University of Malawi, College of Medicine, School of Public Health, Blantyre, Malawi.
University of Malawi, College of Medicine, Department of Health Systems and Policy, Lilongwe, Malawi.
Glob Health Res Policy. 2021 Nov 24;6(1):41. doi: 10.1186/s41256-021-00225-z.
Informal payments in public health facilities act as a barrier to accessing quality health services, especially for poor people. This research aimed to investigate informal payments for health care services at Kamuzu Central Hospital (KCH), a public referral hospital in Malawi. Results of this study provide evidence on the prevalence and influencing factors of informal payments for health care so that relevant policies and strategies may be developed to address this problem.
This study employed a mixed methods research design. The quantitative study had a sample size of 295 patients and guardians. The qualitative study had 7 key informant interviews (with health workers, health managers and policy makers) and 3 focus group discussions (FGDs) with guardians. Each FGD included 10 participants. Thus, in total, the qualitative sample comprised 52 participants. Quantitative data was analyzed using Excel and STATA. Qualitative data was analyzed using a thematic content analysis approach.
80% of patients and guardians had knowledge of informal payments. Approximately 47% of respondents admitted making informal payments to access health services, and 87% of informal payments were made at the request of a health worker. Lack of knowledge, fear and desperation among patients and guardians, low salaries of health workers, and lack of effective disciplinary measures, were reported as key factors influencing informal payments. Regression analysis results showed that occupation and gender were the main determinants of informal payments.
Informal payments exacerbate inequality in access to free public health services. Particularly, poor people have limited access to health services when informal payments are demanded. This practice is unethical and infringes on people's rights to universal access to health care. There is a need to strengthen the public health care system by formulating deliberate policies that will deter informal payments in Malawi.
公共卫生机构的非正规支付行为成为获得优质卫生服务的障碍，尤其是对贫困人口而言。本研究旨在调查马拉维卡姆祖中央医院（KCH）的卫生保健服务中的非正规支付情况，该医院是一家公立转诊医院。本研究结果提供了有关卫生保健非正规支付的流行情况和影响因素的证据，以便制定相关政策和策略来解决这一问题。
本研究采用混合方法研究设计。定量研究的样本量为 295 名患者和监护人。定性研究包括 7 次与卫生工作者、卫生管理人员和政策制定者的关键知情人访谈，以及 3 次与监护人的焦点小组讨论。每次焦点小组讨论包括 10 名参与者。因此，定性样本总计包括 52 名参与者。使用 Excel 和 STATA 对定量数据进行分析。使用主题内容分析方法对定性数据进行分析。
80%的患者和监护人了解非正规支付。大约 47%的受访者承认为获得卫生服务而支付非正规费用，87%的非正规支付是应卫生工作者的要求支付的。患者和监护人缺乏知识、恐惧和绝望、卫生工作者工资低以及缺乏有效的纪律处分措施，被报告为影响非正规支付的关键因素。回归分析结果表明，职业和性别是非正规支付的主要决定因素。
非正规支付加剧了获得免费公共卫生服务的不平等。特别是，当要求非正规支付时，贫困人口获得卫生服务的机会有限。这种做法不道德，侵犯了人们普遍获得医疗保健的权利。马拉维需要通过制定旨在遏制非正规支付的深思熟虑的政策，来加强公共卫生保健系统。
