Corruption in the health sector

Good practice - Examples

Project description

Sweden has supported the health sector development of the Government of Bangladesh since 1972. In 1998 Sida, joined four other so called pool financiers led by the World Bank to support a sector wide approach initiative called the Health and Population Sector Programme (1998-2003).

Based on the lessons of this programme, the Ministry of Health and Family Welfare (MOHFW) has developed a successor programme, the Health, Nutrition and Population Sector Programme (HNPSP). It is based on a Strategic Investment Plan for the health sector lasting until June 2010. The HNPSP aims at improvements of basic health services to cost-effective, equitable and accessible levels.

Alternative financing mechanisms will be developed to reduce demand side barriers like staff absenteeism and informal payments that negatively affect utilisation of public services, especially by the poorest segments. Collaboration between the MOHFW and its development partners will be strengthened in order to gain and share better understanding of how to improve governance in the health sector, reduce system loss and strengthen accountability mechanisms.

The MOHWF will support the mechanisms of community and stakeholder participation in monitoring the programme. A Health Service Users Forum will be set up at national level, linked to community and district level monitoring groups. A demand-side financing mechanism as a way of transferring purchasing power to poor people to choose their services providers will be piloted.

Anti-corruption aspects

The assessment memorandum for the Swedish participation in the Health, Nutrition and Population Sector Support Programme in Bangladesh was presented to Sida Project Committee (PC) on April 7, 2005. It was the first of four health sector support programmes to be presented during 2005 with a special focus on anti-corruption measures.

The PC recommended that anti corruption should be part of the policy dialogue as elaborated in the Specific Agreement. The PC further asked the Swedish Embassy to provide an analysis of the corruption situation in Bangladesh in general and in the health sector in particular to be included in the final assessment memorandum.

In the following discussions the Embassy highlighted that financial risks had been analysed and presented in an annex to the memorandum, Assessment of Financial Management and Audit Systems.

The Swedish contribution is suggested to be pooled with other financial resources. Annual program reviews will be co-ordinated by the World Bank. Sida will sign a trust agreement with the World Bank outlining the responsibilities of the World Bank towards Sida regarding monitoring and reporting. The agreement will be a tool for regulating joint responses to suspected corruptive behaviours, transparency within the donor group and procedures for sanctions and withdrawals.

Other donor supported activities in Bangladesh of relevance for reducing the risk of corruption in the health sector:

• The World Bank is the lead agency in the health sector and complementary information regarding the risks and measures taken to counter these risks can be found in their Project Appraisal Document (latest version Jan 14, 2005). Corruption risks are not mentioned directly. There is however a number of issues of direct relevance for reducing the risk of corruption presented in the document: governance issues, the public sector's capacity, financial analysis, fiduciary aspects with focus on the necessity to strengthen the procurement and distribution of health sector goods. Report No: 31144-BD.

• DFID is supporting a Financial Management Reform Programme in co-operation with the Royal Netherlands's Embassy. The goal of the programme is to improve the efficiency and effectiveness of the allocation of resources and to achieve more equitable and improved public service. It will further strengthen line ministries role in resource allocation and management as well as the management capacity of the Financial Management Academy and Auditor General.

See also case 4: DFID support to "Social Sector Performance Surveys" in Bangladesh.

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

• Transparency and Anti-Corruption in the Public Service Sector Management of Water and Sanitation Services, South Asia
  Ministry of Foreign Affairs, Netherlands, 1999-2002.

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