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

Document Type : Original Article


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


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.

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

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.

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.


Main Subjects

  1. 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
  2. Transparency International. Corruption perception index 2016. http://transparency.org/news/feature/corruption_perception_index_2016.   Published 2017.
  3. Savedoff WD. Transparency and Corruption in the Health Sector: A Conceptual Framework and Ideas for Action in Latin American and the Caribbean. Washington, DC: Health Technical Note; 2007.
  4. Hutchinson E, McKee M, Balabanova D. Five reasons we aren’t talking about corruption in health systems – and why we need to start. https://www.internationalhealthpolicies.org/blogs/five-reasons-we-arent-talking-about-corruption-in-health-systems-and-why-we-need-to-start/.  Published 2018.
  5. Hoffman LK, Patel RN. Collective Action on Corruption in Nigeria: A Social Norms Approach to Connecting Society and Institutions. London: Chatham House; 2017.
  6. Mooketsane KS, Phirinyane MB. Health governance in Sub-Saharan Africa. Glob Soc Policy. 2015;15(3):345-348. doi:10.1177/1468018115600123d
  7. Onotai L, Nwankwo NC. A review of the Nigerian health care funding system and how it compares to that of South Africa, Europe and America. J Med Med Sci. 2012;3(4):226-231.
  8. Tormusa DO, Idom AM. The impediments of corruption on the efficiency of healthcare service delivery in Nigeria. Online J Health Ethics. 2016;12(1):3. doi:10.18785/ojhe.1201.03
  9. World Bank. New health care model launches in Nigeria to improve women and children’s health. http://www.worldbank.org/en/news/feature/2016/09/23/new-health-care-model-launches-in-nigeria-to-improve-women-and-childrens-health.  Published 2016.
  10. Vian T. Review of corruption in the health sector: theory, methods and interventions. Health Policy Plan. 2008;23(2):83-94. doi:10.1093/heapol/czm048
  11. Transparency International. Corruption perceptions index, 2017. https://www.transparency.org/news/feature/corruption_perceptions_index_2017.  Published 2018.
  12. Kamorudeen A, Bidemi SA. Corruption in the Nigerian public healthcare delivery system. Sokoto J Soc Sci. 2012;2(2):98-114.
  13. Akokuwebe ME, Adekanbi DM. Corruption in the health Sector and Implications for Service Delivery in Oyo State Public Hospitals. Ilorin J Sociol. 2017;9(1):200-217.
  14. World Bank. World Development Indicators 2015. Washington, DC: World Bank; 2015.
  15. Enakhimion IL. Corruption in Nigeria. http://lup.lub.lu.se/luur/download?func=downloadFile&recordOId=2174526&fileOId=2174528.  Published 2011.
  16. Ibenegbu G. What are the problems facing healthcare management in Nigeria? https://www.naija.ng/1104912-what-the-problems-facing-healthcare-management-nigeria.html#1104912.  Published 2017.
  17. 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(1):149. doi:10.1186/s12916-016-0696-1
  18. Dabo N, Rogers D, Tam-Baryoh D, Sesay M. National anti-corruption strategy (Sierra Leone) (2014 -2018). https://psru.gov.sl/sites/default/files/STRATEGY.pdf.  Published 2014.
  19. Khan M, Andreoni A, Roy P. Anti-Corruption in Adverse Contexts: A Strategic Approach. A working paper. https://eprints.soas.ac.uk/23495/.   Published 2016.
  20. Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7(4):466-492. doi:10.1177/002188637100700404
  21. Bloom G, Standing H, Lucas H, Bhuiya A, Oladepo O, Peters DH. Making health markets work better for poor people: the case of informal providers. Health Policy Plan. 2011;26 Suppl 1:i45-52. doi:10.1093/heapol/czr025
  22. Akwataghibe N, Samaranayake D, Lemiere C, Dieleman M. Assessing health workers' revenues and coping strategies in Nigeria--a mixed-methods study. BMC Health Serv Res. 2013;13:387. doi:10.1186/1472-6963-13-387
  23. Onah MN, Govender V. Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective. PLoS One. 2014;9(4):e93887. doi:10.1371/journal.pone.0093887
  24. Hussmann K. Addressing corruption in the health sector: Securing equitable access to health care for everyone. U4 Issue; 2011. http://www.u4.no/publications/addressing-corruption-in-the-health-sector-securing-equitable-access-to-health-care-for-everyone/.  
  25. Amnesty International. At a Crossroads: Sierra Leone’s Free Health Care Policy. London: Amnesty International; 2011.
  26. Onwujekwe O, Dike N, Uzochukwu B, Ezeoke O. Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria. Health Policy. 2010;96(1):72-79. doi:10.1016/j.healthpol.2009.12.014
  27. Chimezie RO. Failure of primary healthcare delivery in Africa. Int J Interdiscip Multidiscip Stud. 2015;2(4):208-215.
  28. Maduke T. Corruption in Health Sectors of Low- and Middle-Income Countries: A report on preliminary findings from a survey of health sector leaders and managers in 95 countries. https://drive.google.com/file/d/1vUsuxDTTZzvVuqj7SDf7k0p1ltOo22fJ/view.  Published 2013.
  29. Stakeholder Democracy Network (SDN). A case study of poor service delivery: Bodo primary healthcare centre and Bodo general hospital, Gokana LGA healthcare in Rivers State, Nigeria. http://www.stakeholderdemocracy.org/stockholm/wp-content/uploads/2015/04/SDN_BODO_REPORT_V1.pdf.  Published 2013.
  30. Nordberg C, Vian T. Corruption in the Health Sector. U4 Issue; 2008. https://www.cmi.no/publications/3208-corruption-in-the-health-sector.  
  31. Akinbajo I. The Massive MDG Fraud: How the health ministry steals from the sick and dying. Premium Times; 2012. https://www.premiumtimesng.com/news/93565-how_the_health_ministry_is_stealing_from_the_sick.html.  Published 2012.
  32. Obi P. FG seeks who support to curb corruption in health sector. This Day; July 11, 2016.
  33. Garuba HA, Kohler JC, Huisman AM. Transparency in Nigeria's public pharmaceutical sector: perceptions from policy makers. Global Health. 2009;5:14. doi:10.1186/1744-8603-5-14
  34. Saka MJ, Saka AO, Isaiaka SB, Abdul FI. Governance and curbing corrupt practices in health care systems in Nigeria. Int Conf Public Manag. 2016;1:1-14.
  35. Osimen GU, Adenegan TS, Balogun A. An assessment of corruption in the public sector in Nigeria: A study of Akure South local government Area, Ondo State. Can Soc Sci. 2013;9(5):87-97.
  36. Oche M, Oladigbolu R, Ango J, Okafoagu N, Ango U. Work absenteeism amongst health care workers in a tertiary health institution in Sokoto, Nigeria. J Adv Med Med Res. 2018;26(2):1-9. doi:10.9734/jammr/2018/40467
  37. Isah EC, Omorogbe VE, Orji O, Oyovwe L. Self-reported absenteeism among hospital workers in Benin city, Nigeria. Ghana Med J. 2008;42(1):2-7.
  38. Khan MH. Beyond good governance: An agenda for developmental governance. In: Sundaram JK, Chowdhury A, eds. Is Good Governance Good for Development? A&C Black; 2012:151-182.
  39. Levy B, Cameron R, Hoadley U, Naidoo V. The Politics and Governance of Basic Education: A Tale of Two South African Provinces. Oxford University Press; 2018.
  40. Levy B. Working with the Grain: Integrating Governance and Growth in Development Strategies. Oxford University Press; 2014.
  41. Ukase P, Audu B. The role of civil society in the fight against corruption in Nigeria’s fourth republic: Problems, prospects and the way forward. Eur Sci J. 2015;11(2):171-195.
  42. Jackson D, Köbis N. Anti-corruption through a social norms lens. https://www.u4.no/publications/anti-corruption-through-a-social-norms-lens.pdf. Published 2018.
  43. Akpomuvie OB. Poverty, access to health care services and human capital development in Nigeria. Afr Res Rev. 2010;4(3):41-55.
  44. Azuh D. Corruption and other challenges facing health care delivery at the grassroots level in Nigeria. State and Society: An Interdisciplinary Journal of the Nigerian Sociological Society. 2012;2(1).
  45. Turay A. Tackling corruption in Sierra Leone’s health sector. http://sierraexpressmedia.com/?p=77540.  Published 2016.
  46. Ciccone DK, Vian T, Maurer L, Bradley EH. Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries. Soc Sci Med. 2014;117:86-95. doi:10.1016/j.socscimed.2014.07.010
  47. Gaal P, McKee M. Informal payment for health care and the theory of 'INXIT'. Int J Health Plann Manage. 2004;19(2):163-178. doi:10.1002/hpm.751
  48. Onwujekwe O, Agwu P, Orjiakor C, et al. Corruption in Anglophone West Africa health systems : a systematic review of its different variants and the factors that sustain them. Health Policy Plan. 2019;34(7):529-543. doi:10.1093/heapol/czz070
Volume 9, Issue 7
July 2020
Pages 286-296
  • Receive Date: 18 July 2019
  • Revise Date: 08 October 2019
  • Accept Date: 27 November 2019
  • First Publish Date: 01 July 2020