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Corruption in public health 69
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the process that allows citizens to select, hold accountable,
monitor and replace government; and,
the respect of government and citizens for the institutions that
govern economic and social interaction.
Multiple institutions collect indicators of governance. Kaufman,
Kraay and Mastruzzi (2005) have boiled them down to six dimensions
of governance: voice and accountability; political stability and
lack of violence; government effectiveness; regulatory quality; rule
of law; and, control of corruption – all of which affect the environment
within which health care services function. The robustness of
the private sector in health will be affected by factors such as poor
regulation or an ineffective court system, the elements of particular
relevance to service delivery are voice and accountability, government
effectiveness and control of corruption.
Voice and accountability reflect external accountability, the effectiveness
of citizen and institutional influences on government
action. While much of the broader concerns are with human rights,
in health factors such as the viability of the political system, media
independence and trust in government reflect the degree to which
citizens can influence government decisions that affect them. For
example, where local leaders are not elected, localities cannot hold
public servants accountable for their decisions or actions, and public
bodies have little incentive to effectively serve the community. The
lack of voice leaves localities at the mercy of public sector whims.
Voice and accountability permit communities to be involved in decisions
and oversight of health care services.
Government effectiveness encompasses efficiency of the bureaucracy
and public servants, roles and responsibilities of local and
regional governments, including the administrative and technical
skills of government, effectiveness of policy and program formulation,
governing capacity, and effective use of resources. Extending
the example above, decentralization that comes without funding or