Corruption 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.
- Each institution needs good and sound accounting carried out by trained staff. The institution should produce regular and acceptable financial reports
- Each institution must simplify the cash collection procedures, and internal auditors must daily check the cash collection.
- The institutional board should routinely review that purchases are done as wanted by the government
- Institutions should regularly be supervised and checked by public licensing authorities
- Each institutions should keep an absentee registry, and thus assure that workers do not collect salaries and work at other places
- 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