Paiements Informels, Motivation du Personnel et Performance des Formations Sanitaires Publiques en RDC
DOI:
https://doi.org/10.47941/hrlj.3953Keywords:
Paiements informels, Motivation du personnel, Performance, Formation sanitaire, RDCAbstract
Objectif de l’étude : Cette étude vise à évaluer l’influence des paiements informels sur la motivation du personnel de santé et, par son intermédiaire, la performance des formations sanitaires publiques en RDC.
Méthodologie : Une enquête transversale a été menée auprès de 2331 prestataires de santé dans des formations sanitaires publiques. Les données ont été collectées via un questionnaire structuré auto-administré, ce qui implique une possible sensibilité aux biais de désirabilité sociale et ont été analysées à l'aide du logiciel SPSS version 26.0. Des analyses descriptives, des tests de fiabilité, des analyses factorielles exploratoires, des tests de comparaison, des corrélations et des régressions linéaires multiples ont été réalisés.
Résultats : Les paiements informels sont largement répandus : 84,5% des répondants reconnaissent que ces pratiques sont connues du personnel et 78,7% rapportent que des remerciements en espèces sont sollicités. L'Alpha de Cronbach (0,924) indique une excellente fiabilité. L'ACP révèle cinq dimensions expliquant 71,38% de la variance. Les paiements informels sont négativement corrélés avec la motivation intrinsèque (r=-0,438, p<0,001) et la performance perçue (r=-0,401, p<0,001). La régression montre que les paiements informels expliquent 28,4% de la variance de la motivation (R²=0,284, p<0,001).
Contribution Unique à la Théorie, aux Politiques et à la Pratique : Cette étude établit empiriquement le lien causal entre les paiements informels, l'érosion de la motivation intrinsèque et la dégradation de la performance des formations sanitaires publiques en RDC, mobilisant les théories de l'autodétermination et Principal-Agent dans un contexte de fragilité institutionnelle. Ces résultats sont toutefois à interpréter avec prudence en raison du caractère transversal et auto-déclaré des données, qui ne permet pas d’établir une causalité définitive et expose à des biais de désirabilité sociale.
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References
Arnaud, S., & Chandon, J.-L. (2013). Will monitoring systems kill intrinsic motivation ? An empirical study : Revue de gestion des ressources humaines, N° 90(4), 35‑53. https://doi.org/10.3917/grhu.090.0035
Benjamin Bob Odon Déclerck Arlette Celestin Joseph Gérard, A. M. J. S. N. M. M. M. H. L. L. N. W. M. L. E. E. E. M. (2024a). Accessibilité financière des ménages aux services et soins de santé primaires à l’ère de la couverture sante universelle en Rd Congo à travers les mécanismes de financement public dans la province du sud-ubangi, rd congo. https://doi.org/10.5281/Zenodo.15567160
Binyaruka, P., Balabanova, D., McKee, M., Hutchinson, E., Andreoni, A., Ramesh, M., Angell, B., Kapologwe, N. A., & Mamdani, M. (2021). Supply-side factors influencing informal payment for healthcare services in Tanzania. Health Policy and Planning, 36(7), 1036‑1044. https://doi.org/10.1093/heapol/czab034
Buch Mejsner, S., & Eklund Karlsson, L. (2017). Informal Patient Payments and Bought and Brought Goods in the Western Balkans – A Scoping Review. International Journal of Health Policy and Management, 6(11), 621‑637. https://doi.org/10.15171/ijhpm.2017.73
Buchanan, A. (1988). Principal/agent theory and decisionmaking in health care. Bioethics, 2(4), 317‑333. https://doi.org/10.1111/j.1467-8519.1988.tb00057.x
Buligescu, B., & Espinoza Peňa, H. (2020). Informal payments in Romanian health care system. A sample selection correction. Sociologie Romaneasca, 18(2), 40‑73. https://doi.org/10.33788/sr.18.2.2
Dallera, G., Palladino, R., & Filippidis, F. T. (2022). Corruption In Health Care Systems : Trends In Informal Payments Across Twenty-Eight EU Countries, 2013–19: Study examines corruption in health care systems across European Union countries. Health Affairs, 41(9), 1342‑1352. https://doi.org/10.1377/hlthaff.2021.01931
Deci, E. L. (2017a). Intrinsic Motivation and Self-Determination☆. In Reference Module in Neuroscience and Biobehavioral Psychology (p. B9780128093245056133). Elsevier. https://doi.org/10.1016/B978-0-12-809324-5.05613-3
Deci, E. L. (2017b). Intrinsic Motivation and Self-Determination☆. In Reference Module in Neuroscience and Biobehavioral Psychology (p. B9780128093245056133). Elsevier. https://doi.org/10.1016/B978-0-12-809324-5.05613-3
Deci, E. L., & Ryan, R. M. (2008). Self-determination theory : A macrotheory of human motivation, development, and health. Canadian Psychology / Psychologie Canadienne, 49(3), 182‑185. https://doi.org/10.1037/a0012801
Dombestein, H., Norheim, A., & Lunde Husebø, A. M. (2020). Understanding informal caregivers’ motivation from the perspective of self‐determination theory : An integrative review. Scandinavian Journal of Caring Sciences, 34(2), 267‑279. https://doi.org/10.1111/scs.12735
Dumoulin, J., & Kaddar, M. (1993). Le paiement des soins par les usagers dans les pays d’Afrique subsaharienne : Rationalité économique et autres questions subséquentes. Sciences sociales et santé, 11(2), 81‑119. https://doi.org/10.3406/sosan.1993.1266
Kabia, E., Catherine Goodman, Dina Balabanova, Kui Muraya, Sassy Molyneux, & Edwine Barasa. (2021). The hidden financial burden of healthcare : A systematic literature review of informal payments in Sub-Saharan Africa. https://doi.org/10.60692/N96YG-0VZ97
Field, A. (2018). Discovering Statistics Using IBM SPSS Statistics (5th ed.). SAGE Publications.
Fotaki, M. (2009). Informal Payments : A Side Effect of Transition or a Mechanism for Sustaining the Illusion of ‘Free’ Health Care ? The Experience of Four Regions in the Russian Federation. Journal of Social Policy, 38(4), 649‑670. https://doi.org/10.1017/S0047279409003274
Fox, S., Witter, S., Wylde, E., Mafuta, E., & Lievens, T. (2014). Paying health workers for performance in a fragmented, fragile state : Reflections from Katanga Province, Democratic Republic of Congo. Health Policy and Planning, 29(1), 96‑105. https://doi.org/10.1093/heapol/czs138
Frey, B. S., & Jegen, R. (2000). Motivation crowding theory : A survey of empirical evidence [Application/pdf,Online Datei]. https://doi.org/10.3929/ETHZ-A-004373506
Gaal, P., Belli, P. C., McKee, M., & Szócska, M. (2006). Informal Payments for Health Care : Definitions, Distinctions, and Dilemmas. Journal of Health Politics, Policy and Law, 31(2), 251‑293. https://doi.org/10.1215/03616878-31-2-251
Georgellis, Y., Iossa, E., & Tabvuma, V. (2011). Crowding Out Intrinsic Motivation in the Public Sector. Journal of Public Administration Research and Theory, 21(3), 473‑493. https://doi.org/10.1093/jopart/muq073
Habibov, N., & Auchynnikava, A. (2022). Quantifying the influence of informal payments on self-rated health : Evidence from 26 post-communist countries. Health Policy and Planning, 37(1), 112‑122. https://doi.org/10.1093/heapol/czab118
Horodnic, A. V., Williams, C. C., Ciobanu, C. I., & Druguș, D. (2022). Informal payments by patients, institutional trust and institutional asymmetry. Frontiers in Psychology, 13, 1015208. https://doi.org/10.3389/fpsyg.2022.1015208
Incaltarau, C., Horodnic, A. V., Williams, C. C., & Oprea, L. (2021). Institutional Determinants of Informal Payments for Health Services : An Exploratory Analysis across 117 Countries. International Journal of Environmental Research and Public Health, 18(23), 12421. https://doi.org/10.3390/ijerph182312421
Jahangiri, R., & Aryankhesal, A. (2017a). Factors Influencing on Informal Payments in Healthcare Systems : A Systematic Review. Medical Ethics Journal, 11(40), 73‑92. https://doi.org/10.21859/mej-114073
Jahangiri, R., & Aryankhesal, A. (2017b). Factors Influencing on Informal Payments in Healthcare Systems : A Systematic Review. Medical Ethics Journal, 11(40), 73‑92. https://doi.org/10.21859/mej-114073
Kahindo Mbeva Jean-Bosco, & Mahamba Nzanzu, K. N. (2020). Fonds d’achat des services de santé : Une expérience de renforcement de l’accessibilité aux soins et un pas vers l’assurance santé au Nord Kivu. https://doi.org/10.5281/ZENODO.7075021
Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20(1), 141-151.
Karnavat, K. (2024). Review of Self-Determination Theory-Based Interventions and Their Impact on Intrinsic Motivation. Zenodo. https://doi.org/10.5281/ZENODO.15187301
Koufopoulou, P., Vozikis, A., Souliotis, K., & Koutoupis, A. (2023). Informal Health Payments in the SARS-CoV-2 Era : Options from Greece. In K. T. Çalıyurt (Éd.), Integrity, Transparency and Corruption in Healthcare & Research on Health, Volume II (p. 179‑189). Springer Nature Singapore. https://doi.org/10.1007/978-981-99-5502-2_10
Kuvaas, B., Buch, R., & Dysvik, A. (2020). Individual variable pay for performance, controlling effects, and intrinsic motivation. Motivation and Emotion, 44(4), 525‑533. https://doi.org/10.1007/s11031-020-09828-4
Laleva, K., & Atanasova, E. (2019). Informal payments—Definitions and concepts. Health Economics and Management, 18(4). https://doi.org/10.14748/hem.v70i4.5945
Liu, N., Chen, Z., & Bao, G. (2021). Unpacking the red packets : Institution and informal payments in healthcare in China. The European Journal of Health Economics, 22(8), 1183‑1194. https://doi.org/10.1007/s10198-021-01330-z
Lohmann, J., Houlfort, N., & De Allegri, M. (2016). Crowding out or no crowding out ? A Self-Determination Theory approach to health worker motivation in performance-based financing. Social Science & Medicine, 169, 1-8. https://doi.org/10.1016/j.socscimed.2016.09.006
Maini, R. (2020). Health workers in the Democratic Republic of Congo : An exploration of their motivation, incentives, and the effects of an intervention to improve their remuneration by government. https://doi.org/10.17037/PUBS.04657205
Mannion, R., & Huw, D. (2018). A principal-agent perspective on clinical governance. In D. Kernick, Getting Health Economics into Practice (1re éd., p. 67‑78). CRC Press. https://doi.org/10.1201/9781315385525-9
Martela, F. (2020). Self‐Determination Theory. In B. J. Carducci, C. S. Nave, & C. S. Nave (Éds.), The Wiley Encyclopedia of Personality and Individual Differences (1re éd., p. 369‑373). Wiley. https://doi.org/10.1002/9781118970843.ch61
Masiye, F., Kaonga, O., & Banda, C. M. (2020). Informal payments for primary health services in Zambia : Evidence from a health facility patient exit survey. Health Policy OPEN, 1, 100020. https://doi.org/10.1016/j.hpopen.2020.100020
Meskarpour Amiri, M., Bahadori, M., Motaghed, Z., & Ravangard, R. (2019). Factors affecting informal patient payments : A systematic literature review. International Journal of Health Governance, 24(2), 117‑132. https://doi.org/10.1108/IJHG-01-2019-0006
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). McGraw-Hill.
Nzira, J. E., Parlasca, M. C., & Qaim, M. (2025). An inquiry into labor conditions across key rural sectors in Africa. PLOS One, 20(12), e0338694. https://doi.org/10.1371/journal.pone.0338694
Olken, B. A., & Singhal, M. (2011). Informal Taxation. American Economic Journal: Applied Economics, 3(4), 1‑28. https://doi.org/10.1257/app.3.4.1
Petroia, A., & Zubcova, E. (2016a). Global Fight Against Informal Payments for Health Services. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2859372
Petroia, A., & Zubcova, E. (2016b). Global Fight Against Informal Payments for Health Services. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2859372
Rogan, L., & Boaden, R. (2017). Understanding performance management in primary care. International Journal of Health Care Quality Assurance, 30(1), 4‑15. https://doi.org/10.1108/IJHCQA-10-2015-0128
Schaaf, M., & Topp, S. M. (2019). A critical interpretive synthesis of informal payments in maternal health care. Health Policy and Planning, 34(3), 216‑229. https://doi.org/10.1093/heapol/czz003
Smith, P. C. (2002). Measuring health system performance. The European Journal of Health Economics, 3(3), 145‑148. https://doi.org/10.1007/s10198-002-0138-1
Stringhini, S., Thomas, S., Bidwell, P., Mtui, T., & Mwisongo, A. (2009). Understanding informal payments in health care : Motivation of health workers in Tanzania. Human Resources for Health, 7(1), 53. https://doi.org/10.1186/1478-4491-7-53
Tumlinson, K., Gichane, M. W., & Curtis, S. L. (2020a). “ If the Big Fish are Doing It Then Why Not Me Down Here ?” : Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya. Studies in Family Planning, 51(1), 33‑50. https://doi.org/10.1111/sifp.12107
Tumlinson, K., Gichane, M. W., & Curtis, S. L. (2020b). “ If the Big Fish are Doing It Then Why Not Me Down Here ?” : Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya. Studies in Family Planning, 51(1), 33‑50. https://doi.org/10.1111/sifp.12107
Valdiglesias, J. (2025). Corruption as a Key Driver of Informality : Cross-Country Evidence on Bribery and Institutional Weakness. Economies, 13(10), 281. https://doi.org/10.3390/economies13100281
Van Den Boogaard, V., Prichard, W., & Jibao, S. (2019). Informal taxation in Sierra Leone : Magnitudes, perceptions and implications. African Affairs, 118(471), 259‑284. https://doi.org/10.1093/afraf/ady049
Wilkesmann, M. (2016). Von Fürsten zu Knechten ? In I. Bode & W. Vogd (Éds.), Mutationen des Krankenhauses (p. 207‑228). Springer Fachmedien Wiesbaden. https://doi.org/10.1007/978-3-658-11853-2_11
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Copyright (c) 2026 Bwalya Peti Richard, Chuy Kalombola Didier, Monga Yengo Hilaire, Ngoy Kamona Pierre Hubert, Kilufya Kisoma Hugues
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