Ethics, payments and maternal survival in Tanzania. (360G-Wellcome-094966_Z_10_Z)

In the context of Tanzania's high maternal mortality and low levels of access to life-saving interventions, the limited existing research on charging levelsfor emergency obstetric and post-natal care confirms their potentially exclusionary levels, and facility surveys identify problems of poor quality and staff morale. Both the charging practices and the other quality problems are widely seen as unethical, but there is a gap in the research literature ontheir interactions at facility level. This project aims to add to knowledge about the ethical content and implications of individual payment systems for maternal care, and to generate policy-relevant evidence as to how health management can achieve more ethical and inclusive care through breaking interactive linkages between individual payments, abuse, exclusion and collapse in staff morale. The project methodology is largely qualitative, to be undertaken in four districts of Tanzania including districts which have, and have not, been the subject of policy intervention to improve quality and access to maternal care. The results will be fed into policy and health management debate through strong links of Economic and Social Research Foundation (ESRF) to local policy processes and through international dissemination of results.