Household health-seeking behaviour and response to Informal payment: does economic status matter?

Introduction: Corruption is a major factor that influences health seeking behaviour. However, there is paucity of empirical evidence from research on how corruption affects different population groups when they seek healthcare services from formal healthcare facilities. The paper presents new evidence on how informal payments, which is a major form of corruption, affect health-seeking behaviour people and how household economic status has sustained it in Nigeria.

Methods: We used a pre-tested interviewer-administered questionnaire to conduct interviews in 1,652 households in Enugu and Kano states, in the south and north of Nigeria, respectively. Descriptive statistics was used to estimate household health-seeking behaviour and Ordinary Least Square, binary logistic and multinomial logistic regression analyses to assess how experience of informal payment and economic status (quintiles: extremely poor, poor, average, rich, extremely rich quintiles) affect household health-seeking behaviour.

Results: Poorer households were most likely to attend health posts and health centres, while extremely rich households disproportionately used hospitals (59%). Household economic status determines the likelihood of paying informally, with richer ones paying more (p < 0.05). Household size, age of the patient, sex, years spent on formal education and state were other identified determinants of informal payments. Experience of informal payment in public facilities significantly reduces household use of tertiary hospitals compared to primary health centres or health posts by 58% (p < 0.05). The choice of tertiary hospital compared to a primary health centre or health post is significantly reduced by 31% because of informal payments (p < 0.01).

Conclusion: Informal payments in public facilities negatively affect health seeking, driving the poorest households to use low-quality care services. This problem needs to be widely recognised and sufficiently tackled in order for the country to reduce the economic burden of health seeking and achieve equitable access and utilisation of high-quality health services.