Gender Differences in Informal Payments for Healthcare: Evidence from 36 African Countries.

Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving Universal Health Coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particularly in low- and middle-income countries. Our study aimed to examine gender disparities in paying informally for healthcare in Africa. We used Afrobarometer Round 7 survey data collected between September 2016 and August 2018 from 34 African countries. The final sample was 44 715 adults. We used multiple logistic regression to evaluate associations between gender and paying informally to obtain healthcare. Our results show that 12% of women and 14% of men reported paying informally for healthcare. Men were more likely to pay informally for healthcare than women in African countries (OR 1.22 [95% CI 1.13-1.31]), irrespective of age, residential location, educational attainment, employment status, occupation, and indicators of poverty. To make meaningful progress towards improving Universal Healthcare Coverage in African countries, we must improve our understanding of the gendered aspects of informal payments in healthcare, which can act as both a barrier to accessing care and a determinant of poor health.