Background papers and case studies

Tim Macke Bryan Liang. 2013. Combating Healthcare Corruption and Fraud with Improved Global Health Governance. https://www.semanticscholar.or...

Corruption poses major challenges to global health outcomes, with severe financial and health consequences. Yet, endemic forms of corruption affect global health systems worldwide in public and private sectors, and in developed and resource-poor settings alike. Fraud and misuse of resources in global health initiatives also undermine future investment. Current domestic and sectoral-level responses are fragmented and have been criticised as ineffective. To address this issue, the authors propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue.  

European Commission. 2013. Study on Corruption in the Healthcare Sector.  

This study aims to promote a better understanding of the extent, nature and impact of corrupt practices in the healthcare sector across the EU and to assess the capacity of the member states to prevent and control corruption within the healthcare system. It also considers the effectiveness of these measures in practice, with a particular focus on medical service delivery; procurement and certification of medical devices; and procurement and authorisation of pharmaceuticals. The latter part of the study explains current anti-corruption efforts in the health sector and provides general recommendations that are applicable to medium and high-income countries. The report finds that what is needed is a combination of effective generic anti-corruption policies and practices (legislation, enforcement), policies and practices aimed at addressing fundamental health system weaknesses (managerial and financial), a general rejection of corruption by society (including a self-regulation by health sector actors), as well as specific anti-corruption policies and practices in healthcare.  

Jillian Kohler & Natalia Ovtcharenko. 2013. Good Governance for Medicines Initiatives: Exploring Lessons Learned. U4 Issue 2013:3.  

Corruption in the pharmaceutical system results in wasted resources, limited access to health services and poorer outcomes. This U4 Issue paper explores select global initiatives promoting good governance and medicines by the World Bank, WHO, Global Fund and the Medicines Transparency Alliance that have been applied since the year 2000. These initiatives have been particularly useful in generating greater awareness about the issue, as well as fostering political and policy dialogue around the issue of pharmaceutical good governance systems.  

The initiatives are found to have some success in identifying weaknesses in the pharmaceutical system and providing baseline data. They have also created important multi-stakeholder alliances and implemented sector-specific governance initiatives. However, a significant gap between the identification of problems, the strategic design to address problems and their implementation remain. Recommendations include the need for political analysis, and monitoring and evaluation – particularly in the measurement of results – and the streamlining and uniformity of assessment tools across institutions.  

Soren Holmber and Bo Rothstein. 2010. Dying of Corruption. Health Economics, Policy and Law.  

In many poor countries, over 80 per cent of the population have experienced corrupt practices in the health sector, while in rich countries, corruption takes other forms, such as overbilling. This article explores the correlation between corruption, healthcare quality and health indicators, by reviewing the literature and then running regressions based on the assumptions of previous theoretical studies. Using cross-sectional data from more than 120 countries, this paper finds that a quality of government variable is positively associated with higher levels of life expectancy, lower levels of mortality rates for children and mothers, higher levels of healthy life expectancies and higher levels of subjective health feelings. In contrast to the strong relationships between the quality of government variables and health indicators, the relationship between the health-spending measures and population health are rather weak most of the time and occasionally non-existent. The authors conclude improving health levels around the world, in rich countries as well as in poor countries, will require improved quality of government rather than spending. A secondary finding is that healthcare systems primarily financed with public rather than private money are more effective.  

Taryn Vian and Carin Nordberg. 2008. Corruption in the Health Sector. Bergen: Chr. Michelsen Institute. U4 Issue 2008:10. 

This comprehensive article outlines the complexities of fighting corruption in the health sector, providing an elaborate overview of the factors that contribute to health sector corruption. It focuses on procurement and financial resources management, the management of medical supplies and healthcare provider-patient relationships. It provides several strategies to combat corruption in health, including budget transparency and participation, improved resource control and accounting systems, decentralisation, tracking resource flows and information campaigns. The paper concludes with a literature review of important material on healthcare corruption.  

William Savedoff. 2008. The Impact of Information and Accountability on Hospital Procurement Corruption in Argentina and Bolivia. U4 Brief.  

Argentina and Bolivia have both attempted to curb corruption in the procurement of hospital supplies by monitoring and publicising information on prices. In the late 1990s, the city Buenos Aires collected information about prices paid for a wide range of non-pharmaceutical medical supplies commonly purchased by hospitals, allowing a comparison of the prices that different hospitals paid. Data collected showed that the dispersion of prices, as well as the average price, fell quite dramatically in the first months of the experiment. In the same period, Bolivia devolved numerous responsibilities to municipalities and to representative bodies that included local citizens. Local supervision appeared to be more effective at controlling corruption than the standard “vertical” controls embedded in the management and administrative channels of the public health system. However, lessons drawn from these experiences suggest that, unless there are consequences attached to identified malpractice, monitoring and publicising information will not guarantee sustained gains.  

Jillian Cohen, Monique Mrazek & Lorraine Hawkins. 2007. Corruption and Pharmaceuticals: Strengthening Good Governance to Improve Access.  

Inequalities in access to pharmaceuticals are caused by many variables, including poverty, high drug prices, and poor health infrastructure and corruption, and has a devastating impact on a country’s health outcomes. Inadequate quality control regulations can result in unsafe counterfeit drugs, with severe health and economic consequences. Capture of the pharmaceutical regulatory system can result in irrational public spending on medicines that are appropriate, effective or even safe.  

The chapter of “The many faces of corruption: tracking vulnerabilities at the sector level” provides an overview of the pharmaceutical sector’s vulnerabilities to corruption, provides examples of how corruption occurs, highlights diagnostic tools for detecting it and offers recommendations designed to minimise its occurrence.  

Transparency International. 2006. Global Corruption Report: Corruption and Health.  

The Global Corruption Report 2006 focused on corruption and health. The book includes expert reports on the risks of corruption in different healthcare systems; the scale of the problem, from high-level corruption in Costa Rica and counterfeit medicines in Nigeria to healthcare fraud in the United States; the costs of corruption in hospital administration and the problem of informal payments for healthcare; the impact of corruption at various points of the pharmaceutical chain; and anti-corruption challenges posed by the fight against HIV/AIDS.  

Rafael Di Tella, and Ernesto Schargrodsky. 2003. The Role of Wages and Auditing during a Crackdown on Corruption in the City of Buenos Aires. Journal of Law & Economics 46, no. 1 (April 2003): 269–92.  

This study measured the effects anti-corruption campaigns have on the prices that hospitals pay for basic equipment, pharmaceuticals and hygiene products in Argentine hospitals. The study finds that during the anti-corruption campaigns (which involved specialised auditing of hospital accounts), prices paid for these inputs tended to drop. The authors found that, while increasing wages in the hospitals also led to a drop in prices, anti-corruption campaigns had a greater effect.


Iñaki Albisu Ardigó; Marie Chêne


Matthew Jenkins

Contributing experts:

Umrbek Allakulov (Water Integrity Network)

Shaazka Beyerle (US Institute of Peace)

Simone Bloem (Center for Applied Policy)

Claire Grandadam (Water Integrity Network)

Jacques Hallak (Jules Verne University – Amiens)

Mihaylo Milovanovitch (Centre For Applied Policy)

Muriel Poisson (International Institute for Educational Planning (IIEP-UNESCO)

Juanita Riano (Inter-American Development Bank)

Marc Y. Tassé (Canadian Centre of Excellence for Anti-Corruption)

Vítězslav Titl (University of Siegen)

Davide Torsello (Central European University Business School)

Patty Zakaria (Royal Roads University)



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