More on Bribes to Access Health Care

Further to the previous study,[1] Kankeu et al. also studied how supply-side factors affect informal payments.[2] In contrast to the previous study across multiple diseases and countries, this study concerns itself with one disease (HIV) and one country (Cameroon). The study was built on a naturally representative survey among people with HIV/AIDs. Like the previous paper, this study concerns not all out-of-pocket payments, but specifically payments above stipulated tariffs – i.e. the focus on informal payments / bribes. The Global Corruption Barometer, published by Transparency International, shows that across all conditions, a third of people who visit a health care facility in Cameroon pay a bribe. As it turns out, bribes are less often exacted from HIV payments. Supply-side factors seem to have a large influenza on bribe payment in HIV patients in the study; 12% in private for-profit facilities, 3% in public, and under 1% in private not-for-profit. The actual amount paid when a bribe is elicited is highest in urban areas and in private for-profit facilities. Importantly, facilities where more than one care provider carries out all tasks required for a given patient have a higher probability of eliciting bribes than those where provision is spread among more than one person. The authors caution that increasing salaries might not reduce bribe taking (rent seeking) and may actually increase in line with a previous News Blog report.[3] In both papers the authors recommend National Insurance systems, and in this particular paper the authors fancy performance-related pay, despite its caveats.

— Richard Lilford, CLAHRC WM Director


  1. Kankeu HT, Ventelou B. Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries. Soc Sci Med. 2016; 151: 173-86.
  2. Kankeu HT, Boyer S, Toukam RF, Abu-Zaineh M. How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon. Int J Health Plann Manage. 2016; 31(1): E41-57.
  3. Lilford RJ. Improving Health Care From Outside Organisations. NIHR CLAHRC West Midlands News Blog. October 14 2016.

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