Health Providers in Nigeria
What could work to curb health sector corruption and improve health outcomes?
Corruption is common across different levels of the health sector in Nigeria, and a major barrier to achieving universal health coverage. This project seeks to identify the most common and damaging forms of corruption, establish why they occur, and to assess a range of approaches to help reduce corruption in healthcare delivery and its impacts on health outcomes for Nigerian citizens.
Achieving the Sustainable Development Goal 3 of Universal Health Coverage is hampered in many countries by widespread health sector corruption. This project aims to identify the patterns of corruption among frontline public health providers and their managers in Nigeria, and explore the underlying determinants – systemic and individual factors - that give rise to corrupt behaviours. It will synthesize available evidence on the impact of corruption on users of health services and identify and assess the potential of accountability measures, including recent reforms, to constrain corrupt practices among frontline public health providers and their managers. Finally, it will make recommendations towards a more resilient, efficient and accountable health system.
The project methodology uses 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.
From the literature review and workshops with health providers and policy makers, we found that absenteeism, diversion of patients to private clinics, inappropriate prescribing, informal payments/bribery and theft of drugs and supplies were the top five corruption problems in the health sector. In addition, absenteeism was identified as the most prevalent type of corruption, as well as the type of corruption that was most feasible to address: to improve healthcare outcomes, policy-makers could therefore focus first on strategies to address absenteeism, particularly in rural areas. Further recommendations on the most effective ways to work with health workers to address absenteeism will follow.
Pallavi Roy (SOAS University of London), Obinna Onwujekwe (University of Nigeria Nsukka), Dina Balabanova and Eleanor Hutchinson (LSHTM), Prince Agwu, Aloysius Odii, Pamela Ogbozor and Charles Orjiakor (University of Nigeria Nsukka).