Corruption Categories

Corruption is pervasive within healthcare to the extent it has become normalised. From the politician to the patient, corruption is part of doing business in the healthcare sector all over the world.

Research conducted by Transparency International’s Health Initiative (TI-HI) has shown that individuals in the healthcare sector do not always understand what corruption is and how it may undermine their work. Conversely, anti-corruption specialists do not always understand and appreciate the complexity of the health care system. This map – a project that will be kept updated – attempts to bridge that gap by providing for the first time, a comprehensive and accessible guide to a health system and the types of corruption that may occur.

Health systems are particularly vulnerable to corruption for several reasons. Information asymmetry between individuals and groups, susceptibility of the patient, the complexity of the products, and the large sums of money cascading through the health system all play a part. Nor are factors that influence health outcomes limited to changes in health policy and legislation. Trade policies, education systems and nutrition practices all impact directly or indirectly on health.

Some of the experts interviewed have gone so far as to argue that the whole system is broken, as multiple individuals, companies and groups involved in healthcare are placing their private self-interests over wider public health goals. But applying the definition of corruption – the abuse of entrusted power for private gain – is not always straightforward. In health, it may be fair to say that all individuals, companies and groups are entrusted to provide or support the delivery of products or services that healthcare depends on.

Who is ultimately responsible for the health of the global population? When does market failure and waste become corruption? When does criminal activity committed by those who are not “entrusted” become corruption? And when does something that is considered unethical become outright abuse of entrusted power for private gain?

While forms of corruption such as bribery, conflicts of interest and fraud can occur throughout a health system, this map identifies how they specifically occur in different parts of a health system. The 37 identified types of corruption are clustered into eight categories that represent different areas of the healthcare sector. Though these corruption types do not occur in an isolated part of a system – their effects often lead to other types of corruption occurring. For example, a doctor that is encouraged to pay for a promotion may try to offset the cost by demanding bribes from patients. Some corruption types are easy to identify, while others are implicit and more complex.

However, all 37 corruption types have one thing in common – they negatively impact health systems and health outcomes.