Publications

Key messages:

• Corruption in health systems has significant effects on health. It:
  • undermines health outcomes;
  • disproportionately harms the poor and vulnerable and deepens health inequities;
  • erodes public trust;
  • wastes money and reduces the impact of health investments;
  • causes wider economic costs by failing to keep people healthy and economically active.
• Corruption exists in all health systems. It is exacerbated by health emergencies when oversight is weakened.
• Anti-corruption measures based on accountability and transparency measures or sanctions are not effective in isolation. Initiatives are more effective when they are tailored to address specific forms of corruption and take into account:
  • the level of corruption (micro, meso or macro) and its scale;
  • the factors enabling corruption – such as political and governance structures and economic contexts;
  • social and cultural norms and the ways in which patients and staff think about the ethics involved.
• Context is critical in tackling corruption. Health leaders may find it helpful to:
  • address the roots of corruption – its systemic and structural causes;
  • consider who benefits from corruption, the incentives that motivate them, and the resistance that anti-corruption measures face, as well as who can enforce rules;
  • identify and focus on the forms of corruption that are most damaging to health system performance, equity and health outcomes;
  • look at the successes and failures of anti-corruption efforts in other sectors including education, policing and public finance;
  • design flexibility into anti-corruption interventions so they can be adapted and corrected during implementation;
  • prepare for any unintended consequences of anti-corruption interventions by building in real-time monitoring mechanisms;
  • build coalitions for change including alliances of civil society organizations, professional associations and reform-minded officials;
  • use tools like scorecards, audits and dedicated evaluation units to monitor the equity and quality impacts of corruption and anti-corruption efforts, particularly on poor and vulnerable populations;
  • invest in long-term evaluation through longitudinal studies, randomized trials and ethnographic research to improve anti-corruption interventions over time.