Health providers in Bangladesh

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.

Health care that people receive in many countries is far from ideal. One reason 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 – corruption. 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.

Our research aimed at identifying policies and practices that remove financial and non-financial incentives for ineffective and inappropriate health care, specifically absences from work, diverting patients to private facilities, informal charging, and under- and over-treatment. Research methods included a 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.

SOAS-ACE is currently undertaking research in Bangladesh and Nigeria, including in the education, health and power sectors, as well as on successful collective action that overthrew a corrupt autocracy. Moving beyond pure research, we are also monitoring the implementation of anti-corruption strategies our research has recommended, such as a strategy to reduce pharmaceutical companies’ overpricing of medicines.

Our partners on this project were the London School of Hygiene and Tropical Medicine (LSHTM) and James P Grant School of Public Health (JPGSPH) of BRAC University.