Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA.
Institute for Global Health Sciences, School of Medicine, University of California, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA.
Health Policy Plan. 2020 Jun 1;35(5):600-608. doi: 10.1093/heapol/czaa008.
While it is mandated that reproductive and child health services be provided for free at public facilities in India, qualitative evidence suggests it is common for facilities to request bribes and other informal payments for medicines, medical tests or equipment. This article examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs) and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth. Women who delivered in public facilities in Uttar Pradesh, India were administered a survey on sociodemographic characteristics, bribe requests, total OOPEs, types of health checks received and experience of maternal complications. Data were analysed using descriptive, bivariate and multivariate statistics. Among the 2018 women who completed the survey, 43% were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were associated with lower odds of receiving all health checks upon arrival to the facility (aOR = 0.49; 95% CI: 0.24-0.98) and during labour and delivery (aOR = 0.44; 95% CI: 0.25-0.76), lower odds of receiving most or all health checks after delivery (aOR = 0.44; 95% CI: 0.31-0.62) and higher odds of experiencing maternal complications (aOR = 1.45; 95% CI: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centred on improving person-centred care (particularly guidelines around bribes), health system conditions and women's expectations of care are needed.
虽然印度的公共设施必须免费提供生殖和儿童健康服务，但定性证据表明，设施经常要求贿赂和其他非正式支付药品、医疗检查或设备费用。本文研究了在印度北方邦，公共设施中，请求贿赂、总自付支出（OOPE）以及贿赂请求与总 OOPE 与分娩期间的护理质量和产妇并发症之间的关联。对在印度北方邦公共设施分娩的妇女进行了一项关于社会人口特征、贿赂请求、总 OOPE、接受的健康检查类型和产妇并发症经历的调查。使用描述性、双变量和多变量统计方法分析数据。在完成调查的 2018 名妇女中，有 43%的人被要求支付贿赂，73%的人产生了 OOPE。请求贿赂与以下情况的可能性降低相关：到达设施时接受所有健康检查（优势比 [aOR] = 0.49；95%置信区间 [CI]：0.24-0.98）和分娩期间（aOR = 0.44；95%CI：0.25-0.76），接受大部分或全部健康检查后（aOR = 0.44；95%CI：0.31-0.62）的可能性较低，以及经历产妇并发症的可能性较高（aOR = 1.45；95%CI：1.13-1.87）。尽管印度的公共设施规定必须免费提供产妇护理，但这些发现表明 OOPE 很高，贿赂/小费贡献很大。需要以改善以人为本的护理（特别是围绕贿赂的准则）、卫生系统条件和妇女对护理的期望为中心的干预措施。
