Opening the Policy Window to Mobilize Action Against Corruption in the Health Sector; Comment on “We Need to Talk About Corruption in Health Systems”

Document Type : Commentary


1 Global Health Policy Institute, San Diego, CA, USA

2 Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, CA, USA


Corruption in the health sector has been a “dirty secret” in the health policy and international development community, but recent global activities point to a day when it will no longer be neglected as a key determinant of health. To further explore next steps forward, this commentary applies the Kingdon’s multiple-streams framework (MSF) to assess what opportunities are available to mobilize the global agenda to combat health corruption. Based on this analysis, it appears that Kingdon’s problem, policy, and political streams are coalescing to create a policy window opportunity that can be leveraged based on recent developments in the global health and international development community around corruption. This includes the recent formation of the Global Network on Anti-Corruption, Transparency and Accountability (GNACTA) led by the World Health Organization (WHO), the Global Fund, and the United Nations Development Programme in 2019. It also includes bridging shared goals of addressing corruption in order to make progress towards health-specific goals in the United Nations (UN) Sustainable Development Goals (SDGs) and for achieving universal health coverage.


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. WHO. The World Health Report:  Health Systems Financing - the path to universal coverage. Accessed February 13, 2019. Published 2010.
  3. Gee J, Button M. The financial cost of healthcare fraud 2015:   What data from around the world shows. Accessed February 13, 2019. Published 2015.
  4. Hanf M, Van-Melle A, Fraisse F, Roger A, Carme B, Nacher M. Corruption kills: estimating the global impact of corruption on children deaths. PLoS One. 2011;6(11):e26990. doi: 10.1371/journal.pone.0026990
  5. Mackey TK, Kohler JC, Savedoff WD, et al. The disease of corruption: views on how to fight corruption to advance 21(st) century global health goals. BMC Med. 2016;14:149. DOI:10.1186/s12916-016-0696-1
  6. Mackey TK, Vian T, Kohler J. The sustainable development goals as a framework to combat health-sector corruption. Bull World Health Organ. 2018;96(9):634-643.
  7. Mackey TK, Kohler J, Lewis M, Vian T. Combating corruption in global health. Sci Transl Med. 2017;9(402):eaaf9547. DOI: 10.1126/scitranslmed.aaf9547
  8. Vian T. Review of corruption in the health sector: theory, methods and interventions. Health Policy Plan. 2008;23(2):83-94.
  9. Mackey TK, Liang BA. Combating healthcare corruption and fraud with improved global health governance. BMC Int Health Hum Rights. 2012;12(1):23. 10.1186/1472-doi:698X-12-23
  10. Gaitonde R, Oxman AD, Okebukola PO, Rada G. Interventions to reduce corruption in the health sector. Cochrane Database Syst Rev. 2016;(8):CD008856. doi: 10.1002/14651858.CD008856.pub2.
  11. Béland D, Howlett M. The role and impact of the multiple-streams approach in comparative policy analysis. Journal of Comparative Policy Analysis: Research and Practice. 2015;18(3):221-227. Doi:10.1080/13876988.2016.1174410
  12. Guldbrandsson K, Fossum B. An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena. Health Promot Int. 2009;24(4):434-444. Doi:10.1093/heapro/dap033
  13. Savedoff W, Glassman A, Madan J. Global Health, Aid and Corruption: Can We Escape the Scandal Cycle? Accessed June 14, 2016. Published 2016.
  14. Micah AE, Zlavog B, Friedman S, et al. The US provided $13 billion in development assistance for health in 2016, less per person than many peer nations. Health Aff (Millwood). 2017;36(12):2133-2141.
  15. G20 Osaka Leaders’ Declaration. Accessed  July 19, 2019.
  16. Corruption in the USA: The difference a year makes. Accessed May 2, 2019. Published 2017.
  17. Homans C. Americans Think “Corruption” Is Everywhere. Is That Why We Vote for It? The New York Times. July 10, 2018. Accessed May 2, 2019.
  18. Kohler JC, Mackey TK, Ovtcharenko N. Why the MDGs need good governance in pharmaceutical systems to promote global health. BMC Public Health. 2014;14:63. Doi:10.1186/1471-2458-14-63
  19. Mackey TK, Nayyar G. A review of existing and emerging digital technologies to combat the global trade in fake medicines. Expert Opin Drug Saf. 2017;16(5):587–602. Doi:10.1080/14740338.2017.1313227
Volume 8, Issue 11
November 2019
Pages 668-671
  • Receive Date: 02 May 2019
  • Revise Date: 19 July 2019
  • Accept Date: 20 July 2019
  • First Publish Date: 01 November 2019