Corruption in the Health Sector
Nordberg, Carin, updated by Taryn Vian (U4 Issue 2008:10)

This U4 Issue presents some essential resources for anyone promoting anti-corruption in the health sector, or otherwise wanting to learn about the challenges of corruption in the health sector. The text is originally developed as web pages by U4 based on research by Carin Norberg of Transparency International and were later updated by Taryn Vian (tvian@bu.edu) of Boston University.

La corruption dans le secteur de la santé
Nordberg, Carin, mis á jour par Taryn Vian (U4 Issue 2009:14)

La présente étude de U4 constitue une source d’information essentielle pour quiconque participe à la lutte contre la corruption dans le secteur de la santé ou souhaite se documenter sur les défis que pose le phénomène de la corruption dans ce même secteur.

Approaches to teaching and learning about corruption in the health sector
Vian, Taryn (U4 Brief 2009:30)

Training and education programmes which deal with the topic of corruption and health can help change the way people approach their jobs as public administrators or development agency workers, and increase transparency and accountability. This U4 Brief summarises experiences and approaches to educating new and experienced public health professionals and donor agency practitioners about how to analyse problems of corruption in the health sector and design strategies to address them.

Benefits and drawbacks of per diems: Do allowances distort good governance in the health sector?
Vian, Taryn (U4 Brief 2009:29)

Per diems, or daily allowances, are an important mechanism for reimbursing work‑related expenses, encouraging participation in professional development activities, and motivating under‑paid employees. Yet, sometimes employees may abuse per diem policies by falsifying travel reports or inflating workshop budgets for private gain. In addition, the possibility of earning per diem can have a distorting impact on programme design, management decisions, and how employees spend their time. Drawing on a focus group and interviews with experienced development professionals, this U4 Brief explores the benefits and drawbacks of per diems, especially their potential negative impact on development goals.

The Impact of Information and Accountability on Hospital Procurement Corruption in Argentina and Bolivia
Savedoff, William D. (U4 Brief 2008:7)

Argentina and Bolivia have both attempted to curb corruption in procurement of hospital supplies. With varying degrees of success, their experiences tell a lesson: unless there are consequences attached to identified mal-practice, monitoring and publicizing information will not guarantee sustained gains.

Fraud in Hospitals
Musau, Steve, Taryn Vian (U4 Brief 2008:8)

Hospitals are vulnerable to corruption. In the U.S., health care fraud has been stimated to cost $60 billion per year, or 3% of total health care expenditures - much of it in the hospital sector. Hospitals account for 50% or more of health care pending in many countries. Fraud and corruption in hospitals negatively affect access and quality, as public servants make off with resources which could have been used to reduce out-of-pocket expenditures for patients, or improve needed services. This U4 Brief discusses common types of fraud which occur in hospitals in low-income countries, and suggests ways to prevent and control it.

Transparency in Health Programmes
Vian, Taryn (U4 Brief 2008:9)

Transparency is an important tool for good governance, helping to expose abusive practices including fraud, patronage, corruption, and other abuses of power. Increasing transparency can also enhance accountability by providing performance management information and exposing policies and procedures to oversight. This U4 Brief discusses the role of transparency in preventing corruption in the health sector.

Transparency and Accountability in an Electronic Era: The Case of Pharmaceutical Procurements
Waning, Brenda, Taryn Vian (U4 Brief 2008:10)

The burgeoning HIV/AIDS epidemic means that more labor and financial resources are being dedicated to the procurement of antiretroviral (ARV) medicines for  reatment. While patients, physicians, national governments and development partners are eager to see treatment programs expanded, rapid scaleup often results in circumstances whereby resources have to be spent quickly, and sometimes resources are added to systems that are already weak and vulnerable to corruption. Program expansion in these circumstances can result in more risk, waste and losses, especially in the procurement process. Transparency of ARV prices is the first step towards identifying and minimizing corruption in procurement. This U4 Brief describes how international partners and national procurement agencies have used information technology to improve transparency and increase accountability in  procurement of HIV/AIDS medicines.

Embezzlement of Donor Funding in Health Projects
Semrau, Katherine, Nancy Scott, Taryn Vian (U4 Brief 2008:11)

Donor funding has fuelled a vast increase in service delivery, medical research and clinical trials throughout the developing world. Yet, there is a dark side to this badly needed influx of funding: with pressures to spend funds quickly and achieve results, projects may not pay sufficient attention to internal monitoring and security systems to protect against embezzlement. This U4 Brief analyses how this type of corruption occurred in a donor-funded project, and what can be done to minimise the risk.

Pay for Honesty? Lessons on Wages and Corruption from Public Hospitals
Savedoff, William D., (U4 Brief 2008:13)

Theft, graft, absenteeism and soliciting bribes in the health sector in developing countries is often blamed on low pay. But does low pay actually explain corruption? Several studies of public hospitals in Latin America suggest otherwise. In particular, they show that low pay may contribute to corruption; however, without some form of monitoring to detect corruption and a real chance of penalties, raising wages is not likely to make a difference.

Informal pay and the quality of health care: lessons from Tanzania
Mæstad, Ottar, Aziza Mwisongo (U4 Brief 2007:9)

Informal payments for health services are common in many transitional and developing countries. Informal payments are often claimed to reduce access to health services, especially among the poorest. Impacts on the quality of care are, however, less obvious. Both positive and negative consequences are conceivable.

This Brief draws on a qualitative study among health workers in Tanzania to describe the nature of informal payments that are taking place in the health sector, and their potential impacts on access to and the quality of health care. Particular attention is devoted to the policy implications. A more comprehensive report from this research can be found in CMI Working Paper 5/2007.

Anti-Corruption in the Health Sector: Reducing Vulnerabilities to Corruption in User Fee Systems
Vian, Taryn (U4 Brief 2006:3)

Designed to promote efficiency and expand access to health care services by leveraging financial contributions from patients, user fee systems are in place in government and private facilities throughout the world. Yet, without proper financial controls and personnel management systems, user fee revenue is vulnerable to corruption. This case-based brief illustrates how one hospital was able to introduce policy and system changes to reduce corruption and increase responsible stewardship of user fee revenues for the public good.

Anti-Corruption in the Health Sector: Preventing Drug Diversion through Supply Chain Management
Vian, Taryn (U4 Brief 2006:4)

Drug supply is an essential component of health care systems, accounting for 10-30% of health care costs. Drugs can be expensive, and willingness to pay for drugs is high, creating the danger that employees will divert drugs for re-packaging and sale in the gray market, or for personal use. This case-based Brief describes how the President's Emergency Plan for AIDS Relief (the U.S. PEPFAR initiative) and the related Supply Chain Management System (SCMS) Project are working to increase transparency and provide a secure, high-quality supply of HIV/AIDS drugs to developing countries in Africa and Asia.

Using financial performance indicators to promote transparency and accountability in health systems
Vian, Taryn, David Collins (U4 Brief 2006:1)

This case-based brief presents experiences of district health management teams in
South Africa, where interventions to improve district health planning and reporting, including the integration of financial data and service utilization statistics, proved helpful
in increasing transparency and focusing attention on areas most vulnerable to abuse.

Corruption in the Health Sector
Norberg, Carin, updated by Taryn Vian (U4 Issue 2006:1)

This U4 Issue presents some essential resources for anyone promoting anti-corruption in the health sector, or otherwise wanting to learn about the challenges of corruption in the health sector. The text is originally developed as web pages by U4 based on research by Carin Norberg of Transparency International and were later updated by Taryn Vian (tvian@bu.edu) of Boston University.

U4 welcomes any feedback on the U4 Health pages

Approaches to corruption in drug management

Gender and corruption in humanitarian assistance

Low salaries, the culture of per diems and corruption

Corruption challenges at sub-national level in Indonesia

Corruption in the health and education sectors in Mali

Tackling forms of corruption that affect the poor most

Review of corruption in the health sector: theory, methods and interventions .pdf
(Taryn Vian)
This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalizations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.
Published in Health Policy and Planning (Volume 23, Number 2, March 2008). [The Open Access to this article is sponsored by U4]

A tale of two health systems. pdf
(William D. Savedoff)

A closer look at two countries demonstrates how corruption manifests itself differently across health systems. Colombia and Venezuela are neighbouring Latin American countries with comparable incomes that share many similarities in history, culture and language. Until 1990, the two countries also had similarly fragmented health systems, comprised of a large social security institutions that served the formal sector; national or state-level governments that directly provided health care services to the rest of the population; and an active private sector that relied predominantly on direct payment for services by patients and their families. In the early 1990s, Colombia engaged a series of dramatic health reforms that decentralised public services to the municipal level and, in parallel, created a mandatory universal insurance system with the participation of non-governmental insurers (for-profit and non-profit).

Detailed Implementation Review India Health Sector 2006-2007 Volume II .pdf
This Report summarizes the findings of a Detailed Implementation Review (DIR) of five Bank-financed projects in India: the Food and Drugs Capacity Building Project, the Orissa Health Systems Development Project, the Second National AIDS Control Project, the Malaria Control Project, and the Tuberculosis Control Project.

Governance and Corruption in Public Health Care Systems
Maureen Lewis, Centre for Global Development, 2006

This excellent working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed. The paper provides policy options for promoting better governance.