Beyond Talking: We Need Effective Measures to Tackle Systemic Corruption and the Power That Allows It to Persist in Health Systems; A Response to Recent Commentaries

Our Blind Spots in the Fight Against Health Systems Corruption Comment on "We Need to Talk About Corruption in Health Systems"

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.81 ◽

2019 ◽

Vol 9 (1) ◽

pp. 34-38

Author(s):

Reinhard Huss

Keyword(s):

Health Systems ◽

Low Income ◽

Health Workers ◽

Social Systems ◽

Health Sector ◽

Low Income Countries ◽

Financial Flows ◽

The Sustainable Development ◽

Systemic Corruption

The health sector often appears prominent in surveys of perceived corruption, because citizens experience the symptoms of systemic corruption most distressingly during their interaction with frontline health workers. However, the underlying drivers of systemic corruption in society may be located in other social systems with the health system demonstrating the symptoms but not the path how to exit the situation. We need to understand the mechanisms of systemic corruption including the role of corrupt national and international leaders, the role of transnational corporations and international financial flows. We require a corruption definition which goes beyond an exclusive focus on the corrupt individual and considers social systems and organisations facilitating corruption. Finally there is an urgent need to address the serious lack of funding and research in the area of systemic corruption, because it undermines the achievement of the Sustainable Development Goals (SDGs) in many low income countries with the most deprived populations.

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Demystify False Dilemmas to Speak About Corruption in Health Systems: Different Actors, Different Perspectives, Different Strategies Comment on "We Need to Talk About Corruption in Health Systems"

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.61 ◽

2019 ◽

Vol 8 (10) ◽

pp. 620-622

Author(s):

Karen Hussmann

Keyword(s):

Health Policy ◽

Health Systems ◽

Health Service Delivery ◽

Political Systems ◽

Access To Health ◽

State Capture ◽

False Dilemma ◽

The Media ◽

Systemic Corruption ◽

Policy Communities

The call of the editorial of the International Journal of Health Policy and Management regarding the "Need to talk about corruption in health systems" is spot on. However, the perceived difficulties of why this is so should be explored from an actor’s perspective, as they differ for government actors, donors and the research community. In particular, false dilemmas around definition problems should be demystified, including by building systematic bridges between the anti-corruption/integrity and health policy communities of practice. In addition, the focus on corruption in frontline health service delivery generating mainly problems of access to health, needs to be complemented with addressing sophisticated kickback schemes, nepotism, and state capture of legislative and regulatory agencies and processes draining the health systems of large amounts of resources leading to another false dilemma of assumed sector underfunding. In terms of what can be done, comprehensive corruption experience and risk assessments conducted by independent actors, eg, universities, aimed at generating some basic consensus among the different actors of priority areas to be addressed on the basis of a co-responsibility approach could provide the basis for reform. Finally, governments and private sector actors in countries characterized by systemic corruption and clientelistic political systems will not reform themselves without strong and sustained demand from civil society and the media.

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