Dilhan Perera
Publications and news by Dilhan Perera.
Publications
Addressing Bribery and Associated Social Norms in Healthcare: Results of a Behaviour Change Intervention in Tanzania
This open-access, peer-reviewed journal article examines the results of a pilot behavioural intervention in Tanzania. The project tested a behavioural anti-corruption intervention to reduce bribery in a hospital. It targeted deeply ingrained social norms while also leveraging the social networks and influence of key staff members.
The research was funded by the Global Integrity Anti-Corruption Evidence Programme of the UK Foreign Commonwealth and Development Office (FCDO). It was a collaboration between the Basel Institute on Governance, the UK Behavioural Insights Team, the University of Dar es Salam and the University of Utrecht.
Abstract
Practices of bribery in the delivery of public services become entrenched when they are driven by social norms of reciprocity.
The resulting economies of favours, which are common across diverse geographical regions, are resilient to conventional anti-corruption measures because they are underpinned by strong social pressures.
This article describes the results of a behaviour change intervention to address gift-giving as a form of bribery in a Tanzanian hospital. The intervention utilised environmental cues and a peer-led network approach to deliver messages aimed at disincentivising bribery.
An exit survey of hospital users indicates a reduction of the ‘gift-offering propensity score’, capturing self-declared behaviour, from 23% before implementation of the intervention to 13% afterwards. We find similar changes in the enabling norms score.
Semi-structured interviews with hospital users and health workers further support these findings.
These results suggest that practices and norms around bribery might be changed through a multi-pronged approach that addresses both the ‘supply’ and ‘demand’ side of bribery.
Using behavioural insights to reduce gift giving in a Tanzanian public hospital: Findings from a mixed-methods evaluation
This is the final technical report of the research project Addressing bribery in the Tanzanian health sector: A behavioural approach.
Previous research has shown that social norms of gift-giving and reciprocity are linked to patterns of bribery in the Tanzanian health sector. Health facility staff that do not accept a gift or reciprocate a favour are often punished by means of gossip, criticism, and even social isolation, further enforcing the norms. On the other hand, gift-giving and bribery exacerbate inequality in access to healthcare, as patients who are able and willing to give gifts might receive preferential treatment at the expense of those who cannot afford them. At the extreme, gifts and other unofficial payments become a requirement for access to services, with life threatening consequences for the most vulnerable groups.
In this mixed-methods evaluation we aimed to understand the feasibility and potential impact of a multi-component behavioural intervention on rates of gift exchange between users and staff of a public regional referral hospital in Dar es Salaam, Tanzania. The intervention aimed to shift users’ (i.e. patients and individuals accompanying them to the health facility) and health providers’ attitudes and perceived social norms around gift-giving, and to reduce actual exchange of gifts (i.e. the behaviour).
This research project was funded by the Global Integrity Anti-Corruption Evidence Programme (GI-ACE), funded with UK aid from the UK government. The project implementation was a collaboration between the Basel Institute on Governance, the UK Behavioural Insights Team, the University of Dar es Salam and the University of Utrecht.
The technical report is free to share under a Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence.
Using behavioural insights to reduce gift-giving in a Tanzanian public hospital Findings from a mixed-methods evaluation
This report relates to the research project Addressing bribery in the Tanzanian health sector: A behavioural approach. As part of the project, a pilot behavioural intervention was implemented at a Tanzanian hospital that aimed to shift hospital users’ and health providers’ attitudes and perceived social norms around gift-giving. It also aimed to reduce actual exchanges of gifts.
The research project as a whole was funded by the Global Integrity Anti-Corruption Evidence Programme (GI-ACE), funded with UK aid from the UK government. The project implementation was a collaboration between the Basel Institute on Governance, the UK Behavioural Insights Team, the University of Dar es Salam and the University of Utrecht.
The technical report is free to share under a Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence.