Abstract
BackgroundThere 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.MethodsNine 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.ResultsThe 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.ConclusionThis 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.
Highlights
There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries
Background on Tanzania The human resource crisis is severe in Tanzania, as a consequence of restrictive government policies in the last few decades that have resulted in a freeze in recruitment of health workers [27]
Six out of nine focus groups were held in Tumbi regional hospital, which had a large number of employees available for each cadre, allowing the research team to conduct the focus groups without stopping routine activities
Summary
There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania It aims to assess how informal earnings might help boost health worker motivation and retention. Apart from the traditional categories of health workers (doctors, nurses, midwives), in the Tanzanian health system there are several non-traditional cadres that do not hold internationally recognized qualifications. Among these are Clinical Officers and Assistant Medical Officers, who serve as doctors, and Nurse Aides and Medical Attendants as substitutes for nurses. These non-traditional cadres are paid lower salaries than their traditional counterparts
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