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Health sector corruption

Practical recommendations for donors

Corruption in the health sector can make the difference between life and death. It has severe consequences for access, quality, equity, efficiency, and efficacy of health services and is an obstacle to the long-term goal of achieving universal health coverage. An estimated US$500 billion in public health spending is lost globally to corruption every year. This is a lot more than would be required to achieve universal health coverage. Donors should support long-term, strategic approaches to health sector integrity based on a sound understanding of dynamics in the sector and different actors' roles.

Also available in Spanish
14 June 2020
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Main points

  • Health systems are particularly susceptible to corruption due to large amounts of resources, information asymmetry, the large number of actors, system complexity and fragmentation, and the globalised nature of the supply chain for drugs and medical devices.
  • An array of tools help diagnose the problem and generate buy-in for anti-corruption measures, but most tools do not assess high-level sector corruption or state capture. A combination of different tools will be useful, and the support of donors for this is essential.
  • Anti-corruption initiatives in the health sector seem to be targeted at either specific problems, processes, or institutions. More holistic, strategic, and medium- to long-term initiatives seem to be rare. It is not clear to what extent capture of health regulatory and oversight agencies is addressed, if at all.
  • A number of international initiatives have been created for the pharmaceutical sub-sector and health related procurement, as well as specific risk areas, such as of transparency in drug pricing and clinical trials.
  • The tools used are often normative and prescriptive, and usually do not adequately capture the complex dynamics that lead to corrupt behaviour.
  • Surprisingly, documented evidence on outcomes of anti-corruption initiatives in the health sector is patchy – with mostly unknown impact.
  • Social accountability tools, however, show promise for reducing corruption in health service delivery.
  • At the international level, donors could foster linkages of the three Sustainable Development Goals (3, 16, 17) that contain commitments to addressing health sector corruption with health sector initiatives, multi-stakeholder initiatives on corruption and health, as well as research and learning.
  • At the national level, donors should support long-term, strategic approaches to integrity in the health sector based on a sound understanding of sector dynamics and the various actors’ roles – focusing both on corruption in service delivery as well as regulatory and institutional integrity.
  • Finally, donors could strengthen their internal structures and processes by fostering interactions between health and governance teams, including an integrity lens in new health programmes, and strengthening donor coordination on corruption in health.

Cite this publication


Hussmann, K.; (2020) Health sector corruption. Bergen: U4 Anti-Corruption Resource Centre, Chr. Michelsen Institute (U4 Issue 2020:10)

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About the author

Karen Hussmann is a public policy expert with extensive experience in governance, anti-corruption issues, health-sector integrity, and fragile states. Her experience includes having been the director of an EU financed anti-corruption programme in Colombia, senior consultant for the U4 Anti-Corruption Resource Centre and the EUROsociAL II Programme in Latin America, and accountability expert with UNDP in Afghanistan. She has also worked many years with Transparency International. She is currently an independent consultant conducting applied policy research and working with partners on policy development and implementation of anti-corruption standards. She teaches the U4 online courses Essentials of anti-corruption and Corruption risk management.

Disclaimer


All views in this text are the author(s)’, and may differ from the U4 partner agencies’ policies.

This work is licenced under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND 4.0)

Keywords


health sector, accountability, anti-corruption tools, corruption risk assessment, donor coordination, ethics, transparency