with health workers, health managers and policy makers) and 3 focus group discussions (FGDs) with guardians. Each FGD included 10 participants. Thus, in total, the qualitative sample comprised 52 participants. Quantitative data was analyzed using Excel and STATA. Qualitative data was analyzed using a thematic content analysis approach. Results 80% of patients and guardians had knowledge of informal payments. Approximately 47% of respondents admitted making informal payments to access health services, and 87% of informal payments were made at the request of a health worker. Lack of knowledge, fear and desperation among patients and guardians, low salaries of health workers, and lack of effective disciplinary measures, were reported as key factors influencing informal payments. Regression analysis results showed that occupation and gender were the main determinants of informal payments. Conclusions Informal payments exacerbate inequality in access to free public health services. Particularly, poor people have limited access to health services when informal payments are demanded. This practice is unethical and infringes on people’s rights to universal access to health care. There is a need to strengthen the public health care system by formulating deliberate policies that will deter informal payments in Malawi.

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Informal payments for health services: the experience of Bulgaria after 10 years of formal co-payments

European Journal of Public Health ◽

10.1093/eurpub/ckt165 ◽

2013 ◽

Vol 24 (5) ◽

pp. 733-739 ◽

Cited By ~ 15

Author(s):

Elka Atanasova ◽

Milena Pavlova ◽

Emanuela Moutafova ◽

Bernd Rechel ◽

Wim Groot

Keyword(s):

Health Services ◽

Informal Payments

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Informal payments for health care in Iran

International Journal of Health Governance ◽

10.1108/ijhg-02-2018-0007 ◽

2018 ◽

Vol 23 (3) ◽

pp. 205-215 ◽

Cited By ~ 5

Author(s):

Mohammad Meskarpour Amiri ◽

Abbas Assari ◽

Mohammadkarim Bahadori ◽

Ramin Ravangard ◽

Sayyed Morteza Hosseini-Shokouh

Keyword(s):

Health Care ◽

Health Services ◽

Health Sector ◽

Nationwide Survey ◽

Cross Sectional Study ◽

Outpatient Services ◽

Cross Sectional ◽

Informal Payments ◽

Content Type ◽

One Year

PurposeReducing informal payments (IPs) for health services has always been a top priority for health policymakers all over the world. As the newest attempts to reduce IPs, Iran’s Government applied a set of reforms in the health care system in 2014 called “Health Sector Evolution Plan” (HSEP). The purpose of this paper is to investigate the prevalence and nature of IPs one year after implementing this plan.Design/methodology/approachThis descriptive and cross-sectional study was a nationwide survey on Iran's health sector informal payments carried out in 2016. To do this, a sample of 1,112 Iranain households was selected from all over the country using a multistage cluster-stratified sampling method. The prevalence and nature of IPs were determined through conducting face-to-face interviews using a standard questionnaire.FindingsOne year after implementing the HSEP, about 27.7 percent of sampled Iranians had at least one experience of IPs for health services. The prevalences of compulsory and voluntary IPs were 21.4 and 11.5 percent, respectively. IPs were reported by 26.1 and 12.5 percent in the inpatient and outpatient services, respectively.Originality/valueAccording to the results, compulsory IPs are still prevalent in both the outpatient and inpatient services of Iran’s health system and it seems that the HSEP has not been completely successful in achieving the goal of eradicating IPs. It can be said that the HSEP has been the first step toward eradicating IPs in Iran and should not be the last one. The study provides useful results of the prevalence and nature of IPs after implementing the HSEP, which should be considered in designing the next steps.

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