Lifesaving or Life Threatening: Perceptions and Experiences of Bribery among Women Giving Birth at Bwera and Kilembe Mines Hospitals in Kasese District, Western Uganda

Abstract

Background: Bribery for health service delivery remain a major challenge in many healthcare systems especially in developing countries. Paying bribes can have negative effects on health care access, equity and health status as they lead health consumers to forgo or delay seeking care, or to sell assets to pay for care. In Uganda, despite of the anecdotal evidence that women across the country pay bribes and gifts to health workers in order to access childbirth services, no studies have been conducted to explore their experiences and perceptions in regard to giving and receiving bribes and gifts during childbirth in Kasese District. There is thus limited qualitative understanding of whether and how gifts and bribes for care during childbirth occur in both public and private not for profit (PNFP) hospitals.

Methods: Focus Group Discussions (FGDs) among mothers who had delivered from Bwera Government Hospital and Kilembe Mines PNFP Hospital as well as among health care providers who worked in maternity wards and surgical theatres were conducted. In-depth interviews (IDIs) were also conducted among the hospital managers and administrators. Data analysis was don using a thematic approach.

Findings: A total of 8 FGDs among mothers, 2 FGDs among health care providers and 10 IDIs among hospital managers and administrators were conducted. Mothers expressed varied personal and other women's experiences that confirmed existence of bribery for childbirth services in both the Public (Government) and PNFP hospitals. They were mainly demanded directly by the health workers; and cases of neglect and abandonment when a mother failed to pay the bribe were reportedly frequent. While both mothers and health workers believed that bribes were detrimental to utilization of maternal and newborn services, they were willing to pay and receive them respectively. Bribes were being ‘normalized' by misguided beliefs that they are a necessary means to show gratitude to a health worker for aiding delivery of a live baby.

Conclusion: Mothers delivering from both public and private not for profit hospitals in Kasese district paid bribes and they are increasingly becoming a significant type of private health expenditure for childbirth services. A multidisciplinary approach will be necessary to curb down the incidence of bribes for childbirth services.