I am a lawyer specializing in law and development. I joined U4 in 2016 and coordinate U4’s theme on mainstreaming anti-corruption in public service delivery and integrating gender in anti-corruption programming.

Previously, I lectured at Makerere and Cavendish Universities in Uganda and was Dean of Law at Cavendish University. I was also an external consultant with various NGOs, international organisations and justice, law and order sector agencies, providing technical assistance on human rights, gender mainstreaming, legal reform, strategy development and improving processes and procedures. I was Assistant Lead Counsel to the Commission of Inquiry into Allegations of Corruption in Uganda Revenue Authority (2002-2003) and subsequently wrote my PhD thesis on the role of commissions of inquiry in the fight against corruption in Uganda.

I am an Advocate of the High Court of Uganda and a member of the Uganda Association of Women Lawyers. I hold a Bachelor of Laws (Hons) Degree from Makerere University, a Post-Graduate Diploma in Legal Practice from the Uganda Law Development Centre, a Masters’ in Law and Development from the University of Warwick, UK and a PhD in Law, also from Warwick. 

I am a public health professional with an interest in health systems and anti-corruption. I joined U4 at the end of 2020 as an adviser on health sector corruption. I currently advise the ACTA for health alliance project.

Previously, I managed a health education project for adolescents in the south of Sweden. I was also a student consultant for a private company, where I organised a digital workshop on health.

I hold a Bachelor of Science in Health promotion from Gothenburg University, and a Master of Medical Science in Public health from Lund University, Sweden.

I am a public policy professional with experience working in the fields of anti-corruption, health and sustainable development. I am interested in how anti-corruption measures can lead to more equitable access to health services and better health outcomes. 

I joined U4 as Health Adviser in 2021 to provide policy support to the Anti-Corruption, Transparency and Accountability for Health Alliance project. 

Previously, I worked as Researcher at Transparency International Global Health, where I developed research funding proposals, engaged with WHO and the private sector, and conducted policy advocacy as part of the Action for Global Health Network. I also worked as Research Fellow at the United Nations System Staff College, contributing to learning and training initiatives for sustainable development. There, I worked with UNDP to design and develop the online course “Anti-Corruption in the Context of the 2030 Agenda for Sustainable Development”. 

I hold a Bachelor of Political, Economic, and Social Sciences (Honours) from the University of Sydney, and a Master of Public Policy from the Hertie School of Governance in Berlin.

New aid modalities in the health sector – implications for corruption

It is important to understand how various aid modalities affect transparency and accountability. Disappointment with budget support and project approaches made results-based financing (RBF) seem like a feasible alternative. RBF is a performance-based aid modality where donors condition disbursements or payments to service providers on desired outcomes. It is supposed to allow service providers to focus on achieving real impact rather than following a set of rules. RBF pilot schemes in the health sectors of several developing countries show mixed results. Some RBF schemes have had unintended consequences, which has led academics, consultants and health practitioners call for a 

rethink of RBF in developing country health sectors

. Their advice is to be cautious about scaling up these schemes.

In a forthcoming publication (2018) we will analyse the link between corruption in the health sector and “gaming” in RBF schemes. This includes unethical practices such as falsifying results or coercing patients to receive unnecessary treatments – just to reach programme goals. Accordingly, more research on successful interventions that have managed to both improve incentives for health workers and patients and promote transparency and accountability is important.

Information and communication technology 

How has the digital revolution affected health information systems and their role in health service delivery? Can digitising health data lead to improved health outcomes? What implications do recent and up-coming innovations in information and communication technology – such as blockchains – have for transparency and accountability in the sector? Can blockchain technology reduce healthcare insurance fraud and other types of fraud in the sector? Can they eliminate 

Blockchain for fraud prevention: Industry use cases

A global anti-corruption framework for the health sector?

Professors Tim Mackey and Bryan Liang think we need a 

 to tackle corruption in the health sector more effectively. They argue that current national and sectoral level efforts are too fragmented to have an impact. Instead, they suggest, the World Health Organization (WHO) and the United Nations Office on Drug and Crime (UNODC) could spearhead an internationally binding legal framework. UNODC oversees the 

United Nations Convention against Corruption (UNCAC)

, which Mackey and Liang say is inadequate because it does not delineate the specific challenges posed by national and global health corruption.

However, given the uncertain track record of international law in solving other national and global challenges such as poverty, human trafficking and even war crimes and crimes against humanity; we must wonder – do we need yet another international treaty? Can we achieve the same goal using a “soft law” approach and an international coalition modelled on the 

 show that international coalitions built on a soft law foundation can 

. Is there a way to bring all the initiatives together under the umbrella of the WHO and come up with a comprehensive template for all its member states?

Corruption is one of the biggest threats to universal health coverage. It takes different forms in different countries, depending on the structure, organisation and sources of funding for healthcare. A number of initiatives to address health sector corruption have shown that it is possible to make a positive change. Learn about types of corruption that are common in the health sector, and the various possible entry points for anti-corruption interventions in different health sub-sectors.

Basic guide to corruption and anti-corruption efforts in the health sector

The health sector is vulnerable to corruption due to 

 (PDF) between health care providers and patients, combined with massive amounts of money involved in the global health sector.

 (PDF) states that annual global health expenditure is about US$ 7.35 trillion. Of this, about US$ 300 billion (6%) is lost to mistakes or corruption.

Corruption in the health sector occurs in both rich and poor countries. In poor countries especially, it can be a matter of life and death. There are many examples of its devastating effects. Globally, counterfeit malaria medicines lead to over 450,000 preventable deaths every year, prompting one academic to describe drug counterfeiting as a 

Corruption presents a substantial global health security threat. It played a role in the 

West African Ebola virus epidemic in 2014

 at a hospital in Uttar Pradesh, India, because of corruption in the procurement of oxygen cylinders. Corruption is also central to the ongoing 

 and since March 2020 there have been a wave of corruption-related incidents, and decreasing transparency and accountability.

Corruption is one of the biggest threats to universal health coverage, which is one of the targets of the Sustainable Development Goals (under 

 It affects health outcomes by reducing government funding for health services. It has a negative effect on access and quality of patient care. If user fees or insurance contributions disappear through 

 and procurement fraud, less money is left for salaries, medicines and equipment. Poorly paid health workers can feel demoralised, leading to low-quality care and less readiness to preform services.

reducing corruption can improve health outcomes

 by making public spending more effective.

Corruption in the health sector takes different forms in different countries, depending on the structure, organisation and sources of funding for healthcare. See for example 

 answers on health sector corruption in 

. However, there are commonalities across countries that help understand typical health sector corruption categories and typologies. Moreover, some forms of health-related corruption, such as counterfeit medicines, are cross-country or global issues, requiring a concerted international effort to address them.

Find out more about the health sector’s susceptibility to corruption in the U4 Issue 

 The main reasons the health sector is vulnerable include: 

National health systems’ complexity and fragmentation

The globalised nature of the drug and medical devices supply chain

Corruption in the pharmaceuticals sub-sector hinders access to medicines and leads to negative health outcomes. It includes drug counterfeiting as well as the manufacture and sale of substandard, falsified and unregistered drugs.

Corruption in medicine procurement can inflate prices. Even when the government is the purchaser, the poor bear the brunt when government over-spending in one sub-sector leads to spending cuts in another sub-sector. Theft and diversion of medicines from health units to the private market is another problem that adversely affects the poorest and most vulnerable in society. This is especially a problem in quickly evolving epidemic or pandemic situations – as can be seen 

Conflicts of interest can arise when health staff prescribe and dispense drugs and medical supplies based on recommendations from the manufacturers. This issue is in the spotlight in the 

, where many doctors get favours from pharmaceutical companies to prescribe strong painkillers that patients become addicted to.

A less talked about form of corruption in health system governance is collusion, politicking and 

. This may for example lead to unnecessary inclusion of non-essential drugs in a country’s 

-list – generating profits for producers and importers.

Corruption mitigation strategies for the health sector

The health sector at the national level is often one of the biggest basic service delivery sectors. It has thousands of units employing hundreds of thousands of health workers and treating millions of patients. In most countries, both public and private entities provide health services. This poses several challenges for mainstreaming anti-corruption in the sector, because the various corruption problems cannot be dealt with at once. It is therefore important to conduct a corruption risk and vulnerability assessment in the sector, and identify which problems are the most urgent or most feasible to deal with. Once risks and vulnerabilities, power relations and social context are mapped, the tools and strategies to reduce corruption and improve service delivery can be selected and implemented.

The World Health Organization’s framework of 

six ‘building blocks’ for health systems

 is a useful guide for analysing corruption risks in a country’s health sector. The building blocks can help identify where corrupt practices are likely to occur across the sector in service delivery, health workforce, information, medicines, financing, and governance. In identifying corruption risks in a country or programme, it is important to remember that disease prevention and treatment is not apolitical

 Who holds political and bureaucratic power and influence in the health sector and how they exercise it, is at the heart of how corruption manifests.

Information sources on corruption in the health sector include:

Global Fund Office of the Inspector General Audit and Investigation reports

 can point to weaknesses and vulnerabilities in the health systems of global fund recipient countries. Once risks and vulnerabilities, power relations and social context are mapped, it is time to choose the tools and strategies to reduce corruption and improve service delivery.

Health

Corruption and anti-corruption efforts in the health sector

From basic guides to in-depth perspectives, all in one place.

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