Contextualizing Corruption in the Health Sector in Developing Countries: Reflections on Policy to Manage the Risks

• Author: Kempe Ronald Hope
• DOI: http://doi.org/10.1002/wmh3.165
• Published date: 01 December 2015
• Date: 01 December 2015

Contextualizing Corruption in the Health Sector in

Developing Countries: Ref‌lections on Policy to Manage

the Risks

Kempe Ronald Hope Sr.

Corruption in the health sector is a concern in all countries, but it is a particularly signif‌icant

problem in most developing countries where public resources are severely constrained. It is,

therefore, imperative that the developing countries’ governments close corruption loopholes within

their health-care system. This work contextualizes, examines, and analyzes the corruption risks in

the health sector in developing countries based on research observation and some interviews with

key personnel in that sector. Drawing on the literature and best practices in developing countries, it

also offers policy recommendations for managing corruption risks in that sector and improving

health service delivery.

KEY WORDS: corruption, health sector, developing countries, risk management, policy

Introduction

In almost all developing countries, the health sector falls under the purview

of a Ministry of Health (MOH). That Ministry’s mandate is generally, among

other things, to improve the health status of the people by providing preventive,

promotive, curative, and rehabilitative services. Such services are also required to

be of high quality, relevant, accessible, affordable, equitable, and socially

acceptable; to promote healthy lifestyles; and to consistently improve the health-

care delivery system by focusing on eff‌iciency and sustainability (see, for

example, Government of Sri Lanka, n.d.; Republic of Ghana, n.d.; Republic of

South Africa, n.d.). Notwithstanding all of the initiatives aimed at improving

health service delivery, there is insuff‌icient support aimed at strengthening the

health ministries to help them develop their own capacities to mitigate corruption

and associated risks within their health service delivery chains. Corruption in

most developing countries permeates all sectors and it is prevalent in many

aspects in the health sector (Chattopdhyay, 2013; Hussmann, 2010; Nishtar, 2010;

OECD, 2015; Savedoff, 2007; Vian, 2008; Vian, Savedoff, & Mathisen, 2010). In

many of the poorer countries, over 80 percent of their populations have

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experienced corrupt practices in the health sector (Holmberg & Rothstein, 2011).

It is therefore imperative that their health ministries demonstrate their commit-

ment toward closing potential corruption loopholes or gaps within their health-

care systems that could deter access to health service delivery and thereby,

ultimately, lead to an improvement in the anticorruption efforts in their health

sectors.

This work contextualizes, examines, and analyzes the corruption risks in the

health sector in developing countries based on research observation and inter-

views with key personnel in that sector. The interviews incorporated for this

work were conducted informally for a wider study of sectoral corruption. They

were conducted primarily via electronic mail as a modif‌ied knowledge, attitudes,

behavior, and practices (KABP) survey. This KABP survey was conducted with a

number of health professionals and policymakers, mostly in the public sector,

that included senior medical personnel, other health professionals, procurement

off‌icers, medical stores personnel, and ministry of health personnel and covered

countries in sub-Saharan Africa, the Caribbean, and Asia. Drawing on the

literature and best practices in developing countries, this work also offers policy

recommendations for managing the corruption risks in that sector and improving

health service delivery and equitable access. We use the standard def‌inition of

developing countries as classif‌ied by the World Bank and denoting low- and

middle-income countries (World Bank, 2014, 2015). The term developing countries

is used for convenience; it is not intended to imply that all economies in the

group are experiencing similar development or that other economies have

reached a preferred or f‌inal stage of development. In that regard, there are 24

developing countries in the East Asia and Pacif‌ic region; 21 in Europe and Central

Asia; 26 in Latin America and the Caribbean; 13 in the Middle East and North

Africa; 8 in South Asia; and 47 in sub-Saharan Africa (World Bank, 2015).

The Conceptual Context

In conducting this analysis, it is important to f‌irst set the stage by taking into

consideration those key concepts and issues pertaining to the context and nature

of corruption, corruption risk assessment, corruption risk management, procure-

ment, and supply chain management that will inform the content of this article.

However, due to space limitations, this section is necessarily brief. First, let us

begin by noting that corruption is found in both rich and poor countries,

developing and developed, albeit in different forms and magnitude. Consequent-

ly, eradicating corruption and the f‌ight against it remain a key policy agenda of

virtually every country across the globe but, in particular, the developing

countries as def‌ined above.

In many developing countries, corruption is persistent, and it represents a

systemic failure of governance where the principal institutions responsible for

ensuring public accountability, the observance of ethics and integrity standards,

and enforcing the rule of law are compromised and may themselves be infested

with corrupt individuals and syndicates. The result is that a chain environment of

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