Informal Payments during Childbirth: Magnitude, Determinants and Strategies for Improving Maternal and Child Health at Public and Non-Profit Hospitals in Uganda

Abstract

Background: Informal payments during childbirth is a growing concern in many developing countries including Uganda yet there is limited understanding of their magnitude and determinants in Public and Private Not for Profit (PNFP) hospitals in Uganda. 

Aim: To establish the level of private health expenditure, in the form of informal payments and their determinants, for care during childbirth in public and PNFP hospitals in Kasese district, Uganda

Methods: The study population consisted of 389 mothers who had just given birth from Bwera and Kilembe Mines Hospital, selected through systematic random sampling. 

Results: Over 31% and 3.6% of the mothers in the Public and PNFP Hospitals respectively gave informal payments during childbirth. The average total informal payments given in the Public Hospital was Uganda Shillings (UGX) 65,750 while that in the PNFP Hospital was UGX11,000.  Thirty-six percent and 15.1% of the mothers in the Public and PNFP Hospitals respectively also offered gifts. The average total amount for the gifts was UGX 10,500; and 12,600 in the Public and PNFP Hospitals respectively. Gifts and informal payments constituted 48% of the total costs paid during childbirth”which are never reflected in the official payment system. Informal payments were higher for the public hospital (p<0.001); deliveries made by caesarean section (p<0.001); and admissions beyond three days (p=0.003). 

Conclusion: In addition to official payments during childbirth, mothers incur costs in form of gifts and informal payments in both Public and PNFP hospitals. They form an important part of the private health expenditure that is rarely acknowledged in planning for maternal health services