A group of women in Nigeria holding signs that say
caption Credit: The White Ribbon Alliance (CC BY-NC-ND 2.0)

Action on Accountability and Anti-corruption for SDGs

The Action on Accountability and Anti-corruption for SDGs (AAA-SDG) Thematic Working Group (TWG) focuses on increasing the understanding of the drivers of poor accountability and corruption within health systems and the systemic structures that allow it to thrive.

The SDGs provide an opportunity to rethink how health and development goals are achieved. They recognise the importance of effective governance, based on rule of law, as a cross-cutting enabler of development and the achievement of UHC. Governance is multifaceted and includes efforts to design and implement policies, to effectively allocate resources and to foster collaboration among multiple actors. Poor accountability is particularly experienced at the service frontline, disproportionally affecting access and quality of care for the poorest groups.

Advances in accountability and anti-corruption research provide new ways to ensure that major obstacles hindering UHC can be overcome. The recent definition of corruption‘The abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organization or others close to oneself in a way which diverts institutions from their core aims’ – is shifting the attention from individuals to institutions, recognising that unaccountable and corrupt practices are enabled by ineffective systems and political and professional networks. Increasingly, research is highlighting informal practices and norms that shape what solutions are possible.

Evidence on anti-corruption solutions, such as strategies that have achieved clear and sustained results, is scarce. During the Covid-19 pandemic, poor accountability in contracting, safeguarding resources, and politically influenced decisions have constrained responses worldwide. We see a clear shift in the global debate. At HSR2018, there were only a few sessions dedicated to anti-corruption, while at HSR2020, it featured as a subtheme (‘Engaging political forces’) with multiple sessions.

The TWG AAA-SDG will document local strategies and lessons learned, crowdsource successful and novel initiatives to counter these practices, and empower action through collaborations and outreach with a wide range of actors across and beyond the health sector. There is an urgent need for sustained dialogue and this TWG will build on and catalyse strong interest among its membership and constituencies.

Objectives

  • Generate knowledge on the manifestations of poor accountability and corruption across different settings. We will include calls for submission of evidence on AAA to be hosted on an open access repository jointly with WHO ACTA Alliance, supporting members to develop evidence synthesis and sessions with interdisciplinary researchers/practitioners to conceptualise the research agenda and develop funding proposals. Leads: Dr Eleanor Hutchinson and Pamela Ogbozor
  • Promote co-production of novel accountability and anti-corruption strategies that can work in different contexts. We will conduct regional/country-level dialogues to discuss novel AAA strategies, write up ‘success stories’ of what has worked and why, crowdsourcing and story-telling and listening events to showcase experiences at the frontline especially among marginalised communities. Leads: Dr Ankita Meghani and Prince Agnu
  • Support HSG member capacity development. We will hold seminars/podcasts on multi-disciplinary approaches and methods to study accountability and corruption, work with training organisations (e.g., U4) to expand access to training for HSG members (especially women and junior researchers), promote peer mentoring and exchange. Leads: Ms Sarah Steingrüber and Charles Orjiakor
  • Mobilising HSG Members and Constituents for policy engagement and AAA advocacy. We will host webinars/interviews/debates and develop policymaker fora to debate feasible solutions – jointly with WHO ACTA Alliance and Transparency International Global Health Programme, support members support to document and publish experience in AAA. Lead: Jonathan Cushing.

The TWG membership will reach out to diverse communities in the field of health and public policy: researcher organisations; civil society and non-governmental organizations; UN agencies, including the WHO; governments; the private sector; and the media. Specifically, we aim to engage policy actors and will involve early career researchers and members from LMICs; women, from underrepresented communities and regions where HPSR capacity is weaker.

Facilitators

Dina Balabanova

Dina Balabanova

Co-Chair

Obinna Onwujekwe

Obinna Onwujekwe

Co-Chair

David Clarke

David Clarke

Co-Chair

Lindi van Niekerk

Lindi van Niekerk

Coordinator

Dina Balabanova

Dina Balabanova

Co-Chair

Dina Balabanova is a Professor of Health Systems and Policy at the London School of Hygiene and Tropical Medicine, with interests in health systems governance and systems strengthening in LMICs. She leads research exploring institutional, structural and social drivers of health sector corruption — informal payments, absenteeism — and on identifying pragmatic solutions in Bangladesh, Nigeria, Tanzania, Malawi (SOAS ACE & Anti-Corruption Evidence & Accountability in Action). She co-leads work to accelerate HPSR capacity in the Western Pacific Region, and was an HSG board member and TWG on Teaching and Learning HPSR chair (2012-2018).

Obinna Onwujekwe

Obinna Onwujekwe

Co-Chair

Obinna Onwujekwe is medically qualified and has MSc and PhD in Health Economics. He is a Professor of Health Economics, Systems & Policy at the University of Nigeria Enugu. He is the Director of the Nigerian National Centre on Health Systems, which is part of the African Health Observatory Platform (AHOP) on Health Systems. His expertise includes health policy and systems research, especially on issues of governance, accountability and corruption in the health sector. He is part of the SOAS based Anti-Corruption Evidence (ACE) consortium and the LSHTM based Accountability in Action research project.

David Clarke

David Clarke

Co-Chair

David Clarke is from Wellington in New Zealand and is an expert in governance, strategy, law and health policy. He started his career in the public sector working for the New Zealand Ministry of Health, leaving to build a public health consulting company, before moving to Geneva in 2015 to lead the WHO's work on the stewardship of the private sector in mixed health systems, UHC law reform and anticorruption efforts. David is currently Team Leader, World Health Organization, UHC And Health Systems Law, Health System’s Governance and Financing, Lead for the forthcoming ACTA Alliance.

Lindi van Niekerk

Lindi van Niekerk

Coordinator

Dr Lindi van Niekerk (MBChB, MSc) started her career as a clinician working across all levels of the health system in South Africa. Over the last 10 years she has worked in social innovation in health, with projects that included establishing the first public sector innovation lab in Cape Town, leading a multi-partner research study of 25 social innovations across 17 countries and building universities research capacity in Malawi, Uganda, the Philippines and Colombia. Lindi has produced multiple inspirational videos showcasing impactful global health initiatives.

Publications and resources

The authors were delighted to receive 14 responses to their editorial on corruption in health systems and thank the authors for their excellent contributions. It seems that in discussing why health systems researchers are reluctant to discuss corruption, this journal has created a window of opportunity to discuss this neglected topic. Taken together, the responses represent a condensed introduction to the field and key areas of concern.

In health, accountability has since long been acknowledged as a central issue, but it remains an elusive concept. The literature on accountability spans various disciplines and research traditions, with differing interpretations. There has been little transfer of ideas and concepts from other disciplines to public health and global health. In the frame of a study of accountability of (international) non-governmental organisations in local health systems, the authors carried out a meta-narrative review to address this gap.

Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. This article describes a consensus building exercise in which the authors asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector.

The Anti-Corruption Evidence (ACE) research consortium – led by SOAS, University of London - is responding to the serious challenges facing people and economies affected by corruption by generating evidence that makes anti-corruption real and using those findings to help policymakers, business and civil society adopt new, feasible, high-impact strategies to tackle corruption. You can view their publications repository here.

Global and national accountability for maternal, newborn and child health (MNCH) is increasingly invoked as central to addressing preventable mortality and morbidity. Strategies of accountability for MNCH include policy and budget tracking, maternal and perinatal death surveillance, performance targets and various forms of social accountability. However, little is known about how the growing number of accountability strategies for MNCH is received by frontline actors, and how they are integrated into the overall functioning of local health systems. The authors conducted a case study of mechanisms of local accountability for MNCH in South Africa, involving a document review of national policies, programme reports, and other literature directly or indirectly related to MNCH, and in-depth research in one district.

This paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. The authors consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. They present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice.