Health Providers in Tanzania

Corruption, provider practice, motivation and health system performance in Tanzania

Summary:

Health systems in many countries create incentives for health workers to engage in corrupt practices that lead to inappropriate and ineffective care, leading to high costs and poor outcomes for those in need of care.

The corruption issue:

We know that the health care that people receive in many countries is far from ideal. There are many reasons for this but one is that even the most committed health workers often face insuperable barriers to providing the care that their patients need while, at the same time, the incentives created by the health system encourage them to adopt responses that benefit themselves but harm the patient. In Tanzania, the health sector was singled as one of the most corrupt sectors (Lancsar, E. and J. D. Swait, 2014). Many of the corruptions measures are crude and do not distinguish between the different types of illicit practice, corruption and poor governance, and their differential route causes, therefore failing to inform strategies to address these.

Theory of Change:

IF: we can identify and implement policies and practices that remove the incentives for ineffective and inappropriate health care (specifically absences from work, diverting patients to private facilities, informal charging, under- and over-treatment), which can be financial (e.g. higher and better targeted pay, performance-related bonuses, other benefits) and non-financial (e.g. improved training and working conditions)

THEN: patients will receive better and more appropriate care

BECAUSE: the research will uncover policy combinations that work effectively in the specific political context by disincentivising poor practice.

Research Methods:

Scoping literature review, policy analysis, qualitative study, survey of up to 400 providers including discrete choice experiment (DCE) and open-ended vignettes methods to understand the choices made by health providers, given a series of hypothetical anti-corruption strategies.

Main Partners:  The London School of Hygiene and Tropical Medicine (LSHTM) and the Ifakara Health Institute (IHI) in Tanzania.

 

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