Strengthening accountability for better health outcomes in Tanzania

Exploring the drivers of informal payments and absenteeism in primary health facilities

Research question

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.

Project summary

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), yet 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.

This project aims to identify the patterns of corruption among frontline public health providers and their managers in Tanzanian mainland, and explore the underlying determinants – systemic and individual factors - that give rise to corrupt behaviours. It will synthesize available evidence on the impact of corruption on users of health services and identify and assess the potential of accountability measures, including recent reforms, to constrain corrupt practices among front line public health providers and their managers. Finally, it will make recommendations towards a more resilient, efficient and accountable health system.

Existing health sector policies and reforms need to be assessed to ensure they do not exacerbate rule-breaking as an unintended effect. Further research will seek reforms which could help reduce absenteeism and informal payments.

Main partners 

Masuma Mamdani, Hadija Kweka, Peter Binyaruka and Mary Ramesh (Ifakara Health Institute), Dr Ntuli Kapologwe, Director of Health, Social Welfare and Nutrition Services (Presidents Office – Regional Administration and Local Government, Tanzania), Eleanor Hutchinson and Dina Balabanova (LSHTM), Antonio Andreoni (SOAS University of London).

Read the project summary