How can corruption in the health sector be tackled? This electronic newsletter produced by the World Bank Human Development Network summarises recent findings and events concerning health, nutrition and population. Focusing on governance issues, particularly within the health sector, articles recognise how corruption hinders human development and poverty reduction. Poor governance practices must not be tolerated purely because they are long-standing. High levels of corruption often coincide with poor economic performance and disproportionately affect the most vulnerable in society. Corruption hinders achievement of Health for All, and the WHO, the UN, NGOs and the private sector must seek to eliminate it by investing in research and preventive actions. The World Bank invites good and bad practice insight to make its projects more responsive to the poor in developing countries.
We are yet to find the most effective intervention to prevent the abuse of power held over health resources and services. Public sector corruption is a problem in both developing and developed countries. Other key points are:
- The World Bank is increasingly understanding the complexities of health governance and the large number of interests and actors involved.
- Typical causes of corruption include: Low public sector salaries; over centralised key functions; semi-privatisation; weak financial accounting; weak monitoring and regulation of corruptive behaviour; and non-prosecution of offenders.
- Counterfeit medicines cause significant harm to consumers in developing and developed countries.
- Studies of the poor’s interactions with the Bangalore health care system show a need to resort to bribery, with all levels of medical personnel and all types of service, to gain good or better quality care.
- Transparency International has identified ‘intransparency’ as being when an excessively complex health system allows certain groups to misuse the system to further their individual needs before those of the community.
The World Bank seeks to promote health systems focusing on service users, with service providers, financers and other actors radiating out from this centre. Anti-corruption programmes must involve civil society. Other implications are:
- The creation and maintenance of a client-focused health service will need the correct incentives, regulatory framework and institutional capacity.
- Ways to reduce corruption include: Strong, visible political support; constant vigilance; improved local and national institutional mechanisms; and stronger legislation backed by enforcement and ethical codes of conduct.
- An effective partnership strategy targeting counterfeit medicines needs to be developed between consumers, governments and pharmaceutical companies at national level, and globally between the WHO, UNICEF and Interpol.
- Social marketing and consumer education can help to discourage corruption by raising the awareness of its costs and an understanding of its causes; influencing behaviour; and mainstreaming corruption concerns within national institutions.
- Funded projects must have actions and institutional measures specifically targeted at minimising corruption, including: Regular users’ surveys; third-party audits; and third-party supervision of ‘risky’ activities.
