This study will identify the nature, drivers and effects of corruption practices in the pharmaceutical procurement units in tertiary hospitals. In particular, we will look at horizontal interventions that could be used to address the issue of corrupt practices. Our enquiry will be guided by a subset of questions:
- How are the current systems of procurement in tertiary hospitals designed and implemented by the pharmaceuticals procurement unit?
- In what ways are the procurement of pharmaceuticals guided by essential medicines lists and data generated from end users of drugs (patients)?
- What are the expected and actual roles and responsibilities of different actors within the pharmaceutical units of hospitals on procurement of pharmaceuticals?
- Are systems in place to monitor and ensure adherence to the pharmaceutical procurement process in the hospitals?
- What interventions have been implemented to improve accountability and decrease corruption in the procurement of pharmaceuticals in Nigeria?
The cost of procuring pharmaceutical products – especially medicines – represents a major share of public health spending. At the same time, the significant financial resources and the nature of players (ministries and bureaucracies, powerful businesses) involved in pharmaceutical procurement makes the process susceptible to corrupt practices. Such corruption in the public sector can potentially lead to cost escalations without a commensurate improvement in health outcomes.
In tertiary hospitals in Nigeria, as also found in most pharmaceutical procurement systems, there are multiple actors with crucial roles in the logistic cycle, each with its own utility-maximising objectives that may diverge from the objectives of maximising societal welfare, strengthen the health system and achieve Universal Health Coverage. The actors include the procurement officers, the pharmacists in the procurement unit, medical doctors, store keepers, clerical officers, accountants, audit, directors, sales representatives, and other key top management staff within the ministries of health and individual teaching hospitals. The for-profit actors are in constant bid to make extra revenues and promote their products in such a manner such that they will have an edge over their competitors marketing similar products, thereby having a monopoly in the sector.
Our research will provide evidence-based insights on the nature and drivers of corruption within the procurement units of tertiary hospitals that are required to understand the enabling factors that lead to corruption in the procurement of pharmaceuticals in tertiary hospitals, determine the causal connections of these factors and how they interact to exacerbate corruption in the procurement of pharmaceuticals.
The study will generate new knowledge on opportunities that could be used by actors to improve the procurement process within the procurement units of tertiary hospitals in a way that would reduce corruption, be efficient and resilient.
Obinna Onwujekwe, Aloysius Odii, Charles Orjiakor, Divine Obodoechi, Chukwudi Nwokolo C (Health Policy Research Group, University of Nigeria); Eleanor Hutchinson, Martin Mckee and Dina Balabanova (London School of Hygiene and Tropical Medicine); Pallavi Roy (SOAS University of London)