Achieving MDGs?

The United Nations recently discussed the achievements so far in achieving the Millennium Development Goals. The goals aim to:

  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat HIV/Aids, malaria and other diseases
  • Ensure environmental sustainability
  • Develop a Global Partnership for Development

The Prime Minister of Norway, Jens Stoltenberg and the Gordon Brown, former PM of Great Britain, underline that governments of poorer nations have to put resources into education and health, and not into corruption.

As I have outlined previously, corruption is widespread at health institutions. Fighting corruption is necessary because corruption reduces the resources available for health. Corruption also lowers the quality, equity and effectiveness of health care services, and it decreases the volume and increases the cost of provided services. Corruption also discourages people to use and pay for health services.

It is encouraging that world leaders talk about broadening the tax base, and identify fighting corruption as a means of achieving the MDGs. The leading donors should encourage governments to put in place mechanisms at each institution to reduce corruption. This should include such basic functions and proper accounting systems and mechanisms for independent financial audits.

Do NGOs corrupt health institutions?

Many international organizations and Non-Governmental Organizations (NGOs) support health work in developing countries. Often, their work is to train staff to get necessary skills, and thus improve health services. Each NGO have their specific goals, and wish these tasks to be carried out at institution. Good examples that have helped many patients include HIV work, reproductive health, and support to specialists to carry out operations at rural institutions.

Although the NGOs do this with the best of intentions, their support is often misused, and unfortunately weakens institutional sustainability and equity.

Some negative examples from south Ethiopia include:

  1. A NGO supports that patients with diseases such cleft lips are operated at district hospitals. The organizations provide the local staff with good training to carry out such treatment. Many patients receive good treatment. Unfortunately, we often note after the early campaigns, operations are not done between campaigns as planned. The NGO pays extra for each operation to the staff during campaigns, but not for operations done between campaigns. This often leads to staff only operating when they receive extra payment. This is an example of “misuse of entrusted power for private gain” (Transparency international definition of corruption).
  2. UN organizations and NGOs often organize training seminars and workshops. The participants might receive daily allowances up to half of their monthly salaries. Unfortunately, some participants are not even qualified to carry out the intended work. We know of examples when managers, without medical training, took part in course on how to treat drug resistant tuberculosis. And some staff take part in courses to resuscitate neonates, but never work in a delivery ward. Again, examples of “misuse of entrusted power for private gain”.

I believe it is time for NGOs and International organizations to look into the side effects of their massive support to health institutions. A proper question is: Are there alternative ways to support institutions with much needed training, and at the same time not tempting the institutions and individuals to take part in corruption?

Most international organizations and NGOs have increased sustainability and equity as part of their visions. If sustainability and equity is a goal for such organization, new ways to support the institutions should be sought.

Reducing corruption at health institutions

ResearchBlogging.orgCorruption depletes resources from the health institutions such as hospitals and health centres. For example, countries with a high corruption index have higher child mortality rates. How can health institutions reduce corruption, and increase available resources for patient treatment?

In a good review article, Taryn Vian (2007) defines what corruption at health institutions is, explains why it reduces necessary and scarce resources, and how corruption can be reduced. Vian outlines the mechanisms on how managers rationalize social norms, moral or ethical beliefs, attitudes and personalities to their own benefit. Weak accountability, lack of citizen voice and transparency turn out to be opportunities for abuse. And, poor wages and pressures from clients become pressures for misuse.

Unfortunately, many health institutions have weak management, inadequate accounting, and there are few lawyers to follow up financial misuse at health institutions. However, much can be done to reduce corruption. In our work in Ethiopia we try to focus on the following points as part of a ways to ensure sustainable health institutions.

  1. Each institution needs good and sound accounting carried out by trained staff. The institution should produce regular and acceptable financial reports
  2. Each institution must simplify the cash collection procedures, and internal auditors must daily check the cash collection.
  3. The institutional board should routinely review that purchases are done as wanted by the government
  4. Institutions should regularly be supervised and checked by public licensing authorities
  5. Each institutions should keep an absentee registry, and thus assure that workers do not collect salaries and work at other places
  6. Each institution needs yearly financial audits. As health institutions collect patient fees, institutions are accountable to the public. Therefore both public and certified auditing institutions should audit the finances of health institutions.

During the past years we have seen hospitals worsen because of changes of staff and a lack of control mechanisms. External support to health institutions in many developing countries should be accompanied with a need for sound management, accounting and auditing practices.

Vian, T. (2007). Review of corruption in the health sector: theory, methods and interventions Health Policy and Planning, 23 (2), 83-94 DOI: 10.1093/heapol/czm048

Corruption at health institution

ResearchBlogging.orgCorruption at health institution is a concern in all countries, but it is especially in developing countries where public resources are already scarce.

Countries with high indices of corruption have for example higher rates of infant mortality.

A recent World Bank report from Ethiopia (Lindelow and Serneels 2006) report on “pilfering drugs and materials, informal health care provision and illicit charging, and corruption” at health institutions in Ethiopia. The authors focus on “weak accountability mechanisms and the erosion of professional norms in the health sector” as a main causes of corruption.

Fighting corruption is important because corruption reduces the resources available for health. Corruption also lowers the quality, equity and effectiveness of health care services, and it decreases the volume and increases the cost of provided services. Corruption also discourages people to use and pay for health services.

Some examples of corruption in health care (from Vian 2002):

  • During construction and rehabilitation of health institutions: bribes, kickbacks and political considerations influence the contracting work, and contractors fail to perform and are not held accountable
  • Buying equipment, supplies, and drugs: bribes, kickbacks, and political considerations influence specifications and winners of bids, bid rigging during procurement, lack of incentives to choose low cost and high-quality suppliers. Suppliers might fail to deliver and are not held accountable
  • Distribution and use of drugs and supplies in service delivery: Theft (for personal use) or diversion (for resale to private institutions) of drugs and supplies at storage and distribution points. It also includes sale of drugs or supplies that were supposed to be free
  • Education of health professionals: bribes to gain place in medical school or other pre-service training, bribes to obtain passing grades, and political influence, nepotism in selection of candidates for training opportunities

Preventing abuse and reducing corruption is important to increase resources available for health, and thus to improve the health status of the population.

In our health work in Ethiopia we only work with institutions that focus of transparent management procedures, and have proper accounting and perform regular external financial audit. In our experience it is also important that public auditing institutions (“Office of general audit”) regularly evaluate health institutions.


Lindelow, M., & Serneels, P. (2006). The performance of health workers in Ethiopia: Results from qualitative research Social Science & Medicine, 62 (9), 2225-2235 DOI: 10.1016/j.socscimed.2005.10.015

Vian T. 2002. Corruption and the Health Sector.