Supply-side factors influencing informal payment for healthcare services in Tanzania

Abstract Informal payments for healthcare are widespread in sub-Saharan Africa. They often regressive, potentially limiting access to quality healthcare, particularly the most vulnerable, and can have catastrophic consequences households. Yet there is little empirical research that uses theory-driven hypotheses explore what influences informal and, especially, from health workers’ perspectives. Consequently, we explored characteristics of workers facilities influencing Tanzania, examining two hypotheses: with power position system more likely receive payments, transparency accountability measures be bypassed by those who game system. We conducted a cross-sectional survey 432 42 public (hospitals centres) 12 district councils Pwani Dar es Salam regions Tanzania. Our dependent variable was whether worker has ever asked or been given bribes, while explanatory variables were measured at individual facility level. Given hierarchical structure data, used multilevel mixed-effect logistic regression determinants. Twenty-seven percent engaged payment. This common amongst younger (<35 years) higher hierarchy (specialists heads departments). Those receiving entitlements benefits timely manner subject continued supervision significantly less payments. The likelihood engaging varied among workers, consistent our first hypothesis, but evidence on second hypothesis remains mixed. Thus, policy responses should address both system-level factors, including ensuring adequate progressive sector financing, better remuneration frontline providers, enhanced governance supervision.