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Corruption in public health 119
and ensure that services meet their needs. The record is mixed on
the effectiveness of voice in improving service delivery, but some
useful lessons emerge.
Information is necessary but not sufficient for citizens’ to be
empowered. Without the information citizen action can only be
random stabs at perceived problems. Information allows concerted
action. In Uganda informing citizens of fiscal transfers from the
central government by posting budget receipts on school doors and
announcing them in the local press led to significantly higher
receipts, a more informed public and a better financed school
system (Reinikka and Svensson, 2004). Similar initiatives would
apply in health since local health districts are financed through
central allocations. In Colombia regular press reports on procurement
regularities reduced overpayment by almost 200 per cent.
Despite the scope of these findings, conclusions are tentative given
the small number of cases, but these suggest promising directions.
The evidence on the role of local voting is uneven. It appears to
have a minimal if any effect on corruption at the local level, though
the number of studies is small and therefore not necessarily representative
of the developing world. In Bolivia no association was
found between perceived corruption and voter turnout, participation
of citizens in cultural and religious associations (a proxy for
social capital) or the number of NGOs, the institutions that are
meant to represent citizen voice in municipal budget councils (Gatti,
Gray-Molina and Klugman, 2003).
In the Philippines and Uganda surveys showed that despite high
election turnouts for both local and national elections voter
numbers were unrelated to corruption levels, and electoral preferences
in both countries were shaped by other factors. A multivariate
analysis of the Philippine data showed that low levels of
corruption (as measured by an index of household and public official
responses) were correlated with voting in local elections and
reading national newspapers. Moreover, in both countries civic
activities were common, suggesting that citizens remain active in
government despite a corrupt environment. That environment may