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Tuesday, 21 May 2013

Corruption in the health sector

Corruption, especially in the health sector, is a fact of life in Bangladesh. Every day, the newspapers  report on some aspects of health sector corruption spanning from informal payments to access services to fraudulent lab report to procurement of medicine and supplies to absenteeism of staff and healthcare providers practicing privately at office hours etc. etc. The people just become helpless victims to this seemingly organized crime!

Corruption in the health sector has gained increased attention globally in recent times. There is consensus among the health policymakers, planners and donors that corruption affects healthcare access and outcomes at both individual and household level, and has negative effects on their health and well-being. It has now become imperative to understand the theoretical underpinning of the problem, identify and measure health sector corruption, and anti-corruption strategies needed. 

Corruption is defined as ‘misuse of entrusted power for private gain’ (Transparency International). The particular vulnerability of the health sector to corruption arises from the uncertainty of service demands (‘who will fall ill, when, and what will they need’), too many players interacting in a complex way (‘patient, provider, payer, government regulator, and supplier’) and asymmetry of information between the providers and the consumers. 

A conceptual framework to understand corruption in health sector incriminates three main forces as drivers for a public sector employee: pressure to abuse, opportunity to abuse and ability to rationalize one’s behavior. Opportunity to abuse’ entrusted power for private gain’ is increased when there is monopoly over provision of services, greater discretion(over decision making) without adequate control, lack of accountability, lack of ‘citizen voice’, and  lack of transparency. At the organizational level issues such as lack of close supervision and monitoring, performance evaluation through reward and punishment, and enforcement of regulation also facilitates corruption. 

Rationalization of one’s own behavior is influenced by individual beliefs, attitudes and social norms, besides personality characteristics (e.g., tolerance of illegal behavior and competitive orientation’ have been found to be associated with tax evasion). Erosion of values in a society is also used for justification of corruption by employees. In some situations, the employee may feel pressured to abuse entrusted power such as paying off a debt or subsidize meager salary etc. Other factors such as gender and marital status are also associated with corruption (In a hospital study in Africa, it was found that procurement prices was low when the purchasing agent was a bachelor or a women. Application of these concepts in health sector is still to go a long way for producing convincing evidence.

Measuring corruption presents a challenge to the researchers. Several methods exist e.g., corruption perception surveys (measures the sense of citizens about the existing problems in health sector), household and public expenditure surveys (measures ‘whether public health spending is providing benefit according to priorities and budget’), qualitative data collection (‘to measure the pressure and social norms related to corruption…’), and risk audit. All have its strengths and weaknesses. 

Informed by the context and guided by evidence, it is necessary to develop programmes to alleviate the pernicious effect of corruption on health sector.

Source: Vian T (2008). Review of corruption in the health sector: theory, methods and intervention. Health Policy and Planning 23: 83-94.

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