Real World Challenges
Edited by Tina Søreide and Aled Williams
Chapter 8: Using salaries as a deterrent to informal payments in the health sector
Informal payments for public services are widespread in many low-income countries (Killingsworth et al., 1999; Balabanova and McKee, 2002; Barber et al., 2004). Such payments can reduce trust in health-care providers (Vian et al., 2006), switch health-worker attention from patientsí health to ability to pay (Lindkvist, 2012) and reduce demand for health care (Falkingham, 2004). Costs related to maternal health care is a likely explanation for the current failure in many countries to reach the health-related millennium development goals (MDGs), in particular when it comes to a reduction of maternal mortality (Borghi et al., 2006). The potential effects on health and poverty could be dire, and we must consider all forms of explanatory factors behind weak performance, including how to reduce the presence of informal payments. Suggestions typically range from formalizing such payments to making it less attractive to accept them.In this chapter I will use data I collected in Tanzania to shed light on the relationship between salary and informal payments: specifically I will discuss the extent to which wage differentials and salary packages can deter corrupt practices among public officials. Tanzania is one of the countries not on track to reduce maternal mortality sufficiently to reach MDG5 (Hogan et al., 2010). Part of the explanation for the slow progress could be the additional costs women incur related to maternal health services. A third of the population have been asked for informal payments (REPOA, 2006), and qualitative data suggest that such payments also occur in the labour ward (Kruk et al.
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