In this project, we ask: How do health systems structures and practices, and informal socio-political and economic structures undermine accountability and encourage corruption at district level, and how can things be improved?

Specifically, we seek to:

1. Understand the different ways that weak accountability and corruption manifest in the financing and provision of care at district and local level and the different actors involved: e.g. informal payments, absenteeism, leakage of health commodities, inappropriate referrals.
2. Identify individual and institutional level drivers of weak accountability and corruption. This will include both formal and informal rule (laws, governance and statutory processes, supervision, but also social, cultural, religious, political and economic networks).
3. Explore how formal institutional structures and rules interplay with informal structures (both within and outside the health system) to impede accountability and sustain corruption:
   
   a) in district management structures,
   b) in provider-patient encounters and
   c) at community level.

Based on the finding from these studies, we will identify openings to implement plausible strategies to address the diverse aspects of weak accountability and corruption that will enable the expansion of coverage. We believe this has to be feasible – taking into account the constrained resources, broader institutional structures and loci of power.