Potential corruption risks in health financing arrangements: Report of a rapid review of the literature

Introduction and purpose: Corruption in health financing poses a significant risk to the achievement of universal health coverage and the health-related targets of the Sustainable Development Goals. Corruption in health systems not only wastes limited public resources and/or development funds allocated to the health sector, but also limits population access to goods and services, undermines citizens’ trust in governments and causes health services to deteriorate. Poor and marginalized populations typically suffer the most from the consequences of corruption in health systems. Accordingly, anti-corruption, transparency and accountability measures are central components of health systems strengthening for universal health coverage. Such measures are also critical for upholding the right to health. The purpose of this rapid literature review is to identify potential corruption risks in relation to health financing. It also seeks to illuminate anti-corruption, transparency and accountability measures that may be helpful in reducing the risk of corruption in health financing. Methods: A rapid literature review was conducted to provide an evidence-base on areas at risk of corruption in the core health financing functions of revenue raising, pooling (within the broader context of public sector management), benefit design and purchasing. Search terms were limited to the English language and informed by WHO publications on health financing and universal health coverage. Experts in health financing and corruption provided inputs on the literature, structure and content of the review. An initial pool of 185 articles was screened for relevance, of which 112 articles were summarized and included in the literature pool. Additional articles were added following suggestions from peer reviewers, resulting in a total of 125 articles and documents in the final paper. A rapid review is limited in that its process gives preference to research that is easily retrievable and, therefore, some bias is necessarily embedded in the methodology. As this review is targeted to specific search terms, it is limited insofar as it does not address all of the core issues related to corruption risks in health financing, including absenteeism, petty theft and other types of public sector abuse. Findings: The studies highlight how health financing arrangements may be at risk of corruption. In the area of revenue raising, embezzled funds and charging of informal payments for health services are identified risks. In the area of pooling, the studies emphasize weak budget management and poor record keeping as issues that may allow corruption, such as the embezzlement of pooled funds. In the area of purchasing, the procurement process stands out as being particularly vulnerable to corruption; for example, fraud may be found in provider billing mechanisms. Lastly, in the area of benefit design, conflicts of interest, lack of transparency in the selection of medicines for national/ institutional formularies, and overly complex benefit systems can make health systems more vulnerable to corruption. Conclusions: To reduce the risk of corruption in health financing arrangements, the literature recommends anti-corruption, transparency and accountability measures including: ensuring adequate funding to health systems; enhancing transparency and accountability; raising awareness; improving monitoring and oversight; integrating anti- corruption, transparency and accountability into health financing diagnostics and policy; and finally, building effective accountability mechanisms. Such measures will reduce the likelihood of corruption in health financing arrangements and help to strengthen health systems towards universal health coverage.World Health Organizatio