A review of corruption among health workers in South and South-East Asia
Abstract
Introduction
Corruption affects health systems worldwide; life-saving resources are wasted, people face
informal payments to access healthcare, are given falsified or sub-standard medicines, and
receive inadequate treatment. Health system corruption can lead to violation of human
rights, and hinder the progress in achieving Universal Health Coverage. Overall, corruption
undermines the capacity of health systems, leading to the loss of lives and resources. Health
system corruption can manifest itself differently among different health system actors, and
across different contexts. This paper investigates corruption among health workers in the
chosen South Asian and South-East Asian low and middle-income countries.
Methods
A narrative literature review was conducted to study corruption among the health workers
in South and South-East Asia. A standardised search strategy with key terms was used to
search across several databases. Twelve articles were included in the literature review.
Findings
Informal payments and absenteeism were predominantly discussed in the reviewed
literature. The informal payments led to unequal access to health services, impacted the
quality of care, and undermined the public trust and willingness to use services. Furthermore,
absenteeism of the health workers undermined service delivery.
The causes of corruption included multiple factors involving pressures, rationalisation, and
opportunities for corruption to occur. Low wages, considerable discretion among doctors,
inappropriate health workforce management, and an informal parallel system with
individually negotiated accountability mechanisms were notable conditions for corruption.
In sectoral anti-corruption practices, the emphasis was on community-based activities. Some
positive results in reducing corruption through citizen engagement were recorded. However,
citizens' efforts alone were insufficient, and in addition, other approaches were needed.
Conclusion and recommendations
Detailed empirical research is required to understand the nature and significance of different
corrupt practices. The risk-based and developmental governance models can promote
practical, targeted solutions to curb corruption.
Appropriate health workforce management is necessary and should be implemented
together with decent salaries. Moreover, understanding and addressing the informal
dimensions of accountability is needed to ensure the effectiveness of formal policies.