Understanding and eliminating health sector corruption impeding UHC at district level in Nigeria and Malawi: institutions, individuals and incentives

了解并消除阻碍尼日利亚和马拉维地区一级全民健康覆盖的卫生部门腐败：机构、个人和激励措施

• 批准号: MR/T023589/1
• 负责人: Dina Balabanova
• 金额: $ 102.46万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT023589%2F1
• 关键词: Understanding; eliminating; health; sector; corruption

Weak accountability and corruption (the abuse of entrusted power for private gain) threatens health in LMICs, especially among the poor. Evidence shows that corruption remains pervasive, harms health and access to care, and is a major barrier to achieving Universal Health Coverage. The health sector is consistently rated as among the most corrupt. Unaccountable and corrupt practice undermines the trust underpinning effective, equitable, and responsive health care and has a major impact on health outcomes. Corruption is often seen as an intractable problem-with limited evidence on successful strategies to address it.Most approaches to weak accountability and corruption have seen these as a failure of management, a result of poorly governed and financed systems or reflecting social norms. Many interventions seek to improve law, policy, accountability and transparency. We argue that these can be more effectively addressed through a) understanding the main types of corruption manifest in the provision of care at district and local level (e.g.informal payments, absenteeism, leakage of health commodities, inappropriate referrals), b) the individual and organisational characteristics that drive it, and c) the underlying power structures. Thus, research must explore how formal structures (policy and its implementation) interplay with informal social, economic and political structures (local elites and kinship networks) to shape everyday practice within the health system. With this knowledge, it is possible to identify pragmatic strategies ('openings') to address corruption that takes into account their fit within the broader organisational and political distribution of power. Drawing on health systems research, anthropology, and political economy, our hypothesis is that measures based on a detailed understanding of the intersections between formal and informal structures, incentives and networks can inform the design of contextually appropriate interventions to tackle corruption in public health systems. The study will take place in Nigeria and Malawi. Both have high levels of corruption and momentum-driven by political leaders and civil society-to tackle corrupt practice. We ask: how do health systems structures and practices, and informal socio-political and economic structures incentivise corruption at district level and how can these be overcome?Our choice of methods reflects our intention to explore incidents of corruption in real time within frontline exchanges between provider and patients in district management structures and local community. We will develop novel and ethically robust approaches and methods: content analysis of policies and regulations, media (print and radio) relating to accountability/anti-corruption. Institutional ethnography in district health offices, primary, secondary and tertiary levels facilities, in-depth interviews with formal and informal political and health systems structures, focus group discussions and a household survey with service users, data from anonymous calls/ messages by individuals reporting corruption cases. The analysis will also draw on political economy, with analysis of actors, their power and their informal networks, on systems theory, especially complexity, and will involve co-production workshops and policy dialogues to interpret and validate findings. In Nigeria we will work in the Enugu state in the south and in the Kano state in the north and, and within each, urban and rural areas, and in Malawi we will select up to 4 districts. These will be selected to represent diverse populations, needs, outcomes, level of resources and institutional strength. We will engage at all health system levels-with community organisations, districts/ state, as well as national authorities, to promote anti-corruption action. We will build a community of practice, share knowledge and support researchers and implementers in LMICs-linked to global anti-corruption initiatives.

问责制薄弱和腐败(滥用受托权力谋取私利)威胁着小岛屿发展中国家的健康，尤其是穷人的健康。有证据表明，腐败仍然普遍存在，损害健康和获得护理的机会，是实现全民健康覆盖的主要障碍。卫生部门一直被评为最腐败的部门之一。不负责任和腐败的做法破坏了支持有效、公平和反应迅速的卫生保健的信任，并对健康结果产生了重大影响。腐败往往被视为一个棘手的问题--解决这个问题的成功战略的证据有限。大多数针对问责制薄弱和腐败的方法都将其视为管理失败、治理不善和资金不足的系统所致，或者反映了社会规范。许多干预措施寻求改善法律、政策、问责制和透明度。我们认为，这些问题可以通过以下方式更有效地解决：a)了解在地区和地方一级提供护理服务中表现出来的主要腐败类型(例如，非正式付款、旷工、医疗商品泄漏、不适当的转介)，b)驱动腐败的个人和组织特征，以及c)潜在的权力结构。因此，研究必须探索正式结构(政策及其执行)如何与非正式社会、经济和政治结构(当地精英和亲属网络)相互作用，以塑造卫生系统内的日常做法。有了这些知识，就有可能确定解决腐败问题的务实战略(“开场白”)，并考虑到它们是否符合更广泛的组织和政治权力分配。借鉴卫生系统研究、人类学和政治经济学，我们的假设是，基于对正式和非正式结构、激励和网络之间的交集的详细理解的措施，可以为设计适合背景的干预措施提供信息，以解决公共卫生系统中的腐败问题。这项研究将在尼日利亚和马拉维进行。这两个国家的腐败程度都很高，在政治领导人和公民社会的推动下，都有打击腐败行为的势头。我们问：卫生系统结构和做法以及非正式的社会政治和经济结构如何激励地区一级的腐败，以及如何克服这些腐败？我们选择的方法反映了我们的意图，即在地区管理结构和当地社区的提供者和患者之间的一线交流中实时探索腐败事件。我们将制定新的、符合道德规范的方针和方法：对与问责/反腐败有关的政策和条例、媒体(印刷和广播)进行内容分析。地区卫生办公室、初级、二级和三级设施的机构人种学，对正式和非正式政治和卫生系统结构的深入访谈，焦点小组讨论和对服务用户的家庭调查，来自举报腐败案件的个人匿名电话/短信的数据。分析还将利用政治经济学，分析行为者、他们的权力及其非正式网络、系统理论，特别是复杂性，并将包括联合制作讲习班和政策对话，以解释和验证调查结果。在尼日利亚，我们将在南部的埃努古州和北部的卡诺州以及每个城市和农村地区工作，在马拉维，我们将选择最多4个区。这些将被选为代表不同人口、需求、成果、资源水平和机构实力的代表。我们将在所有卫生系统级别--与社区组织、区/州以及国家当局--接触，以促进反腐败行动。我们将建立一个实践社区，分享知识，并支持低收入国家的研究人员和实施者--与全球反腐败倡议相联系。

项目成果

Effects of corruption and unaccountability on responses of frontline health workers to COVID-19 in Nigeria: Lessons and considerations for the social work profession.

• DOI: 10.1177/00208728211073391
• 发表时间: 2023-01
• 期刊: INTERNATIONAL SOCIAL WORK
• 影响因子: 2.2
• 作者: Agwu, Prince;Orjiakor, Charles T.;Odii, Aloysius;Onwujekwe, Obinna
• 通讯作者: Onwujekwe, Obinna

Drawing light from the pandemic a new strategy for health and sustainable development (evidence review for the Pan European Commission on Health and Sustainable Development, to inform the work of the G20 and WHO)

从大流行中汲取健康和可持续发展的新战略（泛欧健康和可持续发展委员会的证据审查，为二十国集团和世界卫生组织的工作提供信息）

• 发表时间: 2021
• 作者: McKee MC

The Lancet Nigeria Commission: investing in health and the future of the nation.

• DOI: 10.1016/s0140-6736(21)02488-0
• 发表时间: 2022-03-19
• 期刊: Lancet (London, England)
• 作者: Abubakar I;Dalglish SL;Angell B;Sanuade O;Abimbola S;Adamu AL;Adetifa IMO;Colbourn T;Ogunlesi AO;Onwujekwe O;Owoaje ET;Okeke IN;Adeyemo A;Aliyu G;Aliyu MH;Aliyu SH;Ameh EA;Archibong B;Ezeh A;Gadanya MA;Ihekweazu C;Ihekweazu V;Iliyasu Z;Kwaku Chiroma A;Mabayoje DA;Nasir Sambo M;Obaro S;Yinka-Ogunleye A;Okonofua F;Oni T;Onyimadu O;Pate MA;Salako BL;Shuaib F;Tsiga-Ahmed F;Zanna FH
• 通讯作者: Zanna FH

Public procurement in healthcare systems. Opinion of the Expert Panel on effective ways of investing in Health (EXPH) (the EXPH adopted this opinion at the plenary meeting on 28 April 2021 after public hearing on 3 February 2021)

医疗保健系统中的公共采购。

• 作者: European Commission, Directorate-General For Health;Food Safety, Expert Panel On Effective Ways Of Investing In Health (EXPH)
• 通讯作者: Food Safety, Expert Panel On Effective Ways Of Investing In Health (EXPH)

Memo to the Dean, Faculty of Clinical Science, Bayero University Kano (Nigeria) on the impact of corruption on UHC and the recommended changes to the curriculum of medical students

致尼日利亚卡诺巴耶罗大学临床科学学院院长的备忘录，内容涉及腐败对全民健康覆盖的影响以及对医学生课程的建议修改

• 发表时间: 2021
• 作者: Gadanya M