Definitions
OOP payments are defined by the World Bank as “any
direct outlay by households, including gratuities and inkind
payments, to health practitioners and suppliers of
pharmaceuticals, therapeutic appliances, and other goods
and services whose primary intent” is to enhance or restore
health status [39]. This includes official user fees at
public facilities as well as fees paid in the private sector. IP
is defined as “a direct contribution, which is made in
addition to any contribution determined by the terms of
entitlement, in cash or in-kind, by patients or others acting
on their behalf, to health care providers for services
that the patients are entitled to” [40]. During stakeholder
feedback interviews and focus groups, we found that IPs
are sometimes referred to locally in three categories: conditioned
payments (perceived by patients as necessary in.