Corruption in the health sector

Good practice - Examples

Project description

Over the period 2003 - 2005 DFID is funding three sector surveys in Bangladesh, one each in secondary and primary education and one in primary health.

In the case of Primary Health the survey is intended to stimulate policy debate and support the public sector in becoming more performance-oriented and accountable, with the ultimate objective of increasing the effectiveness and equity of public spending on priority services.

The survey focuses on the lowest tier of service provision in health care, since this tier is essential for the effective delivery of primary services to the population. This means a focus on upazila health complexes or below.

Oxford Policy Management conducted the surveys along with a counterpart national survey organization. The final report for the Primary Health survey was released in November 2005. A summary of lessons learned from implementation of the Bangladesh PETS survey is available on the OPM website. The dissemination of the survey results will be conducted in co-operation with the Ministry of Finance.

Anti-corruption aspects

Areas covered by the surveys included resource flows in formal and informal management systems, resource control and accounting, utilisation of essential inputs at the facilities, outputs and their relationship with inputs, equity and the demand for services. The following research questions are particularly relevant for future anti-corruption initiatives:

•  What is the actual public spending at the primary level?
•  Are provisions reaching the frontline service provider? What are the blocks and  leakages?
•  How important are informal resource flows and how do they relate to leakages of  formal flows?
•  How are informal payments financed?
•  What is the level of absenteeism?
  

During the process, government expenditure was tracked from the Directorates through to the service providers. In a similar manner the flow of goods (e.g. drugs) was tracked from the Directorates to the service provider. At the facility level researchers reviewed staffing, training, supervision, equipment and other provisions as well as assessments of the quality and volume of the services being provided. The factors that affected service uptake by different groups were assessed. The survey indicated how commonly users make unofficial payments for services and what the effects are of these fees on uptake.

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