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80 Fighting the Diseases of PovertyA related 2001 perceptions survey conducted by USAID on corruptionamong public officials in Bosnia and Herzegovina, Bulgaria,Macedonia, Romania, Croatia, and Montenegro showed that 45–55per cent of respondents felt that corruption among doctors waswidespread. Albania and Serbia showed much higher levels – 61–71per cent range. Albania’s perception score for doctors was an outlierrelative to its score for other public officials, but Serbia exhibitedlevels above those of other countries for most categories of officials,suggesting a relatively more corrupt environment (Vitosha/USAID,2002).Business Environment and Enterprise Performance Surveys ofadministrative corruption in ECA capture business managers’ perceptionsof health service quality. Across 20 countries only SloveniaandCzechRepublichadpositiveassessmentsfrom60percentormoreof respondents, indicating management and governance problems inthe other 18 systems (Ryterman, Hellman, Jones et al., 2000).In Bolivia a local survey of patients considered the HealthMinistry and public hospitals less corrupt than customs or police,but ranked corruption 2.7 on a scale of 1–4, noting the nepotism,clientelism and higher charges for the unconnected as some keyindicators of corruption (Gatti, Gray-Molina and Klugman, 2004),evidence that has been corroborated in other studies as discussedbelow. Surveys from South Asia suggest similar perceptions of thehealth sector (Thampi, 2002).A comparison of corruption perceptions among households inthe Philippines and Uganda found 34 and 71 per cent, respectively,reported that corruption is common or very common in governmentgenerally. And among local officials, 25 per cent in the Philippinesand 61 per cent in Uganda acknowledged some kind ofcorruption in public services within the municipalities (Azfar andGurgur, 2001).Explanations from the surveyed on why corruption is so evidentin the health sector emphasize the lack of accountability and transparencyin health care operations, and in some the “power ofmonopoly” where other public or private alternatives simply do not