کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4198302 1279050 2011 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی سیاست های بهداشت و سلامت عمومی
پیش نمایش صفحه اول مقاله
Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers
چکیده انگلیسی

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.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Health Policy - Volume 99, Issue 2, February 2011, Pages 107–115
نویسندگان
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