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Corruption in public health 79
level, and similar estimates have been collected for the health
sector in a subset of countries. Extensive, cross-country surveys of
public officials, the business community and the general public
gauge perceptions of corruption in public service. At a sectoral
level a number of recent perception surveys of medical personnel
in Latin American public hospitals provide a sense of the kinds and
frequency of corruption in facilities as well as the likely perpetrators
by profession (Di Tella and Savedoff, 2001). Both types of
surveys indicate corrupt practices, which by their nature are not
typically visible. Perceptions may be the only alternative in
instances where hard data are either unobtainable or unreliable,
and corruption in general does not lend itself to straightforward
data collection.
Figure 2 summarizes the perceptions of the general population
toward corruption in health in a selection of countries for which
data are available. Data come from various sources all largely based
on perceptions and they are not strictly comparable though they
suggest general levels of corruption in the included countries.
Coverage is uneven with a bias towards the countries of Eastern
Europe and Central Asia (ECA) and South Asia where data are more
plentiful. Of those at or above 60 per cent of the population perceiving
corruption in the health sector half are ECA countries,
results partly due to the disproportionate number of ECA countries.
In corruption surveys interviewing public officials, business
executives and the general public in 23 countries, health ranked first
as the most corrupt sector in Moldova, Slovakia and Tajikistan,
second in Bangladesh, India and Sri Lanka, and in the top four in
Kazakhstan, Kyrgyz Republic, Madagascar and Morocco. For the
most part these countries also ranked highly on the per cent of the
population perceiving high levels of corruption in health – going as
high as 95 per cent in Pakistan, 92 per cent in Sri Lanka, 85 per cent
in Tajikistan, 82 per cent in Moldova and 80 per cent in Morocco. 3
Expectations on paying for public care correspond to the perceptions
of corruption, which in turn are closely related to the need for
informal payments, as will be discussed below.