The Malawian and Nigerian governments are working hard to achieve universal health coverage but both are struggling to find ways to establish systems that can ensure accountability in their health systems and root out corruption. In this project we will work closely with those on the frontline of the health system, listening carefully to their experiences, and working with them to develop measures that can bring about lasting change.
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 thinks be improved?
We are a group of researchers from London School of Hygiene and Tropical Medicine, University of Malawi, University of Nigeria and Options with a long-term interest in health system governance, corruption and accountability. Our team members have expertise in different disciplines and thematic areas: health systems research, public health, ethnography, economics and journalism. We are particularly interested to go beyond the conventional approaches and find out what makes a difference in ensuring health system delivery accessible and equitable services. This sometimes involves finding consensus-based solutions or designing disruptive strategies. Our ultimate objective is to make a difference.
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:
- 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.
- 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).
- 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.
Fascinating talk by Ryan Jablonski and Seim Brigitte in the video below. Hosted by Accountability In Action project, moderator Dina Balabanova
We launched the project virtually and engaged with our country networks in Nigeria and Malawi but also in Africa. We also connect with key global constituencies active on corruption and anti-corruption.
Read our flyer by the project team
Dr. Jablonski and Dr. Seim presents the results of a study designed to rigorously measure drug diversion using long-range and short-range GPS trackers and to test a low-cost, highly efficient anti-theft intervention. They show evidence of limited delivery-based diversion but high rates of post-delivery diversion. The intervention - a monitoring message attached to drug cartons - did not have an effect on diversion. Preliminary evidence indicates the intervention was noticed and remembered, but did not change perceptions of risks of engaging in drug theft.
Read more about the Policy Forum on Malawi on our Updates page.