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”

Document Type : Commentary


Transparency International (TI), Berlin, Germany


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.


Main Subjects

  1. Hutchinson E, Balabanova D, McKee M. We need to talk about corruption in health systems. Int J Health Policy Manag. 2019;8(4):191-194. doi:10.15171/ijhpm.2018.123
  2. Transparency International Health Initiative. The Ignored Pandemic: How corruption in healthcare service delivery threatens Universal Health Coverage.  Published March 2019.
  3. Ali K. Citizens demand better healthcare in Pakistan — and get it.   Published December 5, 2017.
  4. U4 Helpdesk Answer. Anti-corruption in the health sector in Southeast Asia  December 19, 2018.
  5. Investigation in Cambodia.  Published March 3, 2017.
  6. Transparency International. Global Corruption Report 2006: Why are health systems prone to corruption? by W. Savedoff/K. Hussmann.  Published February  1, 2006.
  7. Hussmann K. U4 Report: Anticorruption policy-making in practice: what can be learned for implementing Article 5 of UNCAC. Bergen: Chr. Michelsen Institute; 2007.
  8. Cochrane Database of Systematic Reviews. Interventions to reduce corruption in the health sector. August 16, 2016. doi:10.1002/14651858.CD008856.pub2
  9. Hussmann K, Rivillas JC. Financial “Blood-letting” in the Colombian health system: rent-seeking in a public health insurance fund. In: Søreide T, Williams A, eds. Corruption, Grabbing and Development: Real World Challenges. Edward Elgar Pub; 2014.
  10. Universidad de Antioquia, Grupo de Economía de la Salud (GES).Caracterización de riesgos y prácticas de corrupción y opacidad, e identificación de niveles de tolerancia a la corrupción en el sistema de salud colombiano.   Published May 2018.
  11. Universidad de Antioquia, Grupo de Economía de la Salud (GES). Recomendaciones de política: en búsqueda de una mayor integridad y transparencia en el sistema de salud colombiano.  Medellin, Colombia: MPS Publicidad; 2018.
  12. Second OGP Plan of Colombia which contains the transparency and accountability commitments of the Ministry of Health in its Pharma Policy.   
  13. Universidad de los Andes. Estudio de caso de las estrategias de transparencia en el sector salud en Colombia.  Published December 2017.
  14. Tackling corruption in the health sector to leave no one behind. WHO website.   
Volume 8, Issue 10
October 2019
Pages 620-622
  • Receive Date: 28 May 2019
  • Revise Date: 14 July 2019
  • Accept Date: 14 July 2019
  • First Publish Date: 01 October 2019