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88 Fighting the Diseases of Poverty
meaningless or doesn’t exist without sanctions, and institutions
suffer accordingly.
Purchasing public positions
The insidious practices of selling public positions and requiring
bribes for promotion fundamentally undermine good performance
and builds a corruption spiral since the newly hired and promoted
must find the resources to ensure their continued employment and
advancement. The practice has been documented for much of
Eastern Europe and Central Asia where the breakdown of government
led to the commercialization of public positions (Kaufman,
Pradhan and Ryterman, 1988). Outright purchase of public employment
through bribes is often anecdotally accepted, but some recent
work has tried to quantify it. Evidence from surveys of public officials
in Latvia, Armenia and Georgia showed that the “cost” of
public positions was well known among public officials and the
general public. Interestingly the higher cost jobs were in the most
corrupt enclaves of government (Kaufman, Pradhan and Ryterman,
1988).
In Bosnia and Herzegovina bribes were particularly common in
the health sector with surveys of officials and citizens reporting that
75 per cent thought bribes were required for obtaining positions
and for promotion (World Bank, 2001e). In Ghana 25 per cent of jobs
were allegedly bought in government hospitals. In Uganda 20 per
cent of municipal officials acknowledged that the practice occurred
in the health sector, and in the Philippines 3 per cent noted it (Azfar,
Kahkonen and Meagher, 2001).
In focus groups in Ethiopia health officials complained about
unfair hiring practices, nepotism and preferential treatment to well
connected individuals. Similarly in the Dominican Republic “patronage
propelled personnel rolls” leading to one of the highest rates of
health personnel to population in the region. Promotions routinely
rely on recommendations from politicians, and military authorities
that lead to a mismatch between skills and needs (La Forgia et al.,
2004). An earlier study found that most care was already provided