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.