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78 Fighting the Diseases of PovertyGovernment effectiveness, corruption andaccountability in health care deliverySeparating three components of governance – government effectiveness,corruption and accountability – allows targeting policiesto specific shortcomings. However, the information base is thin andthe elements so intertwined that a separate analysis of each yieldslittle benefit. For example, evidence from provider and other surveysin Mozambique, Nigeria and Uganda suggest that the level of mismanagement,vague and poorly understood performance expectations and thesingular lack of accountability to anyone or any institution makeshaphazard and corrupt practices difficult to identify, separate orcontrol ( Lindelow, Ward and Zorzi, 2004; Lindelow, Reinikka andSvensson, 2003; Das Gupta, Gauri and Khemani, 2003; McPake et.al., 1999).There is a fine line between inefficiency and corruption in manyinstances. Is poor service a function of corruption or simply mismanagement?Better accountability can address both, so should theapproach be combined or separated? In the interests of clarity, thissection will discuss governance, corruption and accountabilityjointly reviewing the evidence and offering an interpretation ofthose findings as they relate to each of these criteria.This discussion begins with an assessment of perceptions of corruptionin select countries to provide that context. It then addressesthe production function elements in reviewing country levelevidence. The analysis tracks productivity of labor, and capitalinputs: drugs, supplies and national transfers, complementing thesewith a brief assessment of management, a central component forcorrecting many of the problems identified.Perceptions of corruption in public health care systemsWhile not strictly part of the production function, perceptionsabout corruption reflect how stakeholders view health systems andtheir effectiveness in producing acceptable health outcomes. Perceptionsprovide the basis for assessing governance at a national