Strengthening Integrity in Africa’s Health Systems

Corruption in health systems is a major barrier to equitable healthcare, reducing access to essential services, wasting public resources, eroding trust in institutions, and deepening gender and social inequalities.

This policy brief presents findings from Corruption Risk Assessments conducted in the Democratic Republic of Congo, Ghana, Madagascar, Rwanda, and Zimbabwe through the Inclusive Service Delivery in Africa (ISDA) project. The assessments reveal significant integrity challenges across procurement, medicine supply chains, workforce governance, and frontline service delivery, undermining the right to health for millions of people. Women, girls, persons with disabilities, and other marginalised groups are disproportionately affected, highlighting the impact of corruption on progress towards Sustainable Development Goals 3 (Good Health and Well-being) and 16 (Peace, Justice and Strong Institutions).

Read Strengthening Integrity in Africa’s Health Systems

The evidence demonstrates how corruption directly affects the availability, affordability, and quality of healthcare. Across the five countries, audits and assessments identified missing medicines, procurement irregularities, weak oversight mechanisms, stock shortages, and failures in supply chain accountability. These findings mirror broader trends across Africa, where billions of dollars are lost annually to health-sector corruption. Women and girls, who are the primary users of reproductive, maternal, and child health services, often bear the greatest burden when medicines are diverted, informal payments are demanded, or services become inaccessible. Corruption also contributes to poor health outcomes through bribery, absenteeism, procurement fraud, and other forms of misconduct that weaken already strained health systems.

Addressing these challenges requires comprehensive reforms that strengthen transparency, accountability, and public participation. The policy brief recommends improving access to procurement information, introducing digital systems to track medicines and payroll, strengthening anti-corruption oversight and whistle-blower protections, and supporting the active involvement of women’s groups and communities in monitoring service delivery. By combining technical reforms with visible integrity measures such as open contracting, civic oversight, and digital traceability, governments can reduce opportunities for corruption, rebuild public trust, and ensure that health resources reach the populations that need them most. Without sustained action, inequities in healthcare access will persist and progress towards universal health coverage will remain out of reach.