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68 Fighting the Diseases of Poverty
system effectiveness since under-utilized public facilities or their bypassing
by target groups suggest implementation problems. Despite
their relevance, such data rarely if ever are collected on a routine
basis in developing countries. Indeed such information only exists
for a subset of countries and often for only a segment of the health
system. In the absence of comparable monitorable indicators this
kind of information can inform policy makers about performance
and the pressure points of health systems development before large
scale data collection is in place.
Governance and corruption in health care delivery
Health care provision depends on efficiently combining financial
resources, human resources, and supplies, and delivering services
in a timely fashion distributed spatially throughout a country. This
requires a “system” that mobilizes and distributes resources,
processes information and acts upon it, and motivates providers’
appropriate behavior by individuals, health care workers, and
administrators. Good governance is a critical factor in making such
a system function.
In health care, good governance implies that health care systems
function effectively and with some level of efficiency. Though many
governance indicators have been developed for countries in the
aggregate, governance indicators for specific sectors, such as health,
are not readily available. Consequently, it is necessary to look for
proxies that reflect the quality of health sector governance. This
paper will focus on one such proxy, evidence of corruption, that
results when governance is poor. This section reviews the definition
of corruption and its application to the health sector.
Sound institutions and good governance go hand-in-hand.
Kaufman and Kraay (2003) define good governance as “the traditions
and institutions by which authority in a country is exercised”.
More specifically it encompasses:
◆
capacity of government to formulate and implement sound
policies, manage resources and provide services efficiently;