International Journal of Health Policy and Management

International Journal of Health Policy and Management

Where Do We Start? Building Consensus on Drivers of Health Sector Corruption in Nigeria and Ways to Address It

Document Type : Original Article

Authors
Obinna Onwujekwe 1, 2
Charles T. Orjiakor 1, 3
Eleanor Hutchinson 4
Martin McKee 4
Prince Agwu 1, 5
Chinyere Mbachu 1, 6
Pamela Ogbozor 1
Uche Obi 1, 6
Aloysius Odii 1, 7
Hyacinth Ichoku 1, 8, 9
Dina Balabanova 4
1 Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
2 Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
3 Department of Psychology, University of Nigeria, Nsukka, Nigeria
4 London School of Hygiene and Tropical Medicine, London, UK
5 Department of Social Work, University of Nigeria, Nsukka, Nigeria
6 Department of Community Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
7 Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nigeria
8 Department of Economics, University of Nigeria, Nsukka, Nigeria
9 Veritas Universit, Abuja, Nigeria
10.15171/ijhpm.2019.128
Abstract
Background
Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector.

 
Methods
We employed three sequential activities. First, a narrative literature review identified which types of corruption are reported in the Nigerian health system. Second, we asked 21 frontline health workers to add to what was found in the review (based on their own experiences) and prioritise them, based on their significance and the feasibility of assessing them, by means of a consensus building exercise using a Nominal Group Technique (NGT). Third, we presented their assessments in a meeting of 25 policy-makers to offer their views on the practicality of implementing appropriate
measures.

 
Results
Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, underthe-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. Frontline workers and policy-makers agreed that tackling corrupt practices requires a range of approaches.

 
Conclusion
Corruption is recognized in Nigeria as widespread but often seems insurmountable. We show how a structured approach can achieve consensus among multiple stakeholders, a crucial first step in mobilizing action to address corruption.
Keywords
Health Sector Corruption
Nigeria
Nominal Group Technique
Priority Setting
Subjects
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International Journal of Health Policy and Management
Volume 9, Issue 7
July 2020
Pages 286-296

  • Received Date 18 July 2019
  • Revised Date 08 October 2019
  • Accepted Date 27 November 2019
  • First Published Date 01 July 2020
  • Published Date 01 July 2020