Working and discussion papersOctober 2019Nichola KitsonNear Ziguinchor Bula, Guinea-Bissau . Photo: jbdodaneInformal payments are widespread in the health sector in Guinea-Bissau. They impact negatively on equity and introduce distortions that negatviely affect efficiency and quality. In the worst cases, treatment may be withheld or deliberately delayed with a view to soliciting informal payments, sometimes with catastrophic results for the patient.There is a growing literature on informal payments in the health sector, which are widespread in low- and middle-income countries. Informal payments have been found to compromise the efficiency of healthcare provision, create perverse incentives that represent an obstacle to health reform policy and undermine the government’s ability to raise funds for health. The cost of informal payments and the barrier this creates to accessing healthcare also places a heavy burden on the poorest members of society. The practice of informal payments therefore undermines increasing international efforts towards achieving universal health coverage. At the same time, informal payments have been described as part of a wider remuneration strategy whereby such payments are one of the many coping mechanisms for health workers, often due to poor working conditions, low and irregular salaries, and a sense of abandonment by the state.This paper explores the situation as it stands in Guinea-Bissau, and outlines some approaches to tackling the rampant practice of soliciting informal payments in the public health sector, as well as the underlying causes prompting the practice. Nichola Kitson was an ODI Fellow in Mozambique and Guinea-Bissau 2015–2017 before winning the first post-ODI Fellowship Research Grant, which allowed her to conduct the research leading to this paper. Read the research Informal payments in the public health sector in Guinea-BissauDocumentpdfRelatedAssessing the cost of ill-health: two case studiesAssessing the full economic cost of ill-health in West Darfur, Sudan and North Kivu, Eastern Democratic Republic of Congo.Research reports and studies13 March 2019Shocks, stresses and universal health coverage: pathways to address resilience and healthThis report identifies and explores pathways to achieving universal health coverage that lead to sustainable and resilient lives for all.Working and discussion papers4 December 2017Public financial management and health services deliveryThis report explores the link between public finance management and better healthcare outcomes.Research reports and studies28 April 2017See more:healthpublic financematernal healthGuinea-Bissau
