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“If the Big Fish Are Doing It Then Why Not Me Down Here?”: Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya

Citation

Tumlinson, Katherine; Gichane, Margaret W.; & Curtis, Siân L. (2020). "If the Big Fish Are Doing It Then Why Not Me Down Here?": Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya. Studies in Family Planning, 51(1), 33-50. PMCID: PMC7124971

Abstract

Informal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care-seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in-depth semistructured interviews in 2015-2016 among a sample of 20 public and private-sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public-sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low-cost services, and evidence-based methods to increase provider motivation.

URL

http://dx.doi.org/10.1111/sifp.12107

Reference Type

Journal Article

Journal Title

Studies in Family Planning

Author(s)

Tumlinson, Katherine
Gichane, Margaret W.
Curtis, Siân L.

Year Published

2020

Volume Number

51

Issue Number

1

Pages

33-50

PMCID

PMC7124971

NIHMSID

NIHMS1061735

Reference ID

12638