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Corruption in public health 115
2001), Cambodia (World Bank, 2004) and Central America (La Forgia,
2005) suggest that contracting out can work even in the lowest
income environments, the challenge is ensuring continued oversight
and accountability of contractors. To date only the four Central
American cases have a track record across elections.
Consumer satisfaction surveys help build accountability. Exit
surveys, mini-household surveys or focus groups to elicit responses
help gauge the strengths and weaknesses of public programs.
Including these in annual reporting up the chain of command, and
encouraging points of service to use these for management
purposes would provide benchmarks for making public services
more responsive, and bolstering their impact and effectiveness.
Controlling corruption
This paper has described the wide range of irregularities that characterize
health care services in developing countries and suggests
that corruption flourishes where there are no standards of performance,
oversight, or penalties for unacceptable behaviors. The
options discussed here have a track record, but the policy context
and actions taken by officials provide the needed detail that explains
why certain policies were found effective. Policies themselves are
necessary but not sufficient as enforcement is equally important.
Game results from an experiment in Ethiopia used to determine
temptation for corruption concluded that higher pay curtails the
level of corruption, but only slightly, and that public servants appear
to expropriate fewer resources when observability is higher, indicating
that better oversight and exposing of inappropriate behavior
can have a dampening effect on corruption (Barr, Lindelow and
Serneels, 2004). In short, the potential for getting caught offers a
strong disincentive for corrupt behavior.
Corruption in the health sector is unlikely to be an isolated public
service failure. Addressing irregularities across the functions of the
sector – construction, procurement and distribution of drugs and
supplies, deployment of underpaid staff, under-the-table payments
– requires an integrated, mutually reinforcing anti-corruption