Re-aligning Incentives to Address Informal Payments in Tanzania Public Health Facilities: A Discrete Choice...

Area of Science:

• Health Economics
• Public Health Policy
• Healthcare Management

Background:

• Informal payments for healthcare disproportionately affect developing countries, increasing financial risk and limiting access to quality care.
• Understanding provider incentives is key to designing effective policies against informal payments.
• Tanzania faces challenges with informal healthcare payments, necessitating investigation into provider preferences for policy interventions.

Approach:

• A discrete choice experiment (DCE) was conducted with 432 healthcare providers across 42 public facilities in Tanzania.
• DCE attributes included payment methods, supervision, private practice, monitoring, anti-informal payment measures, and incentives.
• Mixed multinomial logit models analyzed provider preferences for policy interventions.

Key Points:

• Healthcare providers strongly preferred incentive payments for non-infraction and opportunities for private practice.
• Disciplinary measures at the district level were significantly disliked by providers.
• A 10% salary top-up was a preferred incentive for most, except those already engaging in informal payments or absent for official trips.

Conclusions:

• Improved working conditions, including better earnings and career progression, are highly desired by healthcare providers.
• Provider preferences for interventions vary based on individual characteristics, indicating a need for tailored policy packages.
• Addressing provider incentives is essential for effectively combating informal healthcare payments in Tanzania.