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Corruption in public health 71
health demand, respectively. But perceptions are only part of what
is of interest in assessing governance issues in health
Less corrupt and politically stable countries the more attractive
they are for private investors and donors (Kaufmann, Kraay and
Mastruzzi, 2005). Good governance has been shown to correlate
with property rights and civil liberties, and greater foreign investment
(Hellman et al., 2000), and to “grease” the wheels of government
(Kaufmann and Wei, 1999). Aid effectiveness also rises in
countries with good governance. These clearly have relevance to
health care.
Capturing the effectiveness of public health care services, the
extent of corruption and the degree of accountability pose serious
challenges, which contribute to the lagging effort to address governance
in the sector. Using national level indicators such as access to
health services provides limited guidance on how well the sector is
performing. At the same time, performance indicators are scarce,
and difficult to aggregate where they exist. The heterogeneous
nature of health care and the large number of sui generis events; the
highly variable and unpredictable nature of health care demand; the
multiple actors involved in ensuring effective service delivery; and,
the limited choice of instruments for monitoring all contribute to
the challenge of defining and measuring governance in the health
sector.
Correlates of poor governance and public health care
across countries
The evidence on the link between institutions and health has largely
relied on analyzing the cross-country relationships between corruption
and health outcome measures. With evidence for 89 countries
for 1985 and 1997 Gupta, Davoodi and Tiongson (2000) show
corruption indicators (using Kaufman, Kraay and Zoido-Lobatón,
1999) negatively associated with child and infant mortality, the likelihood
of an attended birth, immunization coverage and low-birthweight.
The correlation of corruption in explaining the same health
outcomes is reduced once factors such as mother’s education, public