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.