School of Public Health, National University of Kyiv-Mohyla Academy, Kiev, Ukraine.
Int J Health Plann Manage. 2013 Apr-Jun;28(2):e169-87. doi: 10.1002/hpm.2155. Epub 2012 Dec 13.
Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities.
乌克兰的孕产妇保健是政府的重点工作。然而，自苏联解体以来，其并未发生重大变化。与乌克兰整个医疗保健部门一样，孕产妇保健服务因资金效率低下而受到影响，导致服务质量低下且获取服务的机会有限。本文旨在探讨乌克兰孕产妇保健领域非正式支付的实践情况，特别是在基辅妇产医院分娩的情况下。本文对消费者和提供者在非正式支付方面的经验进行了民族志研究。结果表明，在基辅妇产医院，分娩时的非正式支付是一种既定做法。孕妇（包括其伴侣）和产科医生之间的讨价还价过程是分娩前安排的重要组成部分，其中包括非正式支付。为了解决基辅妇产医院的非正式支付问题，需要采取以下措施：（i）规范医疗机构层面的“准官方”患者支付；（ii）通过员工培训提高职业道德。这些策略应与改善医疗保健部门的治理相结合，特别是孕产妇保健，以达到国际质量标准和获得适当设施的机会。
