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U4ISSUE

Corruption in the health sector (Updated November 2008) U4 ISSUE 2008:10

AntiCorruption Resource Centre www.U4.no

This is a pdf-version (#3) of the web-based U4 Theme pages on Corruption in the health sector. If you are reading this on paper, please note that you can access all the internet links in the document by viewing the pdf on a computer, or by accessing www.u4.no. All views expressed in this issue paper are those of the author(s), and do not necessarily reflect the opinions of the U4 Partner Agencies. Copyright 2008 – U4 Anti-Corruption Resource Centre.

U4 ISSUE 2008:10

CORRUPTION IN THE HEALTH SECTOR

WWW.U4.NO

Corruption in the Health sector This U4 Issue presents some essential resources for anyone promoting anti-corruption in the health sector, or otherwise wanting to learn about the challenges of corruption in the health sector. The text is originally developed as web pages by U4 based on researcher by Carin Nordberg of Transparency International and were later updated by Taryn Vian ([email protected]) of Boston University.

Contents Overview: 1

Causes and consequences

4

2

Financial resources management

11

3

Management of medical supplies

16

4

Health worker/patient interaction

25

Focus: 5

Good practice –Examples

32

6

Budget transparency

41

7

Salaries

51

Further information on corruption in the health sector: 8

Literature review

60

9

Links to relevant websites

82

3

U4 ISSUE 2008:10

CORRUPTION IN THE HEALTH SECTOR

WWW.U4.NO

1 Causes and consequences 1.1

Improving public health is a fundamental precondition to ensure human development

The importance of health for economic growth and reduction of poverty is reflected in the Millennium Development Goals (MDG). Three out of the eight goals refer directly to health. One additional goal refers to access to affordable drugs in developing countries. To ensure universal and equitable access to quality health services, governments must earmark a sufficient share of public revenues for health. While high income countries spend on average 7% of GDP on health, low income countries spend on average only 4.2% on health.1 Insufficient health budgets due to deteriorating economic conditions, combined with burgeoning health problems such as the global HIV-AIDS pandemic, have led to an acute shortage of health workers (WHO 2006), shortage of drug and medical supplies, inadequate or non-payment of health workers salaries, poor quality of care, and inequitable health care services in many low income and transition countries. With corruption as both a cause and effect the result has been deterioration of general health and degrading of the health system in developing countries (World Bank 2004). Global Corruption Barometer 2007 In 2007, 63,199 people were surveyed in 60 countries in the Voice of the People survey conducted by Gallup International. Included in the survey were a series of questions asked on behalf of Transparency International (TI), the responses to which are presented in Transparency International's 2007 Global Corruption Barometer intended to reflect international perceptions, experiences, and expectations concerning corruption. On average, respondents rated medical services as moderately corrupt. The prevalence of bribery when attending medical services is higher in low income countries than in high income countries. 6% of those who had sought medical services the last month in low income countries reported to have paid a bribe. The income patterns are similar within countries, with lower income households reporting bribery in medical servi