Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 12 Issue 1 2023 12 01 Re-aligning Incentives to Address Informal Payments in Tanzania Public Health Facilities: A Discrete Choice Experiment 1 13 4336 10.34172/ijhpm.2022.6877 EN Peter Binyaruka Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania 0000-0002-1892-7985 Antonio Andreoni Department of Economics, SOAS University of London, London, UK South African Research Chair in Industrial Development, University of Johannesburg, Johannesburg, South Africa 0000-0001-9389-0927 Dina Balabanova Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK 0000-0001-7163-3428 Martin McKee Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-0121-9683 Eleanor Hutchinson Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-9718-2407 Blake Angell The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia 0000-0002-7188-7740 Journal Article 2021 10 21 Background Informal payments for healthcare are typically regressive and limit access to quality healthcare while increasing risk of catastrophic health expenditure, especially in developing countries. Different responses have been proposed, but little is known about how they influence the incentives driving this behaviour. We therefore identified providers’ preferences for policy interventions to overcome informal payments in Tanzania. Methods We undertook a discrete choice experiment (DCE) to elicit preferences over various policy options with 432 health providers in 42 public health facilities in Pwani and Dar es Salaam region. DCE attributes were derived from a multi-stage process including a literature review, qualitative interviews with key informants, a workshop with health stakeholders, expert opinions, and a pilot test. Each respondent received 12 unlabelled choice sets describing two hypothetical job-settings that varied across 6-attributes: mode of payment, supervision at facility, opportunity for private practice, awareness and monitoring, measures against informal payments, and incentive payments to encourage noninfraction. Mixed multinomial logit (MMNL) models were used for estimation. Results All attributes, apart from supervision at facility, significantly influenced providers’ choices (P < .001). Health providers strongly and significantly preferred incentive payments for non-infraction and opportunities for private practice, but significantly disliked disciplinary measures at district level. Preferences varied across the sample, although all groups significantly preferred the opportunity to practice privately and cashless payment. Disciplinary measures at district level were significantly disliked by unit in-charges, those who never engaged in informal payments, and who were not absent from work for official trip. 10% salary top-up were preferred incentive by all, except those who engaged in informal payments and absent from work for official trip. Conclusion Better working conditions, with improved earnings and career paths, were strongly preferred by all, different respondents groups had distinct preferences according to their characteristics, suggesting the need for adoption of tailored packages of interventions.<br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

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