Informal Payments and Moonlighting in Tajikistan's Health Sector
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World Bank, Washington, DC
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This paper studies the relationship
between gender and corruption in the health sector. It uses
data collected directly from health workers, during a recent
public expenditure tracking survey in Tajikistan's
health sector. Using informal payments as an indicator of
corruption, women seem at first significantly less corrupt
than men as consistently suggested by the literature.
However, once power conferred by position is controlled for,
women appear in fact equally likely to take advantage of
corruption opportunities as men. Female-headed facilities
also are not less likely to experience informal charging
than facilities managed by men. However, women are
significantly less aggressive in the amount they extract
from patients. The paper provides evidence that workers are
more likely to engage in informal charging the farther they
fall short of their perceived fair-wage, adding weight to
the fair wage-corruption hypothesis. Finally, there is some
evidence that health workers who feel that health care
should be provided for a fee are more likely to informally
charge patients. Contrary to informal charging, moonlighting
behavior displays strong gender differences. Women are
significantly less likely to work outside the facility on
average and across types of health workers.
Palabras clave
ABUSE, ACCESS TO HEALTH CARE, ACCESSIBILITY, ACCESSIBILITY OF CARE, AGGRESSIVE, BRIBE, BRIBES, CORRUPTION, CRIME, DETRIMENTAL EFFECTS, DOCTOR, DOCTORS, DRUGS, ECONOMIC DECISIONS, ECONOMIC DEVELOPMENT, ECONOMIC REVIEW, EDUCATION LEVEL, EMPLOYEE, EMPLOYER, EQUAL OPPORTUNITIES, EQUALITY, EXCLUSION, EXPENDITURE, EXPENDITURES, EXPOSURE, EXTORTION, FATHER, FATHERS, FEMALE, FINANCIAL SYSTEM, FINANCING OF HEALTH CARE, FISCAL CAPACITY, GENDER, GENDER DIFFERENCE, GENDER DIFFERENCES, GENDER EQUALITY, GENDER GAP, GENDERS, HEALTH AFFAIRS, HEALTH CARE, HEALTH CARE NEEDS, HEALTH CARE SYSTEM, HEALTH CARE SYSTEMS, HEALTH ECONOMICS, HEALTH NEEDS, HEALTH OUTCOMES, HEALTH PLANNING, HEALTH POLICY, HEALTH RESOURCES, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICES, HEALTH WORKERS, HOUSEHOLDS, HUSBANDS, ILLEGAL ACTIVITIES, ILLEGAL ACTIVITY, ILLNESSES, INEQUALITY, INFANT HEALTH, INFORMAL PAYMENTS, INTERNATIONAL BANK, LOW INCOME, MEDICAL ETHICS, MEDICAL SERVICES, MEDICINE, NURSE, NURSES, PATIENTS, PAYMENTS FOR HEALTH CARE, POCKET PAYMENTS, POLICY RESEARCH, PRIVATE INVESTMENT, PRIVATE SECTOR, PROVISION OF CARE, PSYCHOLOGIST, PSYCHOLOGISTS, PUBLIC EXPENDITURE, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC HEALTH PROVIDERS, PUBLIC PROVIDERS, PUBLIC SECTOR, RECEIPT, RISK-TAKING, SEX, SEXUALITY, SOCIAL CAPITAL, SOURCE OF INCOME, SOURCE OF INFORMATION, UNEMPLOYMENT, USER FEES, VICTIMS, VILLAGE, VILLAGES, WAGE DIFFERENTIALS, WOMAN, WORKERS, WORKPLACE