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Table 4 Summary of studies exploring different dimensions of ‘corruption’ (n = 15)

From: The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of south and south-east Asia

Author; year [ref] Type of study Settings Themes/sub-themes Findings
Mannan MA; 2013 [29] Survey using both quantitative and qualitative methods Nationally representative sample from seven divisions included 14 district and 28 sub-district hospitals and 28 union hospitals in Bangladesh Informal payment/hospital admission • Informal payments to facility staff (mainly non-technical) hastened the process of getting admission in a public health facility
• About 1/3rd of inpatients in district hospital and 1/5th in sub-district hospitals made an extra payment for getting admission; 8% of them made extra-payments at least three times and occurred more for the poor as they had no connection to or recommendation from influential people
• In FGDs, 50% of the participants said that they made informal payments because they feared that without these extra payments’ they would either receive no treatment at all or would be subjected to neglect/slow treatment.
Paredes-Solís et al.; 2011 [30] Mixed methods South Asia (and Africa and Europe) Informal payment/ impact • It causes disproportionate financial burden to the poor households due to paying for supposedly free services and non-availability of medicines in hospitals
Impact: Thus, dissatisfaction with services ultimately results in gradual decrease in the use of government services over time
Social audits may be an important tool to identify corruption at service delivery points such as informal payments
Lewis M; 2007 [31] Review LMICs Informal payment/ causes and impact • Informal payment is quite common in south/south-east Asia e.g., Pakistan (96%), Bangladesh (60%), India (24%), Cambodia (55%), Vietnam (81%).
Causes: Low pay, irregular salary payments, poor governance and management
Impact: Increases inequity in access to health care services.
Stepurko et al.; 2010 [32] A systematic review of research methods and instruments 39 countries including LMICs Informal payment • Methodologically, self-administered questionnaires were found to be suitable in a face-to-fact interview for collecting information of sensitive nature such as informal payment
Matsushima M & Yamada H; 2016 [33] Cross-sectional study; household survey Ho Chi Minh city and Hanoi, Vietnam Bribery/ causes and impact • Bribery is common in instances such as enrolling members in health insurance schemes, provision of certain services, bypassing queue to reduce waiting time, transfer and posting of choice, taking unlawful leave etc.
• Bribery is negatively correlated with health outcomes and insurance coverage
Causes: Hospital directors’ autonomy regarding staff hire and fire, salary and perks, transfer and promotion etc. health care workers sell services at higher prices
Impact: Increased price of services
Nguyen VH; 2008 [34] Survey Data 36,000 Households in Vietnam Bribery • Social interactions in the form of advice on choice of a hospital for a particular service leads to an increase in the propensity to bribe and the amount of bribe.
Azfar O &Gurgu, T; 2005 [35] Quantitative Survey 1100 households and 160 health workers from 80 municipalities in 19 provinces of Philippines Bribery/ impact • Bribery reduces immunization coverage, delays newborn vaccination, increases waiting time and discourages public health series
Impact: Bribe increase the cost to consumers which reduces demand for services, reduces Government resources allocated to service delivery, affects health outcome in the rural areas
• Affects of corruption vary by region (rural or urban), and also, affects the poor disproportionately
Abdallah W et al.; 2015 [36] IZA discussion paper 12,240 Households in Bangladesh Bribery/ causes and impact • 41% patients pay illegal consultation fees in public sector health facilities; patients who were living further away from the health facilities, were paying more bribe
Causes: Low payment of health care workers and lack of incentives
Impact: Patients have to wait for a long time to get the service, the Quality of Care of services provided was low for non-bribing patients.
Azad A; 2014 [37] Blog (Bangladesh health sector) Survey from 28 health institutions Bribery/impact • Bribe was paid during recruitment of ad hoc doctors, 3rd – 4th class employees, transfer posting from Upazila to capital etc.
• Doctors earned money from commission agreements with diagnostic centers thereby driving up costs of care etc.
Nanjunda;2014 [28] A cross-sectional survey, informal interview, and participant observation 30 selected Community Health Centers (CHCs) in South Karnataka Absenteeism/ causes and impact • Unauthorized absence is more prevalent among doctors (27%), followed by lab technicians (17%) and female nurses (13%); mostly in the afternoon and around weekends (17%); 76% of doctors were engaged in private practices or running their clinics
Causes: More senior health workers having good relationship with higher authority leads absenteeism in the government facilities, lack of sufficient number of staff and residential facilities for doctors and nurses
Ramadhan and Santoso; 2015 [38] Quantitative survey 9 community health centers in Benkulu city, Indonesia Absenteeism/ causes and impact • Unauthorized absence is found to be 26.5% among Doctors, followed by 23% among midwives and 23% among para-medics
Causes: Most of the doctors are living in city areas, and they leave facilities early, especially on the last working day.
Impact: the poor and disadvantaged cannot receive appropriate and timely treatment
Lewis, M; 2006 [39] CGD Brief Report LMICs Absenteeism/ causes and impact • Absenteeism rate among health workers was 19% (Papua New Guinea) to 75% (Bangladesh)
Causes: Low wages and irregular payments of wages forced workers to indulge in additional income-earning activities which causes absenteeism in the government health facilities
Impact: interference in service delivery, both quantitatively and qualitatively
McDevitt et al.; 2015 [40] Anti-corruption Resource Centre Document Bangladesh Absenteeism • Absenteeism rates in primary health care centres in Bangladesh to be as high as 35%
• The regulatory framework for monitoring health service delivery is weak, with 45 separate laws related to various aspects of health
Knox C; 2009 [41] Quantitative survey 5000 household survey in 52 districts govt. facilities in Bangladesh Absenteeism/Negligence • 42% of the patients encountered corruption while accessing services and 43% faced negligence by professionals, disproportionally affecting the poorest disproportionately
Impact: Lack of trust in health care providers and ultimately lesser use of services by the poor and the disadvantaged
Hipgrave and Hort; 2014 [42] Review LMICs of south/south-east Asia Absenteeism/dual practice • ‘Dual practice’ by health professionals is quite common in south/south-east Asia (e.g., in Bangladesh it is cited to be around 80% while in Indonesia from 70 to 80%)
• Poor regulation of dual practice encourages absenteeism and negatively affects access, quality and equity of services provided