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Corruption in public health 109
ments in transition and developing countries, but there are good
examples of things that can be done based on actual experiences.
This section is divided by category to summarize the evidence and
link these lessons to specific agendas. Accountability and incentives
serve as threads across the components because they represent the
keys to better policy and outcomes.
Key accountability measures include (i) information on performance
and impact, (ii) the ability to audit, (iii) the authority to
reward performance, and discipline, transfer and terminate employees
who engage in abuses; and (iv) answering to stakeholders on
the performance of public services. Accountability tends to be
absent due in part to measurement problems but also to minimal
management, oversight or evaluation of performance. The high
demand from patients for diagnosis and care when they fall ill, and
the difficulty in generalizing across medical conditions further complicate
oversight and accountability.
Improving government effectiveness
The health system that delivers health care is only as good as its
management. This section focuses on government initiatives and
management tools that can raise effectiveness and performance.
Adequate incentives for health professionals lie more in the
structure of the health care system and its financing than in limited
actions that fix existing arrangements. Fundamentally money needs
to follow patients at least in terms of tying medical staff time to
specific patients. Paying providers whether they see (or are
assigned) patients or not, and compensating under and over-performance
equally is both unfair and unlikely to build the trust
needed in a public health system. How that is accomplished is the
challenge, and there are options.
The exception to money following patients may be capitated
payments where physicians receive a fixed prospective payment for
each patient and extends services as needed. It has been shown to
be highly effective at providing the necessary incentives for
providers, but typically is combined with clear management and