Ethics, payments and maternal survival in Tanzania

Investigators

Paula Tibandebage, Research on Poverty Alleviation (REPOA), Dar es Salaam, Tanzania, and Visiting Senior Research Fellow, Department of Economics, The Open University (Principal Investigator)
Maureen Mackintosh, Department of Economics, The Open University
Tausi Kida, Economic and Social Research Foundation, Dar es Salaam, Tanzania
Joyce Ikingura, National Institute for Medical Research, Dar es Salaam, Tanzania

Funding

This project is funded by the Wellcome Trust through a Biomedical Ethics Developing Country Project Grant. All content on this page is the sole responsibility of the investigators. Grant period 1 July 2011-30 June 2013.

Summary

The maternal mortality rate in Tanzania is among the highest in the world, and poor access to competent emergency care is known to be a leading cause of maternal death. This Wellcome Trust-funded research focuses on the interaction between payment practices in maternal care and the quality and ethics of the care provided.

Maternal health care in Tanzania is formally free in the public sector. However access often requires out-of-pocket payment. This collaborative research aims to uncover the extent to which charging practices in maternal care in Tanzania are seen by users and staff as ethical or unethical; the extent to which charging is both a cause and a consequence of other unethical practices; and what can be done about it.

Research questions

How do ethics and payments interact in maternal health care, and what are the implications for patients, staff and management? Specifically:

1. To what extent are payments for emergency obstetric and post-natal care regarded as unethical, and as major influences on exclusion and maternal mortality, and by whom?
2. To what extent are staff morale and professional ethics influenced by type and level of payments?
3. To what extent do ethical and efficient management practices have a positive impact on payment levels and staff morale?

Publications

Tibandebage, P. Kida, T. Mackintosh,M. Ikingura J. (2013) 'Empowering nurses to improve maternal health outcomes'; Paper 1 from the Ethics, Payments and Maternal Survival Project. REPOA Working Paper 13/1

Tibandebage, P. Kida, T. Mackintosh,M. Ikingura J. (2013) 'Understandings of Ethics in Maternal Health Care: an Exploration of Evidence From Four Districts in Tanzania'; Paper 2 from the Ethics, Payments and Maternal Survival Project. REPOA Working Paper 13/2

Tibandebage, P. Mackintosh M. (2010) 'Maternal mortality in Africa: a gendered lens on health system failure' Socialist Register 46

Presentations

Mackintosh, M., Tibandebage, P., Kida, T., Ikingura, J., Jahari, C. 'Charging cultures for maternal health care, (un)ethical behaviours and the challenge of payments reform: evidence from Tanzania', Presentation at the International Health Economics Association World Congress, Sydney, July 2013

Kida T., Tibandebage, P., Mackintosh, M., Ikingura, J., Jahari, C. 'Payments and quality of ante-natal care in two rural districts of Tanzania', Paper presented at the International Association for Feminist Economics Conference, Palo Alto, California, July 2013

Kida, T. Tibandebage P, Mackintosh, M, (2012) 'Payments for care and their impact on experience of maternal health care: evidence from Tanzania', Paper presented at the International Association for Feminist Economics Conference, Barcelona, 27-29 July 2012

Tibandebage P., Kida T. Mackintosh, M., (2012) 'Disempowered nurses and implications for the quality of maternal health care: a case study of public health facilities in Tanzania', Paper presented at the International Association for Feminist Economics Conference, Barcelona, 27-29 July 2012

Mackintosh M., Tibandebage P., (2012) 'Understandings of Ethics in Maternal Health Care: an Exploration of Evidence from Tanzania', Paper presented at the Institute of Philosophy and ESRC Innogen Workshop on Health Innovation and Social Equity in the 21st Century: A focus on new forms of health injustices, University of London, 17 May 2012

Contact

Dr Paula Tibandebage, ptiba@repoa.or.tz
Prof Maureen Mackintosh, maureen.mackintosh@open.ac.uk