Topic Guide: Corruption in Health Services

Access to healthcare is one of the fundamental rights of every human being, enshrined in the International Covenant on Economic, Social and Cultural Rights. It is fundamental to people’s well-being and quality of life and an essential condition to inclusive human and economic development. As part of the 2030 Agenda for Sustainable Development, leaders from the world have committed to “ensure healthy lives and promote well-being for all at all ages” (SDG 3) by 2030.  

Corruption in the health sector is a major impediment to these commitments. Empirical evidence shows that corruption reduces immunisation rates, delays the vaccination of new-borns, discourages the use of public health clinics, reduces satisfaction of households with public health services and increases waiting time at health clinics.[1] Corruption reduces public resources available for medical equipment, drugs, and salaries,[2] thereby undermining the quantity and quality of health services and of patient care.[3] It increases the risks of malpractice and hospital infections. It distorts health policies, denies citizens access to hospitals, medicines and qualified staff and undermines efforts to combat major health challenges, such as malaria and HIV/AIDS. This in turn has a direct negative effect on mortality rates and child mortality rates[4] and life expectancies at birth,[5] and leads to higher incidences of epidemics and disease.[6] Addressing corruption in the health sector is a matter of life and death.  

Corruption in health services also has major economic impacts, raising the cost of healthcare for individuals, healthcare institutions and society in general.[7] Corruption also increases the cost of providing healthcare to citizens on an aggregate scale, as poor healthcare provision may result in incorrect diagnosis or inefficient treatments, which may evolve into other, more costly health conditions. Similarly, as low-quality prevention systems within healthcare lead to more serious disease outbreaks, corruption at the level of primary care provision can generate additional strains on public health systems.[8]  

Corruption in healthcare also has significant effects on the persistence of poverty in developing countries.[9] As they are more reliant on public services to access healthcare, the poor are disproportionally affected by the impact of corruption in the health sector. In addition, corruption in healthcare can have negative effects on productivity and working hours, undermining people’s livelihood as well as economic development and growth prospects.[10

Yet, corruption in the health sector is widespread in many countries. World Bank surveys suggest that, in some countries, up to 80 per cent of non-salary health funds never reach local facilities.[11] There are a number of factors that make the health sector particularly vulnerable to corruption. Health systems are characterised by complex administrative structures and involve large-scale investments as well as a large number of public and private providers, making it harder to establish effective accountability systems.  

At the same time, there are vast funds at stake and these financial flows are attractive targets for abuse. According to a 2008 WHO report, total expenditures on health worldwide represent 8 per cent of the world’s GDP. Every year, more than US$3 trillion is spent on health services globally, primarily financed by taxpayers.[12] The sector is also characterised by a fundamental imbalance of information between health practitioners and patients and risks of conflicts of interest between health officials and private companies.