A critical interpretive synthesis of informal payments in maternal health care

Schaaf, Marta, and Topp, Steph (2019) A critical interpretive synthesis of informal payments in maternal health care. Health Policy and Planning, 34 (3). pp. 216-229.

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Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are proximal and distal impacts, including on household finances, patient satisfaction and provider morale. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches and econometric modelling. Summarizing and discussing the advantages and disadvantages of these and other paradigms illustrates the value of an inter-disciplinary approach. The same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multidisciplinary health systems approach that leverages and integrates positivist, interpretivist and constructivist tools of social science research can lead to better insight. With this, we can challenge 'master narratives' and meet universalistic, equity-oriented global health objectives.

Item ID: 57684
Item Type: Article (Research - C1)
ISSN: 1460-2237
Keywords: corruption, health policy, maternal health, health systems
Copyright Information: © The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Funders: John D. and Catherine T. MacArthur Foundation
Date Deposited: 26 Mar 2019 01:36
FoR Codes: 44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 25%
42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50%
44 HUMAN SOCIETY > 4407 Policy and administration > 440708 Public administration @ 25%
SEO Codes: 94 LAW, POLITICS AND COMMUNITY SERVICES > 9402 Government and Politics > 940204 Public Services Policy Advice and Analysis @ 50%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
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