Challenging Social Norms to Reduce Bribery in Tanzania’s Health Sector

This project piloted a peer-led intervention to shift attitudes toward bribery and gift-giving in public health facilities – using community networks to drive behavioural change.

 Previous research in Tanzania revealed that social norms of gift-giving and reciprocity played a key role in sustaining bribery within the health sector. These norms were reinforced through everyday interactions across social networks, where refusing to offer or accept gifts could result in gossip, criticism, or social exclusion – further entrenching the behaviour.

This project developed and tested an anti-bribery intervention that engaged both health workers and trusted community figures. It delivered tailored messages designed to shift attitudes and behaviours by challenging the perceived acceptability of bribery and highlighting its hidden costs. The intervention aimed to reduce petty corruption by recognising the influence of social pressure and using existing community structures to promote change from within.

Key Findings

• Social norms were deeply embedded in health worker networks.
  Health workers faced strong informal pressures to engage in bribery or favour-exchange, driven by social expectations within their networks. These expectations were closely tied to personal reputation, status, and respectability.
• Gift-giving and reciprocity were seen as part of a social safety net.
  Individuals who shared resources—even those gained through illicit means – were often celebrated, while those who followed formal rules and withheld favours were criticised. This dynamic reinforced a culture where bending rules was not only tolerated but socially rewarded.
• Behavioural change approaches were not a stand-alone solution – but played a reinforcing role.
  The project showed that social norm-focused interventions can complement and strengthen other anti-corruption efforts, especially when paired with environmental and institutional support.
• Shifts in perceived norms were more significant than shifts in personal attitudes.
  While attitudes toward bribery remained relatively stable, participants reported a visible change in what they believed others expected of them (injunctive norms). These shifts were especially linked to environmental cues used in the intervention.
• Information spread through clustered, profession-specific networks.
  The peer-led intervention travelled primarily within professional groups and was often shared during staff meetings. While communication remained largely within these clusters, the message still extended beyond the directly targeted units.

Impact and Implications

Despite the adoption of legal and institutional anti-corruption frameworks, many countries continued to face persistent, systemic corruption. This project highlighted the need for interventions grounded in local realities – tailored to the social, political, and economic dynamics that shape everyday behaviour.

The research provided evidence on the feasibility of leveraging social networks as a vehicle for delivering anti-corruption messages and interventions. It also explored whether shifting social norms could produce more sustainable behavioural change. By examining these behavioural drivers, the project contributed to the growing body of evidence that conventional legal tools alone may be insufficient – and that context-sensitive, network-based strategies offer a promising complement to formal approaches.

Evidence of impact:
The project’s approach to addressing corruption through social norms generated sustained interest from global development and health communities.

Building on the Tanzania research, the team completed a study with U4 and SIDA on small and medium enterprises in Moldova, examining how social norms influence business practices. The findings and recommendations were taken up by the Swiss Embassy in Moldova, which committed to an 11-year intervention. Claudia Baez Camargo, a member of the research team, contributed to co-designing the programme with local consultants – embedding a participatory approach and a strong focus on behavioural change.

The Tanzania project was also featured in a session with the World Health Organization’s Global Network for Anti-Corruption, Transparency, and Accountability (GNACTA). This collaboration led to the establishment of a panel on social norms and corruption at the Health Systems Global conference, helping to raise awareness within the international healthcare practitioner community.

In Indonesia, the team partnered with the University of Medan to support the development of a pilot intervention to address sextortion. Drawing inspiration from the Tanzania model, the intervention was designed to use peer-led networks and environmental cues to shift norms and promote accountability.