Corruption and Accountability Discussed at the Third Health Systems Research Symposium in Cape Town

Meghan Jutras

Monitoring & Evaluation Specialist

Although corruption is a sensitive issue to address or even discuss, it has consequences far beyond economic impacts. Corruption “has a direct negative effect on access and quality of patient care,” so those hurt the most are the very beneficiaries we are trying to serve with our interventions, making this an issue we cannot afford to ignore (U4, 2008:10, 8). In July 2013, LMG conducted an online survey of health managers and leaders to assess their perceptions of corruption in the health sector, and received over 1,000 responses across 95 countries. Responses to three open-ended, qualitative survey questions were coded and analyzed using NVivo 10.

On October 2, 2014, I was honored to co-present in a panel session on corruption and accountability at the Third Health Systems Research Symposium, held in Cape Town, South Africa. My presentation, entitled, “People-centered health systems and corruption: A global survey of health managers’ perceptions of the causes of, and recommended ways to reduce, health sector corruption,” shared our qualitative analysis of survey responses and sparked enthusiastic questions from the audience.

In our survey, the highest reported instance of corruption was healthcare professionals delaying or preventing clients’ access to care by seeking bribes, kickbacks, or informal or illegal fees.  As the theme of the Symposium was “people-centered health systems,” my presentation focused on the critical intersection between clients and the health workforce. We found that the factors that respondents identified as causes of corruption aligned well with the solutions they shared. For example, within the health workforce, respondents cited “Low salaries and motivation of health workers” as a cause of corruption, and identified “Providing balanced pay and incentives to health workers” as a solution. At the level of clients and the community, for example, respondents said that the “Lack of knowledge of the consequences of corruption” could be mitigated by the “Media exposing corruption.” There was consensus around the importance of political will, as well as the need for independent regulatory bodies and stakeholder engagement in general. However, there was a notable lack of consensus among respondents regarding the role that governments and donors should play.

Health leaders and managers have essential perspectives and experience to offer on what measures can be effective in reducing corruption, and are critical stakeholders in this effort. Responses highlighted that solutions for health often do not sit in the health sector alone, so we should borrow from other disciplines and implement a range of solutions to mitigate corruption. For example, respondents cited corrupt practices in other areas that influenced the health sector, such as construction, law enforcement, and politics. Respondents also emphasized the importance of the contextual situation – recognizing different cultural definitions of what is moral or ethical is necessary to address corruption in any given context.

Moderator Jean-Pierre Olivier de Sardan (Director of Research, Lasdel (Laboratoire d’étudeset de recherche sur les dynamiques sociales et le développement local)) raised the issue of accountability overlapping with corruption; for example, a health worker may be expected to provide preferential treatment to her family and kin over her patients, which was echoed by our survey respondents. Audience members asked about the role of the international aid system in fueling corruption, which also challenged our survey respondents – some called for greater donor involvement and support while others argued for reducing donors’ influence. There was broad recognition of the need for further research, particularly regarding how corrupt practices and anti-corruption initiatives take shape “on the ground.” Audience members discussed variations in the definition of corruption and the importance of addressing this in future studies. Others pointed out that although there may be different definitions or cultural perspectives around corruption, some practices are simply unacceptable, such as the “outright demand for money before service provision,” which our respondents noted.

Although there were several sessions on accountability and transparency, this was the only Symposium session on the topic of corruption. It is my hope that the Symposium and subsequent discussions can be leveraged to tackle corruption in the health sector.

Photo: Meghan Guida (center) presents at the Third Global Symposium on Health Systems Research.