Understanding informal payments in health care: motivation of health workers in Tanzania
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BioMed Central
Open Access
Research
Understanding informal payments in health care: motivation of health workers in Tanzania Silvia Stringhini*1,2, Steve Thomas1, Posy Bidwell1, Tina Mtui3 and Aziza Mwisongo3 Address: 1Centre for Global Health, Trinity College Dublin, Dublin, Ireland, 2INSERM U687, Hôpital Paul Brousse, Villejuif, France and 3National Institute for Medical Research (NIMR), Dar Es Salaam, Tanzania Email: Silvia Stringhini* - [email protected]; Steve Thomas - [email protected]; Posy Bidwell - [email protected]; Tina Mtui - [email protected]; Aziza Mwisongo - [email protected] * Corresponding author
Published: 30 June 2009 Human Resources for Health 2009, 7:53
doi:10.1186/1478-4491-7-53
Received: 26 January 2009 Accepted: 30 June 2009
This article is available from: http://www.human-resources-health.com/content/7/1/53 © 2009 Stringhini et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract 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
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