Accountability in action: fighting corruption in Malawi and Nigeria

Across the world, too many people are still unable to access affordable and high-quality health care. But even though the challenges governments face in overcoming a lack of resources are similar, the quality of health services in some countries is much better than in others.

One reason for better performance of health sectors in some countries is better governance, with transparent decision making and systems that prevent corruption. But often, there are few mechanisms that allow health care providers and governments to be held to account for their actions, and far  too little is known about what works in the fight against corruption. This creates opportunities for corruption which disproportionately affects the poor, who do not have the power to demand change. And if we don’t know what works, countries will struggle to deliver on their commitments to roll out universal access to healthcare and achieve the Sustainable Development Goals.

This 3-year research project, which is funded by UK Research and Innovation’s Health Systems Research Initiative, will help us gain insights into factors that drive corruption in district health systems in Nigeria and Malawi and how these can be addressed. The research is led by the London School of Hygiene and Tropical Medicine in collaboration with the University of Nigeria (Enugu Campus) and the University of Malawi, who will gather data and analyse findings in both countries with support from Options.

We have brought together a multi-disciplinary team of researchers and practitioners to ask four questions:

• How do weak accountability and corruption affect how people experience health care in districts, such as informal payments, absenteeism, leakage of health commodities, or inappropriate referrals?
• What drives corruption? What are its formal drivers: rules, laws, governance and statutory processes, supervision, and informal drivers: social, cultural, religious, political, and economic networks?
• How do social and institutional relationships (networks) relate to accountability and corruption?

Answers to these questions will help to identify ways to tackle corruption in health systems in different contexts.

Our findings will feed into government, donor and civil society strategies designed to strengthen accountability and reduce corruption. We will engage with people at every level of the health system, including with community organisations, districts, and state as well as national authorities. Knowledge gained through the research will support researchers and implementers linked to global initiatives in low- and middle-income countries, building a community of practice to combat health sector corruption.