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      Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them


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          West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.

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          Most cited references 40

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          Review of corruption in the health sector: theory, methods and interventions.

           Taryn Vian (2008)
          There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and various aspects of management, financing and governance. Behavioural scientists and anthropologists also point to individual and social characteristics which influence the behaviour of government agents and clients. This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalizations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.
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            Making health markets work better for poor people: the case of informal providers.

            There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.
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              World Development Indicators 2015


                Author and article information

                Health Policy Plan
                Health Policy Plan
                Health Policy and Planning
                Oxford University Press
                September 2019
                04 August 2019
                04 August 2019
                : 34
                : 7
                : 529-543
                [1 ] Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria , Enugu-Campus, Enugu, Nigeria
                [2 ] Department of Health Administration and Management, University of Nigeria , Enugu-Campus, Enugu, Nigeria
                [3 ] Department of Social Work, University of Nigeria , Nsukka, Nigeria
                [4 ] Department of Psychology, University of Nigeria , Nsukka, Nigeria
                [5 ] Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place , London WC1H 9SH, UK
                [6 ] Department of Community Medicine, College of Medicine, University of Nigeria , Enugu-Campus, Enugu, Nigeria
                [7 ] Department of Sociology, University of Nigeria , Nsukka, Nigeria
                [8 ] Department of Economics, University of Nigeria , Nsukka, Nigeria
                Author notes
                Corresponding author. Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Nsukka, Nigeria and Department of Social Work, University of Nigeria, Nsukka. E-mail: prince.agwu@ 123456unn.edu.ng
                © The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 15
                Funded by: SOAS Anti-Corruption Evidence
                Funded by: ACE 10.13039/100005362


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