Health providers in Bangladesh

Corruption, provider practice, motivation and health system performance in Bangladesh

Summary

Health systems in many countries create incentives for health workers to engage in corrupt practices that lead to inappropriate and ineffective care, leading to high costs and poor outcomes for those in need of care.

The corruption issue

We know that the health care that people receive in many countries is far from ideal. There are many reasons for this but one is that even the most committed health workers often face insuperable barriers to providing the care that their patients need while, at the same time, the incentives created by the health system encourage them to adopt responses that benefit themselves but harm the patient. Many of these involve the use of public resources for private gain. Some of the most obvious examples include diverting patients to private facilities owned by the health worker, charging informal fees, and theft of medicines and equipment. Others are less obvious, such as recommending unnecessary treatment for which the health worker is remunerated. In others, the health worker is gaining by depriving the system of their time, for example by being absent from work even though they are being paid to be there. Consequently, these practices fall within our definition of corruption in the health sector.

Theory of Change

  • IF we can identify and implement policies and practices that remove the incentives for ineffective and inappropriate health care (specifically absences from work, diverting patients to private facilities, informal charging, under- and over-treatment), which can be financial (e.g. higher and better targeted pay, performance-related bonuses, other benefits) and non-financial (e.g. improved training and working conditions),
  • THEN patients will receive better and more appropriate care,
  • BECAUSE the research will uncover policy combinations that work effectively in the specific political context by disincentivising poor practice.

Research methods

Scoping literature review, policy analysis, qualitative study, survey of up to 400 providers including discrete choice experiment (DCE) and open-ended vignettes methods to understand the choices made by health providers, given a series of hypothetical anti-corruption strategies.

Main partners 

The London School of Hygiene and Tropical Medicine (LSHTM) and James P Grant School of Public Health (JPGSPH) of BRAC University.