“If the Big Fish Are Doing It Then Why Not Me Down Here?”: A Qualitative Assessment of Informal Fee Payments and Health Care Provider Motivation in Kenya

Katherine Tumlinson , University of North Carolina at Chapel Hill
Margaret Gichane, University of North Carolina at Chapel Hill
Sian Curtis, University of North Carolina at Chapel Hill

Informal fees are payments made by patients to their healthcare provider that are over and above the official cost of services; such payments may result in restricted access to medical care and reduced care-seeking behavior among vulnerable populations. The objective of this study is to examine healthcare worker perspectives on the scope and nature of informal fee payments solicited from reproductive health patients in Kenya. We conducted in-depth interviews in Kenya in 2015-2016 among a sample of 20 public and private-sector healthcare workers. Interviews were analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in healthcare facilities. Providers reported that low public-sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff also soliciting payments. Strategies for reducing this behavior include more adequate remuneration, media campaigns to educate patient populations, and increased provider motivation.

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 Presented in Session 10. Fertility, Family Planning, Sexual Behavior & Reproductive Health 2