Corruption in the health sector

Causes and consequences

Table 1:
Vulnerability Assessment Approaches [1]

Approach	Description	Advantages / Disadvantages
Corruption Perception Surveys	Surveys of perceptions about corruption, to determine areas of concern. Can include citizens, government agents, or sector experts. Examples: World Bank Corruption Perception Surveys, Transparency International's Corruption Perceptions Index	Highlights perceived areas of concern, can monitor changes over time. Current debate on best methodology, and how results may be affected by local understanding of terms Expensive
Household expenditure surveys	Measures expenditures including health care and informal payments. Can determine whether poor are being denied care or not seeking care due to inability to pay. Can be analyzed by income level and region, and compared with stated goals for health spending and service provision. Examples: World Bank Living Standards Measurement Surveys	More detail on health spending by income, region, type of expenditure (formal, informal) Respondents are more likely to be honest than when approached at a facility exit survey Expensive
Qualitative data collection	Qualitative data collection through in-depth interviews and focus groups, to determine areas of concern. Example: Vian et al. 2005; Balabanova and McKee 2002 [2]	Provides more details on motivations, attitudes, and meaning of terms, as well as operational detail Allows follow-up questions Can be expensive
Control Systems Review	As described by Klitgaard in 1988, this approach is applied to specific departments or government units. Examines inherent risks given mission/mode of operation; control environment; and existing safeguards against corruption. Examples: U.S. Office of Management and Budget internal control guidelines (Klitgaard 1988, p. 84-85 [3]), U.S. hospital compliance programs to combat fraud (OIG 1998 [4]); pharmaceutical assessment (Cohen et al. 2002 [5])	Good for comparing actual systems with best practice. Assumes systems are stable, therefore not good for systems undergoing health reform. Works better in countries with developed administrative systems & good documentation
Disaggregated analysis of corruption	Based on principle that different types of corruption require different solutions, this approach disaggregates types of corruption, and determines the scope, seriousness, winners and losers, by type (Klitgaard 1988). Secondary data sources can be sued in this approach; for example, analysis of household expenditure surveys that show amounts paid for allegedly free services.	Provides deeper understanding of each type of corruption, adapted to cultural, political and economic context Depends on secondary data available Good mechanism to encourage participation of

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References

[1] Taryn Vian, Corruption in the health sector: a review of tools and strategies for prevention Boston MA: Boston University School of Public Health. 2005

[2] Vian, T., et al. Informal Payments in Government Health Facilities in Albania: Results of a Qualitative Study. Social Science and Medicine pending publication 2005.

Balabanova, D., and McKee, M. Understanding informal payments for health care: the example of Bulgaria. Health Policy 62: 243-73 2002

[3] Klitgaard, R. Controlling Corruption. University of California Press, Berkley, CA, 1988.

[4] Office of Inspector General OIG Compliance Program Guidance for Hospitals. Federal Register 63: 8987-8898 1998.

[5] Cohen, J. C., Cercone, J. A., and Macaya, R. Improving Transparency in Pharmaceutical Systems: Strengthening Critical Decision Points Against Corruption. Latin American and Caribbean Region: Human Development Network. World Bank, Washington, DC, 2002

	Corruption in the health sector
	Causes and consequences
	Financial resources management
	Management of medical supplies
	Health worker/patient interaction
	Good practice
	Budget transparency
	Salaries
	Literature review
	Links

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SPOTLIGHT

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.

RECOMMENDED READING

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.


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Corruption in the health sector

Causes and consequences

Table 1: Vulnerability Assessment Approaches [1]

References

Table 1:
Vulnerability Assessment Approaches [1]