Healthography and Corruption: A global survey of health managers' perceptions of corruption and priority areas for action

Background

Corruption affects access to healthcare worldwide, particularly amongst the poor and in areas with poor governance, low transparency and accountability, and weak or over-regulation. Corruption’s destructive impact on health systems and its beneficiaries is of critical interest to all engaged in international public health. 

Methods

In July 2013, the LMG project conducted an online survey of health managers and leaders across 95 countries, assessing perceptions of corruption in the health sector. The survey was completed by 1,076 respondents. Three of the sixteen survey questions were open-ended and qualitative, which were coded and analyzed manually and using QSR NVivo 10.

Results

One-third of survey respondents were from Afghanistan, Ethiopia, Kenya, Nigeria, or Peru; countries scoring between 8 and 38 (0=highly corrupt to 100=very clean) on Transparency International’s public sector Corruption Perceptions Index. Respondents cited a culture of corruption, where it is tacitly accepted or even supported. The highest reported instance of corruption was healthcare professionals exploiting clients’ access to care through bribes, kickbacks, or informal/illegal fees. Second was nepotism in employing healthcare professionals, and third was bribery in processing contracts, sales, and billing.

Conclusions

These findings underscore the importance of healthography; corruption significantly impacts clients’ access to care, especially where health systems lack sufficient regulations and oversight. Improving governance, e.g. by promoting accountability and transparency while punishing corrupt practices, is vital.  These countries’ health sectors often rely on international donor funding; thus, government agencies, donors, implementing partners, and health practitioners must collaborate to establish practices mitigating corruption using multi-faceted approaches.