Corruption in the health sector

Good practice - Examples

Project description

Through the establishment of a common health fund all Norwegian funding to the health sector with the exception of one programme (UNFPA) is channelled as a core contribution to the Ministry of Health. The justification for moving towards program support rests in the understanding that this will lead to improved health services, by providing a better overview of available resources and by creating a common framework for setting priorities, articulated in an annual costed plan, with common reporting, monitoring, accounting and audit of all activities. The performance of the health sector will be assessed through a joint annual review, using the national list of indicators, which will be subject for discussion with other partners and the Ministry of Health in the preparations of the annual reviews. All contributing partners have signed a MOU, setting out the conditions for the common fund.

Anti-corruption aspects

The change from a project approach to a programme approach has been difficult. Identified risk areas have been:

• resistance within the Ministry of Health from those who are losing direct control of funds,
• resistance to expose the various topping up schemes for salaries (extremely high salary levels partly created by abundant donor funding),
• costs related to training and/or participation in seminars and
• procurement, partly because the various donors have different requirements and partly because this is a "traditional" corruption risk area.

The process is simultaneous with the development of a new public financial management system, SISTAFE. The establishment of a common planning and budget system, and the connecting financing mechanism, is expected to improve not only government ownership, but also increase transparency and accountability.

The Ministry of Health is expected to be the first ministry to have the new financial system implemented. The elaboration of a new procurement law and its regulations, including assets, is another important parallel process. The work in this regard has unfortunately been slow even if some progress can be noted as from beginning of 2005. The partners in the Health Sector have taken an initiative, recommended by the UN Special Envoy on Human Rights, to assess the possibility of abolishing user fees. The purpose is to increase access to health services and to reduce corruption. The study will most probably be done in cooperation with the education sector (for school fees).

Recommended reading

Primary Health Care in Mozambique by Magnus Lindelöw, the World Bank, Patrick Ward, OPM, Nathalie Zorzi, consultant, July 2003, the World Bank.
Health Sector Expenditure Tracking and Service Delivery Survey for primary health care services in Mozambique funded by DFID in collaboration with the World Bank and Oxford Policy Management (OPM). It assesses the flow of monetary and non-monetary inputs to, and service outputs from, a sample of primary level health facilities. It also collects information on compliance with reporting and control systems at the facilities and at higher administrative levels. The distribution and utilisation of key inputs are being assessed in terms of equity and efficiency.

Other relevant anti-corruption projects in Mozambique from U4 data base:

• Combat Corruption, NORAD, 2002
  
• Etica Mocambique, the Netherlands, 2002
  
• Civil Society Participation in the PRSP process, DFID, 2001

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