Action on Accountability and Anti-corruption for SDGs

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.