TY - JOUR
T1 - Corruption in Anglophone West Africa health systems
T2 - a systematic review of its different variants and the factors that sustain them
AU - Onwujekwe, Obinna
AU - Agwu, Prince
AU - Orjiakor, Charles
AU - McKee, Martin
AU - Hutchinson, Eleanor
AU - Mbachu, Chinyere
AU - Odii, Aloysius
AU - Ogbozor, Pamela
AU - Obi, Uche
AU - Ichoku, Hyacinth
AU - Balabanova, Dina
N1 - Funding Information:
This publication is an output of the SOAS Anti-Corruption Evidence (ACE) research consortium funded by UK aid from the UK Government [Contract P0 7073]. The views presented in this publication are those of the author(s) and do not necessarily reflect the UK government s official policies or the views of SOAS-ACE or other partner organizations. For more information on SOAS-ACE visit www.ace.soas.ac.uk
Funding Information:
This publication is an output of the SOAS Anti-Corruption Evidence (ACE) research consortium funded by UK aid from the UK Government [Contract P0 7073]. The views presented in this publication are those of the author(s) and do not necessarily reflect the UK government’s official policies or the views of SOAS-ACE or other partner organizations. For more information on SOAS-ACE visit www.ace.soas.ac.uk
Publisher Copyright:
© 2019 The Author(s) 2019.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.
AB - West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.
KW - African health systems
KW - Anglophone West Africa
KW - Health sector
KW - health sector corruption
KW - universal health coverage
UR - http://www.scopus.com/inward/record.url?scp=85073123929&partnerID=8YFLogxK
U2 - 10.1093/heapol/czz070
DO - 10.1093/heapol/czz070
M3 - Review article
C2 - 31377775
AN - SCOPUS:85073123929
SN - 0268-1080
VL - 34
SP - 529
EP - 543
JO - Health Policy and Planning
JF - Health Policy and Planning
IS - 7
ER -
