Full text PDF - International Policy Network

78 Fighting the Diseases of Poverty
Government effectiveness, corruption and
accountability in health care delivery
Separating three components of governance – government effectiveness,
corruption and accountability – allows targeting policies
to specific shortcomings. However, the information base is thin and
the elements so intertwined that a separate analysis of each yields
little benefit. For example, evidence from provider and other surveys
in Mozambique, Nigeria and Uganda suggest that the level of mismanagement,
vague and poorly understood performance expectations and the
singular lack of accountability to anyone or any institution makes
haphazard and corrupt practices difficult to identify, separate or
control ( Lindelow, Ward and Zorzi, 2004; Lindelow, Reinikka and
Svensson, 2003; Das Gupta, Gauri and Khemani, 2003; McPake et.
al., 1999).
There is a fine line between inefficiency and corruption in many
instances. Is poor service a function of corruption or simply mismanagement?
Better accountability can address both, so should the
approach be combined or separated? In the interests of clarity, this
section will discuss governance, corruption and accountability
jointly reviewing the evidence and offering an interpretation of
those findings as they relate to each of these criteria.
This discussion begins with an assessment of perceptions of corruption
in select countries to provide that context. It then addresses
the production function elements in reviewing country level
evidence. The analysis tracks productivity of labor, and capital
inputs: drugs, supplies and national transfers, complementing these
with a brief assessment of management, a central component for
correcting many of the problems identified.
Perceptions of corruption in public health care systems
While not strictly part of the production function, perceptions
about corruption reflect how stakeholders view health systems and
their effectiveness in producing acceptable health outcomes. Perceptions
provide the basis for assessing governance at a national