In a large survey in sub-Saharan Africa, adults who said they had paid a bribe for healthcare in the past year were more than four times as likely to report difficulty in obtaining care than those who had not paid bribes. Amber Hsiao and colleagues at the Technical University of Berlin, Germany, report these findings in PLOS ONE.
Previous research has explored how institutional corruption–in which healthcare funds are misappropriated or pocketed by officials–harms health outcomes in Africa. Bribery is a different form of corruption in which an individual must pay a bribe in order to receive healthcare, potentially discouraging them from seeking care or sowing distrust in the medical system. However, the extent to which bribery limits healthcare access has been unclear.
To better understand the effects of bribery in healthcare, Hsiao and colleagues analyzed data from a 2014¬-2015 survey of adults in 32 sub-Saharan African countries. Of 31,322 adults who had received medical care in the year the survey was conducted, 14 percent said they had engaged in bribery to obtain care at least once in the past year.
Controlling for individual and regional factors, survey respondents who had paid one or two bribes were 4.11 times more likely to report difficulties in obtaining care than those who had paid no bribes. Respondents who reported paying bribes “often” were nine times more likely to say they had difficulty accessing care.
These results suggest that bribery poses serious challenges to accessing medical care in sub-Saharan Africa. The findings could help inform efforts of policymakers and researchers as they work toward the United Nations’ goal of universal health coverage by 2030. The authors suggest that future research could focus on individual countries to identify potential strategies for reducing bribery. They also call for increased efforts to combat corruption in healthcare.
Amber Hsiao summarizes: “When patients in sub-Saharan Africa have to pay bribes for healthcare, they are much more likely to report difficulties in obtaining medical care. Bribery at the point of care and its implications need to be better monitored and addressed in the quest to reach universal health coverage.”