Taryn Vian, MSc, Assistant Professor, Department of International Health, School of Public Health, Boston University, T4W, 715 Albany St, Boston, MA 02118, 617-414-1447, tvian@bu.edu

As part of the country program to improve the financing and quality of primary health care in Albania, Partners for Health Reform Plus Project has conducted research on informal payments, a critical factor influencing the operational success of health systems in transitional economy countries. As described in other papers, the PHR Plus Project has documented out-of-pocket expenditures and care-seeking expenditures of citizens, as well as listening to the views of the general public and government health providers on the practice of informal payments. This paper shows how quantitative and qualitative research findings are being used to inform health policies and management strategies intended to reduce informal payments. Several strategies for reducing informal payments in Albania are analyzed, including increasing the income of providers through payment system reform, reforming management systems to better detect and punish illegal practices, and increasing transparency through community oversight. Albania faces specific challenges in implementing these reform options, including how to make sure that under the new payment system providers will stop accepting—and patients will stop offering—under-the-table payments, and how to introduce community boards in a country with limited experience of citizen activism or advocacy. Specific recommendations for policy and management reforms are derived from the anti-corruption literature, including ways to change attitudes about informal payments, options for the creation of rewards and penalties, and lessons for the design hierarchical control systems with appropriate levels of discretion.

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