Research and policy questions and ideas

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 all types of fraud? An IBM blog post Blockchain for fraud prevention: Industry use cases explores these questions.

A global anti-corruption framework for the health sector?

Professors Tim Mackey and Bryan Liang think we need a global health governance framework 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 Maritime Anti-Corruption Network? Indeed, the Global Fund and GAVI show that international coalitions built on a soft law foundation can achieve a lot in tackling corruption. 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?