The ignored pandemic: how corruption in healthcare service delivery threatens Universal Health Coverage

Political corruption Health Health services accessibility Health services administration Poverty Universal health care Public health

Executive summary:

Universal health coverage, meaning that all individuals and communities can access essential quality health services without suffering financial hardship, has become the top priority of the World Health Organization. Achieving the ambitious goal of universal health coverage will require more resources, and the better use of existing resources.

At the same time, efforts to achieve universal health coverage are being significantly undermined by widespread corruption in frontline healthcare service delivery. Corruption in the health sector kills an estimated 140,000 children a year, fuels the global rise in antimicrobial resistance, and hinders the fight against HIV/ AIDS and other diseases. Unless the most harmful forms of corruption are curbed, universal health coverage is unlikely to be achieved.

Based on an extensive review of the literature, this report seeks to open a new page by taking a fresh look at the evidence on corruption and anti-corruption. It explores the drivers, prevalence, and impact of corruption at the service delivery level. In many countries, deep structural problems drive frontline healthcare workers to absent themselves from work, solicit gifts and extort bribes from patients, steal medicines, and abuse their positions of power in a variety of other ways, usually without facing any consequences.

The cumulative damage is staggering. Corruption significantly weakens overall health system performance, and has been found by multiple studies to have a significant negative impact on important health outcomes. Corruption in the sector causes losses of over US$500 billion every year, more than it would cost to bring about worldwide universal health coverage.

Nonetheless, health policy makers have traditionally paid little attention to corruption, and many of the current approaches to anti-corruption in the sector lack effectiveness. Unless this changes, it will be practically impossible to achieve universal health coverage. Business as usual is no longer an option.

Decision-makers urgently need to move beyond the piecemeal and ad hoc anti-corruption measures of the past, and instead make curbing corruption an integral part of wider efforts to strengthen health systems, improve health outcomes, and achieve universal health coverage. While experience shows that tackling corruption in healthcare service delivery is difficult, it is not impossible.

Efforts to curb corruption can be successful if they focus on the most harmful forms of corruption, are based on a thorough understanding of high-level political constraints and ground-level health system operations, and follow a coherent agenda that is firmly embedded within wider health system strengthening efforts.

Nonetheless, there are no simple playbooks, no easy wins and no magic bullets. Successfully curbing corruption in healthcare service delivery requires in-depth research, thorough analysis, the skilful combination of multiple approaches, and a single-minded focus on improving health outcomes.

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