Corruption in the health sector

Good practice - Examples

Project description

The Assessment Memorandum proposes a continued Sector Programme Support (SPS) to the Zambian health sector for the period 2002-2005 in the order of USD 6 million annually.

The Swedish support is by definition flexible in nature and a main objective is to continue the process of strengthening the SWAp process itself. The support is based on the Zambia National Health Strategic Plan 2001-2005, which has been assessed and appraised by a large number of stakeholders.

Since SPS is a long term commitment, very close attention is being paid to the political and economic development in Zambia. The memorandum emphasises the external context in which the SWAp takes place with a risk analysis including a possible alternative strategy. It is argued that SPS is the only sustainable way of supporting the Zambian health sector and the memorandum outlines a strategy on how to do this in a difficult political environment.

Anti-corruption aspects

The memorandum, Chapter 3, "Assessment of the external context", includes a section on corruption stating that:

"there are a number of reports indicating that corruption and misuse of power at a very high political level is widespread and there are numerous examples of supposed corruption and/or misuse of public funds in almost all sectors, including the health sector."

Following Chapter 4 "Risk analysis and alternative strategy: Risks related to good governance and corruption". Corruption is assessed both from a technical and a political perspective. The overall view is that sector support increases the possibility to address corruption risks properly:

"Working with the framework of a SWAp, means that Sweden and other collaborating partners (PC) have an overview of all resources including GRZ, to the health sector. This implies that Sweden may be more aware of mismanagement of funds and corruption than would otherwise be the case. Within a SWAp environment corruption can be better dealt with than in a traditional project environment and it is getting increasingly difficult for politicians and public servants to misuse funds, regardless of whether it is GRZ funds or CP funds".

The political perspective, by which is meant the willingness from the political elite to seriously deal with corruption is "much more complicated". "This perspective is closely interlinked with democracy, human rights and good governance".

A Review of the National Health Strategic Plan was published in February 2004. The report indicates that the health sector has been in receipt of rising budgets. It is however also noted that no exercise has been undertaken to determine if trends of disbursements and expenditures have been in the desired direction. The partners are therefore recommended to attach high priority to tracking resource flows within the health sector for the next period, and to design and implement a revised allocation formula to individual districts to reflect relative mortality/morbidity and poverty situation. There is no specific reference to corruption risks.

Recommended reading

Zambia National Health Accounts 2002: Main Findings, September 2004, byFelix Phiri and Marie Tien, funded by USAID/REDSO, Sida and WHO.
This study also includes a study of the sources and uses of funding for HIV/AIDS. The National Health Accounts methodology is a tool that allows countries to track the flow of all health spending from financial sources to end users. It includes estimates of household expenditures, spending that governments have not historically considered when looking at national health expenditures.

Other relevant anti-corruption projects in Zambia from U4 database:

•  Payroll management and establishment control project, DFID, 2000
  
•  Office of the Auditor General, NORAD, 2003
  
•  Support to Auditor General of Zambia, Ministry of Foreign Affairs, the  Netherlands, 2001

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