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Corruption in provision of health services
1. CORRUPTION IN PROVISION OF
HEALTH SERVICES
Prepared by:
Mwashitete, Donald
EN, RN, BScN
Tukuyu Hospital
0765431666
2. Introduction
• Corruption is a serious threat to good
governance in countries around the world.
• It affect health care as well as other social
sectors.
• Fighting corruption in the health sector is a
complex challenge.
3. Introduction cont…
• Corruption can undermine service delivery,
and has an especially detrimental impact on
the poor.
• Corruption literally violates human rights, as
people are denied the care that their
government are obligated to provide.
4. Introduction cont…
Health
• A major global industry
• A key responsibility and budget expense for
governments and business.
• A global human right.
• Corruption in health deprives people of
access to health care and to poor health
outcomes.
• Recommendations outlined could prevent and
control corruption.
5. Types of corruption and their impacts
on health sector
1. Informal payment
• Payment given to health providers which are
greater than official fees, or for services that
are supposed to be free.
• Reduces access to care, undermines equity in
access and increases financial burden on
patient.
6. 2. Selling government posts
• When a senior official requires payment from
government agents to secure or keep their
position.
• Increase likelihood of unqualified staff;
people may feel pressure to abuse power in
order to finance the purchase of their job.
7. 3. Absenteeism
• Stealing time by not coming to work, or
private practice during work hours.
• Reduce access to and provision of services.
8. 4. Bribes
• Money or something of value promised or
given in exchange for an official action.
• Bribes in registration, selection and
procurement can result in high cost,
inappropriate, or duplicative drugs, or sub-
therapeutic or fake drugs allowed on market.
9. 5. Procurement corruption
• Encompasses many types of abuse including
bribes, kickbacks, fraudulent invoicing,
collusion among suppliers, failure to audit
performance on contract.
• Raises the price paid for goods or services,
thus increasing inefficiency.
• Goods and services may not even be needed,
may not be delivered or may be of sub-
standard.
10. 6. Theft or misuse of property
• Stealing or unlawful use of property such as
medicines, equipment, or vehicles for
personal use, use in a private medical
practice or re-sale.
• Results in higher unit costs, stock-outs of
drugs, interruptions in treatment or
incomplete treatment.
• Can slow down access to care as patients
stop coming to facilities.
11. 7. Fraud
• Deliberate misrepresentation with intent to
secure unlawful gain.
• May include false invoicing, billing for
patients who do not actually exist, or services
not rendered, diversion of accounts
receivables into a private account.
• It may lower the quality of care, denial of
care for some patients or failure of programs
to achieve results.
12. Characteristics that make all health
systems vulnerable to corruption
• Imbalance of information
–Health professionals have more information
than patients.
–Pharmaceutical companies knows more
about their products than public officials.
13. • Uncertainty in health markets.
–Not knowing who will fall ill, when illness
will occur, what kind of illness people get,
how effective the treatment is.
• Complexity of the health system.
–Large number of parties involved;
relationship between medical suppliers,
health care providers and policy maker.
14. Major sources of Corruption in the
Health Sector.
• Contracting and procurement
• Selling accreditation or positions
• Public funds disappearing
• Staff nonattendance
• Informal payment
• Petty theft
15. Underlying causes of corruption
• Lack of clear standards of performance for
providers.
• Lack of effective auditing and supervision.
• Limited enforcement of rules/no sanctions
• Lack of accountability and oversight.
• Lack of citizen/community involvement and
local authority.
• Absence of monitoring and evaluation
16. Underlying causes of corruption
cont…
• Higher level of bureaucracy and inefficient
administrative structures.
• Low level of democracy, weak civil
participation and low political transparency.
• Low press freedom.
• Gender inequality.
• Political instability
• Large government size
17. Measuring of corruption
• Perception of leaders, providers and the
public.
• Contracting: audit and supervision
• Selling accreditation: untrustworthy
• Public fund use: PETS
• Staff attendance: Surveys, records
• Informal payments: Surveys/studies
18. Measures to control corruption
• Health policy goals should include anti-
corruption consideration.
• There is no one size to fit all approach to
combat corruption in the health sector.
• More than one anti-corruption intervention
should be employed to deal with one risk.
19. Measures cont…
• Prioritization is essential:
–Based on evidence, government and others
involved in health projects and
programming should prioritize areas of the
health system that are most susceptible to
corruption and implement appropriate
intervention.
• It is important to work with other sectors.
20. Measures cont…
• Numerous empirical diagnostic tools should
be employed.
• Partners with experience in implementing
anti-corruption strategies and tactics should
be identified for technical support.
• Broad participation in health policy planning.
• Good behaviour should be rewarded, and bad
behaviour purnished.
21. Challenges
• Cultural change is difficult
• Physicians hard to influence
• Oversight is costly and complex
• Some level of corruption emerges in most
health systems.
22. Recommendations for the health
sector
• Anti corruption measures must be tailored to
fit the particular context of a country’s health
system.
• Corruption less likely on societies where there
is rule of law, transparency, trust, effective civil
service codes and strong accountability.
23. Recommendations cont…
• Preventive measures
–Procurement guidelines, code of conduct
for operators in health sector both
individual and institutional; and
transparency and monitoring procedures
are helpful.
25. Reference
Global Corruption Report (2006). Corruption and
Health.
Maureen, L. (2006). Governance and Corruption
in Public Health Care Systems; Center for
Global Development.
Transparency International, 2006.
