World Bank

This slide-format presentation for a United States Agency of International Development (USAID) conference (June 2007) opens with a statement summarising the speaker's intentions, including: define corruption and poor governance for the health sector; demonstrate the relative importance of poor governance to health outcomes; measure corruption and poor governance in health care delivery; and discuss what to do about it.

The presentation defines terminology associated with health and corruption and details the relationship of corruption to the field of health, including the potential role of governance in government effectiveness, control of corruption, and voice and accountability. It analyses the citizen perception of corruption in the health sector worldwide, using its affect on immunisation as an example. The presentation touches on drug and equipment theft; medicine purchase price differences in four Latin American countries; the absence rate among health workers in a selection of locations in Southeast and South Asia, Latin America, and Africa; the proportion of informal to formal medical payments in a number countries; and the percent those payments consume of patient income. The final section answering the question "What to do?" includes a list of government effectiveness and accountability practices, corruption control possibilities, and an assessment of the use of voice, e.g., voting, and citizen participation.

Among the conclusions are the following:

• Returns to health investment may be very low with corruption and low effectiveness
• Institutions matter: health systems cannot be divorced from efforts to improve governance
• Institutional factors need to be strengthened along with spending to improve performance
• Need more evidence
• Health can’t be sidelined in overall corruption agenda of donors or countries.

USAID Health Systems 20/20 website accessed on March 25 2009.