Anti-corruption Evidence (ACE) research team on health, comprising the Health Policy Research Group (HPRG), University of Nigeria; London School of Economics (LSE), and the School of Oriental and African Studies (SOAS) converged at Abuja on 24th April, 2018. The meeting aimed at putting together ideas from a Nominal Group Technique (NGT) workshop in ranking corrupt practices in the health sector of Nigeria. 34 frontline health workers were drawn from Abuja and Enugu as participants.
Commencing the meeting is Prof. Obinna Onwujekwe who stated the modus operandi of the workshop, and a light overview of the ACE project. Dr. Palavi took the floor thereafter explaining in details Anti-Corruption Evidence. Her presentation captured the vertical and horizontal enforcement of anti-corruption efforts. She listed the sectors that are being covered by ACE to include: health, power, textile, fertilizer, rice smuggling and media. She reflected on the rule of law idea and how corrupt practices have impeded successful application of the rule of law across various countries.
Dr. Palavi did not fail to capture gaps that exist, which have clamped on the success of anti-corruption efforts. Featuring prominently is the politicization of anti-corruption institutions. More so, she added that powerful institutions and people have gone ahead to initiate informal rules and practices that contravene formal laws and regulations. Given that these informal rules and regulations are perpetuated by powerful organizations and persons, they have turned out to becoming norms. Hence, vertical and horizontal enforcement of anti-corruption efforts have increasingly become difficult, since the rule of law has moved away from what should be formal to what is informal. Thus, even those who wish not to be corrupt find themselves being corrupt because of much informalities that have characterized the system.
Dr. Palavi quickly touched on the absence of communication of anti-corruption efforts. A case in point is the recent national anti-corruption strategy which those at the grass-root are not in the know of. So, ACE has come up with a design to understand prominent drivers of corrupt practices. Ideas from here will influence anti-corruption efforts that are politically acceptable and technically feasible. This design would cut across all other sectors that are of interest to ACE. Following a reaction from one of the participants on Dr. Palavi’s presentation regarding influencing legalities and policies, Dr. Palavi responded – “we are researchers and we lack the capacity to change legalities and policies, but we have donors like the World Bank, WHO, among others, who can influence legalities and policies”.
The floor was taken next by Associate Professor Dina who tried to highlight the interest of the research team in areas of corruption. She failed not to mention that corruption is obtainable across developed and developing nations, but more pernicious in developing countries because of their economic indices and inequities. Prof. Obi came up next to give a summary of the systematic literature review done by the ACE team on 67 studies. Five main types of corruption where spotted, ranging from absenteeism, theft, inappropriate referrals, informal payments and procurement corruption. He highlighted the effects of corruption as well as mitigation strategies. For the effects, heightened loss of lives and the impossibility of attaining Universal Health Coverage were at the very fore. For mitigation, improvement of transparency, adopting reliable ICT measures, enforcing anti-corruption rules and regulations and improving work incentives and salaries of health workers were spotted to be key. Areas for further research were suggested.
Dr. Eleanor took the floor to facilitate the ranking section for corrupt practices involving health workers. The ranking system produced 49 ranks of corrupt practices which health workers engage. Later on, these 49 corrupt practices will be voted on to understand the 5 dominant and prevalent ones (absenteeism, procurement related issues, under the counter payments, health financing and employment related corruption) respectively. Much later, arguments were made to buttress impressions on found corrupt practices. Issues of procurement, impersonation, inappropriate prescription, leadership to foster right conducts and favouritism/nepotism were at the front burner. From the 5 ranks, one of the participant stated under-the-table-payments was picked to be very pressing and should be prioritized. Another went for favoritism/nepotism as systemic and a driver of items in the ranks. Again, a participant picked under-the-table-payments too, followed by employment irregularities for the sake of protecting competence. In addition, a participant stated that improving the health insurance coverage will help curb under-the-table-payments. He went further to state that procurement irregularities are of more concern to him. However, he stated that it will be very difficult to curb this because of the too many hands in the pipe. A participant suggested a digital clocking system to curb absenteeism, while instituting rewards and sanctions for well doers and defaulters.
The last ranking was taken toward the close of the meeting to identify the most important from the working 5 ranked items as listed above, with absenteeism, under the table payments, employment irregularities, health financing and procurement related corruption appearing respectively in the hierarchy.
Written by the ACE TEAM