A Practical Turn to Writing about Corruption and Health

What a surprise I had last month when preparing for a talk at the World Bank about ways to reduce corruption in the health sector. I was asked to share ideas from a book I recently co-authored, called Anti-Corruption in the Health Sector: Strategies for Transparency and Accountability. In preparing my remarks, I went back to an earlier publication that I co-edited, Diagnosis Corruption: Fraud in Latin America’s Public Hospitals, and realized not only that an entire decade had passed, but that the way people write about corruption and health has changed substantially—it has taken a very practical turn.In Diagnosis Corruption, the team of authors were focused on demonstrating that corruption can be measured and rigorously analyzed. We grounded most of our analysis in principal-agent models and used statistical methods to tease out factors that seemed to reduce corruption (such as active community oversight) and those that apparently didn’t (such as raising procurement officers’ wages). The emphasis was on modeling behavior to discover promising policy directions rather than on assessing the effectiveness of actual experiences.The second book—Anti-Corruption in the Health Sector, which came out last year—turned out to be much more practical. This time, the analysis encompassed, but went beyond principal-agent models to incorporate frameworks from forensics, public health, and management. The flavor is more practical, reading like business case studies rather than economic journal articles. (Credit goes to Taryn Vian for this broader inter-disciplinary approach, which she had developed for an earlier article in Health Policy and Planning.) One chapter recounts the difficulties faced by an NGO when it discovered a local financial officer was embezzling funds. Another discusses the effect of linking health district performance with financial information in South Africa. Still others explain the power of publishing and comparing prices for pharmaceuticals on public websites and efforts to reduce informal payments in Cambodian and Armenian hospitals.Writing on corruption in health has expanded tremendously over the last decade and is characterized by a similar practical turn. One of the most prominent articles in 2000 was by Sanjeev Gupta and co-authors, demonstrating that less corrupt countries had lower child and infant mortality rates. Maureen Lewis’s CGD working paper, “Governance and Corruption in Public Health Care Systems” (2006) might be seen as the fulcrum for the decade, summarizing the broader analytical work before detailing the available evidence on approaches for reducing corruption. Since then, even more pragmatic publications have emerged. Transparency International focused its 2006 Global Corruption Report on corruption in health, including a piece by Dora Akunyili who led the campaign against counterfeit drugs in Nigeria. The U4 Anti-Corruption Resource Centre has published tools and materials on its website dedicated to specific actions aimed at reducing corruption in health services. Just last fall, DFID published a note “Addressing Corruption in the Health Sector” by Karen Hussman that I think is the most practical and complete summary of the topic to date.Corruption in the health sector is not going away anytime soon. We will keep hearing about scandals like the ones that occurred in 2010, such as the theft of malaria medications in Africa; embezzlement of public health dollars in Zambia; and pharmaceutical companies being implicated in kickback schemes. But with wider attention, continuing to build the analytical base, and this kind of practical sharing of experiences, we just might make inroads against it. It makes me wonder how things will look in 2020!(Thanks to Kaci Farrell, Amanda Glassman, and Rachel Nugent for their suggestions.)