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Corruption in public health 123
income levels. Reforms in Chile apply to many countries, but some
will have resources too limited to take on similar reforms. Nonetheless,
there are elements that can be adopted. For example, the
Chilean drug procurement reforms in electronic bidding and institutional
reform of drug purchasing agencies are well within the
purview and capacity of most countries, even if the shifts are more
modest in scale. Reforms in any case are entirely country specific
given the political nature of health care. What the examples provide
here are possible directions, all of which will necessarily be adapted
to country circumstances.
Even without these important inputs simply having benchmark
countries with which to compare countries would strengthen the
cross country evidence. Acceptable indicators, benchmarks and
additional attention to systemic issues would enable more robust
indicators of overall performance, which in turn would inform policymakers
and donors of challenges and opportunities for improving
health institutions.
What needs addressing is the context and framework under
which health systems function. First and foremost is better accountability.
Greater professionalism among health staff, effective
training and supervision of staff at all levels, routine audits of all
aspects of fiduciary transactions, improved records and recordkeeping
to provide systematic data to managers and the bureaucracy,
and procedures that can facilitate service delivery in a more user
friendly fashion all need to be addressed. Running hospitals, clinics
and other points of service in the manner of a business or of a
ministry of finance would be particularly helpful. The discipline
implied and the need to be accountable provides the incentives that
improve productivity, patient satisfaction and performance. That is
where health systems need to move.
Incentives that raise performance – ensuring appropriate,
targeted training so health professionals are equipped to do their job;
linking pay and performance; reviewing and auditing performance;
improving recordkeeping; and upgrading logistics for drugs and
supplies – need to be an integral part of health systems. Investments