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80 Fighting the Diseases of Poverty
A related 2001 perceptions survey conducted by USAID on corruption
among public officials in Bosnia and Herzegovina, Bulgaria,
Macedonia, Romania, Croatia, and Montenegro showed that 45–55
per cent of respondents felt that corruption among doctors was
widespread. Albania and Serbia showed much higher levels – 61–71
per cent range. Albania’s perception score for doctors was an outlier
relative to its score for other public officials, but Serbia exhibited
levels above those of other countries for most categories of officials,
suggesting a relatively more corrupt environment (Vitosha/USAID,
2002).
Business Environment and Enterprise Performance Surveys of
administrative corruption in ECA capture business managers’ perceptions
of health service quality. Across 20 countries only Slovenia
andCzechRepublichadpositiveassessmentsfrom60percentormore
of respondents, indicating management and governance problems in
the other 18 systems (Ryterman, Hellman, Jones et al., 2000).
In Bolivia a local survey of patients considered the Health
Ministry and public hospitals less corrupt than customs or police,
but ranked corruption 2.7 on a scale of 1–4, noting the nepotism,
clientelism and higher charges for the unconnected as some key
indicators of corruption (Gatti, Gray-Molina and Klugman, 2004),
evidence that has been corroborated in other studies as discussed
below. Surveys from South Asia suggest similar perceptions of the
health sector (Thampi, 2002).
A comparison of corruption perceptions among households in
the Philippines and Uganda found 34 and 71 per cent, respectively,
reported that corruption is common or very common in government
generally. And among local officials, 25 per cent in the Philippines
and 61 per cent in Uganda acknowledged some kind of
corruption in public services within the municipalities (Azfar and
Gurgur, 2001).
Explanations from the surveyed on why corruption is so evident
in the health sector emphasize the lack of accountability and transparency
in health care operations, and in some the “power of
monopoly” where other public or private alternatives simply do not