Targeting anticorruption interventions at the front line: developmental governance in health systems

In 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of pro...

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Main Authors: Martin McKee, Nahitun Naher, Syed Masud Ahmed, Dina Balabanova, Eleanor Hutchinson, Pallavi Roy, Susannah H Mayhew
Format: Article
Language:English
Published: BMJ Publishing Group 2020-12-01
Series:BMJ Global Health
Online Access:https://gh.bmj.com/content/5/12/e003092.full
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author Martin McKee
Nahitun Naher
Syed Masud Ahmed
Dina Balabanova
Eleanor Hutchinson
Pallavi Roy
Susannah H Mayhew
author_facet Martin McKee
Nahitun Naher
Syed Masud Ahmed
Dina Balabanova
Eleanor Hutchinson
Pallavi Roy
Susannah H Mayhew
author_sort Martin McKee
collection DOAJ
description In 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with few examples of programmes that have successfully tackled corruption in low-income or middle-income countries. The commitment, by multilateral organisations and many governments to the Sustainable Development Goals and Universal Health Coverage has renewed an interest to find ways to tackle corruption within health systems. These efforts must, however, begin with a critical assessment of the existing theoretical models and approaches that have underpinned action in the health sector in the past and an assessment of the potential of innovations from anticorruption work developed in sectors other than health. To that end, this paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. We consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. We present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice. We conclude by considering the most important areas for research and policy.
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spelling doaj-art-ced6caae5d6440d699dabaafc56a75ff2025-08-20T02:10:43ZengBMJ Publishing GroupBMJ Global Health2059-79082020-12-0151210.1136/bmjgh-2020-003092Targeting anticorruption interventions at the front line: developmental governance in health systemsMartin McKee0Nahitun Naher1Syed Masud Ahmed2Dina Balabanova3Eleanor Hutchinson4Pallavi Roy5Susannah H Mayhew6professor of European public healthCentre of Excellence for Universal Health Coverage at Centre for Equity and Health Systems, James P. Grant School of Public Health, Brac University, Dhaka, BangladeshCentre of Excellence for Universal Health Coverage at Centre for Equity and Health Systems, James P. Grant School of Public Health, Brac University, Dhaka, BangladeshDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKCentre for International Studies and Diplomacy, Department of Politics and International Studies, SOAS University of London, London, UKDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UKIn 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with few examples of programmes that have successfully tackled corruption in low-income or middle-income countries. The commitment, by multilateral organisations and many governments to the Sustainable Development Goals and Universal Health Coverage has renewed an interest to find ways to tackle corruption within health systems. These efforts must, however, begin with a critical assessment of the existing theoretical models and approaches that have underpinned action in the health sector in the past and an assessment of the potential of innovations from anticorruption work developed in sectors other than health. To that end, this paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. We consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. We present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice. We conclude by considering the most important areas for research and policy.https://gh.bmj.com/content/5/12/e003092.full
spellingShingle Martin McKee
Nahitun Naher
Syed Masud Ahmed
Dina Balabanova
Eleanor Hutchinson
Pallavi Roy
Susannah H Mayhew
Targeting anticorruption interventions at the front line: developmental governance in health systems
BMJ Global Health
title Targeting anticorruption interventions at the front line: developmental governance in health systems
title_full Targeting anticorruption interventions at the front line: developmental governance in health systems
title_fullStr Targeting anticorruption interventions at the front line: developmental governance in health systems
title_full_unstemmed Targeting anticorruption interventions at the front line: developmental governance in health systems
title_short Targeting anticorruption interventions at the front line: developmental governance in health systems
title_sort targeting anticorruption interventions at the front line developmental governance in health systems
url https://gh.bmj.com/content/5/12/e003092.full
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