Strategies to reduce informal payments in health systems: a systematic review

Background: Informal payment is a major barrier to universal health coverage, particularly in low and middle-income countries. Aims: The aim of this study was to determine appropriate methods to reduce informal payments in health care via a systematic review. Methods: For this systematic review, we searched the Cochrane Library, PubMed and SCOPUS covering the period 2000-2014: 10 papers which considered reduction strategies for IP were finally included in the review. Three of the authors independently extracted data and assessed the papers against inclusion and exclusion criteria. Results: Improving public awareness and measures towards changing the culture were the main policies to combat informal payment. In addition, providing additional financial support to motivate physicians and other health service providers, appropriate monitoring of legislation, and converting informal to formal payment through tailored new policies were other solutions mentioned towards reducing or removing informal payments. Conclusions: No unique strategy exists for reducing informal payments in any health system. Choosing an appropriate strategy depends on the context and financing structure of the health system in any particular setting.