Common corruption risks in the health sector
Decentralization is another vital issue when viewed from a systems perspective. As with financing, the degree of decentralization changes the dynamics of corrupt opportunities and vulnerabilities. Transferring budgetary and organizational tasks to a decentralized level increases local ownership and opportunities for citizen engagement and direct oversight. At the same time, local elites are more likely to get involved, and corruption can arise if the appropriate measures are not in place.
The above analysis illustrates how a structural understanding of conditions (i.e. the specific mechanisms and processes in place regulating the provision, financing and administration of services) is the basis for identifying vulnerabilities to corruption. Whether there are frequent under-the-table payments requested in a hospital has to be investigated on an individual basis. Similarly, decentralization can generate corruption risks and thus is not a “silver bullet” (Hussmann 2011c:18).