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The #FundNaijaHealth campaign brought together key stakeholders in Lagos State, Nigeria, to advocate for increased MNH budget allocation and transparency

Understanding and eliminating health sector corruption impeding UHC at district level in Nigeria and Malawi: institutions, individuals and incentives 

We explore how formal and informal structures and practices in health systems interact with the socio-political context to undermine accountability and encourage corruption in Malawi and Nigeria, and ask how to overcome them.

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Our project in essence

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.

Our approach

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?

About us
About us Understanding and eliminating health systems 2 columns
About us Understanding and eliminating health systems 2 columns paragraph
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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. 

Our approach
Our approach Understanding and eliminating health systems 2 columns
Our approach Understanding and eliminating health systems 2 columns paragraph
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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. 

Who we are
Team Block

Dina
Balabanova

Associate Professor
Project Lead

Eleanor
Hutchinson

Assistant Professor
Lead for ethnography and qualitative research

Martin
McKee

Professor
Lead for quantitative research

Marleen Vellekoop

Options Consultancy Services/Lead North Nigeria/accountability
Publications and resources
Publications and resources Understanding and eliminating health systems corruption
Journal papers
Beyond Talking: We Need Effective Measures to Tackle Systemic Corruption and the Power That Allows It to Persist in Health Systems; A Response to Recent Commentaries.
Hutchinson E, Balabanova D, McKee M.
2019
Int J Health Policy Manag 2019, 8(4), 191–194
Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them
Onwujekwe O, Agwu P, Orjiakor C, McKee M, Hutchinson E, Mbachu C, Odii A, Ogbozor P, Obi U, Ichoku H, Balabanova D
2019
Health Policy Plan. 2019 Sep 1;34(7):529-543.
We Need to Talk About Corruption in Health Systems.
Hutchinson E, Balabanova D, McKee M.
2018
Int J Health Policy Manag. 2018;8(4):191-4
How Do Nigerian Newspapers Report Corruption in the Health System?
Abba-AjiI M, Balabanova D, Hutchinson E, McKee M
Int J Health Policy Manag 2020 (published online)
Working papers
Exploring health-sector absenteeism and feasible solutions: evidence from the primary healthcare level in Enugu, South East Nigeria
Onwujekwe O, Odii A, Agwu P, Orjiakor C, Ogbozor P, Hutchinson E, McKee M, Roy P, Obi U, Mbachu C and Balabanova D.
2019
SOAS ACE Working paper 0014, Sept 2019
Corruption in the health sector in Anglophone West Africa: Common forms of corruption and mitigation strategies
Onwujekwe O, Agwu P, Orjiakor C, Mbachu C, Hutchinson E, et al. and Balabanova D.
2018
SOAS ACE Working paper 005, Sept 2018
Strengthening accountability for better health outcomes through understanding health-system bottlenecks: insights from Tanzania.
Mamdani M, Kweka H, Binyaruka P, Ramesh M, Kapologwe N, Hutchinson E, Balabanova D, Andreoni A.
2018
SOAS ACE Working paper 008, Nov 2018
Corruption in the health sector in Anglophone West Africa: Common forms of corruption and mitigation strategies.
Onwujekwe O, Agwu P, Orjiakor C, Mbachu C, Hutchinson E, Odii A, Obi U, Ogbozor A, Ichoku H, McKee M, Balabanova D.
2018
SOAS ACE Working paper 005, Nov 2018
Blogs
Tackling COVID 19 in Uganda: private medicine outlets at the frontline
Hutchinson, E. Mbonye, AK. Mundua, S. Ochero, L. Clarke, S. Balabanova, D. Hansen, K. Kitutu, F
2020
Updates
Updates List Block
Project launch, June 2020

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