General corruption risk approaches applicable to the health sector Overview of actors
Tools to analyze at the environmental level: Risk Map and Value Chain Analysis
| Area or process | Types of corruption and problems | Results |
| Construction and rehabilitation of health facilities | Bribes, kickbacks and political considerations influencing the contracting process Contractors fail to perform and are not held accountable | High cost, low quality facilities and construction work Location of facilities that does not correspond to need, resulting in inequities in access Biased distribution of infrastructure favouring urban-and elite-focussed services, high technology |
| Purchase of equipment and supplies, including drugs | Bribes, kickbacks and political considerations influence specifications and winners of bids Collusion or bid rigging during procurement Lack of incentives to choose low cost and high quiality suppliers Unethical drug promotion Suppliers fail to deliver and are not held accountable |
High cost, inappropriate or duplicative drugs and equipment Inappropriate equipment located without consideration of true need Sub-standard equipment and drugs Inequities due to inadequate funds left to provide for all needs |
| Distribution and use of drugs and supplies in service delivery | Theft (for personal use) or diversion (for private sector resale) of drugs/suppliest at storage and distribution points Sale of drugs or supplies that were supposed to be free |
Lower utilization Patients do not get proper treatment Patients must make informal payments to obtain drugs Interruption of treatment or incomplete treatment, leading to development of antimicrobial resistance |
| Regulation of quality in products, services, facilities and professionals | Bribes to speed process gain approval for drug registration, drug quality inspection, or certification of good manufacturing practices Bribes or political considerations influence results of inspections or suppress findings Biased application of sanitary regulations for restaurants, food production and cosmetics Biased application of accreditation, certification or licensing procedures and standards |
Sub-Therapeutic or fake drugs allowed on market Marginal suppliers are allowed to continue participating in bids Increased incidence of food poisoning Spread of infectious and communicable ediseases Poor quality facilities continue to function Incompetent fake professionals continue to practice |
| Education of health professionals | Bribes to gain place in medical school or other pre-service training Bribes to obtain passing grades Political influence, nepotism in selection of candidates for training opportunities |
Incompetent professionals practicing medicine or working in health professions Loss of faith and freedom due to unfair system |
| Medical research | Pseudo-trials funded by drug companies that are really for marketing Misunderstanding of informed consent and other issues of adequate standards in developing countries |
Violation of individual rights Biases and inequities in research |
Risk Map: Key Areas (Vian 2008a: 85)
Two additional tools, The Risk map, and Value Chain Analysis; illustrate how a CRA can be conducted on an environmental level. Depending on the framework, the tools can also be used for analyzing at the organizational level.