How we did it
This project aims to increase the awareness and understanding of corruption in the healthcare sector. Information collected from a literature review, key informant interviews, and a survey with healthcare professionals was used to identify the main corruption types in the healthcare sector and provide contextual information on the profile for each type.
The map of corruption in the healthcare sector identifies 37 types of corruption that are present in health systems worldwide. These corruption types are organised into eight categories that represent different areas of the healthcare sector. A corruption type is placed in the category in which it is most likely to appear, though some corruption types may be applicable to other categories. For example, the corruption type improper inducements to healthcare professionals is placed in the marketing category, but can apply to purchasing decisions that are covered in the procurement category.
Each corruption type has a definition and explanatory text. For each category, explanatory text, a podcast, and case studies offer an overview of corruption and topical issues in that area. Additional resources are referenced to enable users to explore each category in more detail.
The process for identifying and exploring corruption types consisted of the following phases:
- An initial study conducted in 2015 provided the basis of the research. The pharmaceuticals & healthcare sector value chain was mapped to provide a framework of corruption categories, which was supported by key pieces of literature. Corruption types were then organised into the corruption categories based on an analysis of 228 media reports using desk-based research.
- A detailed literature review of existing research on corruption in healthcare. This included books, journal articles, papers published by international organisations and NGOs, as well as media articles. The literature review yielded an overview of the research and practitioner literature on corruption types in the healthcare sector. This was used to identify key corruption types and add to the explanatory text of each type.
- Thirty interviews were conducted July – September 2016 with healthcare experts. Experts were selected from each world region to ensure responses provided a broad global perspective. They included compliance directors at pharmaceutical companies, national investigators of healthcare fraud and corruption, and specialist doctors. All discussed their personal and professional experiences of corruption and commented on the structure of the corruption map. Interviews were conducted either face-to-face or by phone. Experts were offered the opportunity to participate anonymously. The interviews provided: information for use in the corruption types’ explanatory text; feedback on the structure and utility of the map; and information and specific case studies for use in the podcasts.
- An online, anonymous survey was made available to healthcare professionals worldwide. It asked healthcare professionals about their experiences of corruption in the healthcare sector and was distributed through email exchange networks, social media, and the Guardian Healthcare Professionals Network. The survey was online from 1/08/16 to 01/10/16. Responses from 138 individuals were received from 37 countries, from all world regions. Doctors were by far the most common respondent type and comprised nearly half of the responses received. The survey provided general findings to support the inclusion of corruption types in the project.
The intention is to update this map and the constituent corruption types, following further research at the global and national levels.
A common question from experts interviewed for the project was how to apply the definition of corruption in the healthcare sector. Transparency International defines corruption as the abuse of entrusted power for private gain. In the healthcare sector, corruption negatively impacts health outcomes at both the individual and population levels. As most groups in the sector are responsible for conducting services or providing products that improve health outcomes, this definition can be applied broadly. Thus, a major task in this project has been to explore the application of corruption in the healthcare sector.
