Publication Type: Working Paper
Countries: Working Paper
Authors: Md. Noorunnabi Talukder
Publication date: March 2025
Keywords: Md. Noorunnabi Talukder
Despite progress on several key health indicators, Bangladesh’s health sector remains underfunded, overburdened, and vulnerable to various forms of corruption and abuse. These include illegitimate out-of-pocket expenses, procurement irregularities, absenteeism, the overpricing of medicines and the supply of some lower-quality medicines – all of which continue to significantly undermine universal access to health care.
To promote access to affordable and quality health care for all, and reduce out-of-pocket expenditures on health, a number of development partners – including the now-disbanded United States Agency for International Development (USAID), the UK Foreign, Commonwealth and Development Office (FCDO), SIDA, Global Affairs Canada (GAC), and the European Union (EU) – formed a Development Partner Anti-Corruption Coalition (AC Coalition) to address these goals. In the spring of 2023, a group of concerned actors from these development partners, civil society, and academia came together under the umbrella of the Anti-Corruption Partnership Initiative. This initiative was coordinated by the Swedish Embassy and British High Commission in Dhaka in collaboration with other key development partners in the health sector, the U4 Anti-Corruption Resource Centre, Bangladesh Health Watch, Transparency International Bangladesh (TIB), the SOAS Anti-Corruption Evidence (SOAS-ACE) programme, the World Health Organization (WHO), and the United Nations Office on Drugs and Crime (UNODC).
The purpose of the partnership was to develop and test new ways of working on anti-corruption in the health sector using a combination of: (1) addressing specific problems identified by domestic actors; (2) being guided by the latest evidence and working closely with leading researchers; and (3) developing partnerships and working across silos to build new coalitions to reduce corruption. Several meetings were conducted to consider the research that had been done on anti-corruption in the health sector. After this, development partners selected two thrust areas that drew on research on feasible anti-corruption conducted by SOAS-ACE on the health sector. This research identified feasible strategies of reducing corruption in first, the overpricing of some medicines and the supply of some poor-quality medicines, and secondly, the absenteeism of junior doctors in rural health centres. After an extensive discussion of different corruption problems affecting the health sector, the SOAS-ACE research areas were selected as the most important areas in which prior research suggested feasible solutions. A two-pronged focus for the anti-corruption initiative was agreed:
- The pricing and quality of medicines: This stream targets corruption that affects overpricing of medicines of the supply of low-quality medicines. Both problems are related to shortcomings in certification strategy that allow specific types of corruption. It was agreed this area of work would be coordinated by USAID (lead) and SIDA.
- Health staff absenteeism: This stream aims to reduce absenteeism among health-care staff, in particular junior doctors in rural health clinics, so that poor and marginalised citizens have access to good-quality health care. This area of work was to be coordinated by FCDO (lead) and SIDA.
The AC Coalition decided to work first on the quality and pricing of medicines and then on absenteeism. The USAID, leading the pharmaceutical pricing stream, was deeply engaged in assisting the Directorate General of Drug Administration (DGDA) in Bangladesh, and was engaged in strengthening its testing facilities. This provided a useful entry point for the coalition to focus on pharmaceutical product quality and pricing first. A small Working Group was formed to advance the work on drug pricing. The unexpected departure of USAID from Bangladesh in 2025 was a big setback, but the coalition is continuing its work as the introductory work where USAID introduced the AC Coalition to the DGDA team was initiated before the termination of USAID activities. Work on the absenteeism stream is currently at the planning stage, with ongoing discussions about priority activities.
This report documents the AC Coalition’s activities in relation to the AC intervention from March 2023 till 31 March 2025 (Phase 1). This was a preparatory phase, with initial discussions on the selection of priority areas based on research and the mobilization of the anti-corruption coalition. This tracking and documentation project is a process mapping exercise; it maps the process from ‘research to action’, recording the sequence of activities, decisions, inputs and outputs. It is reflective in approach, recognising the contexts, structures and circumstances that shape the pathways from research to action. The process mapping is recording real-time activity to record how the health intervention is being implemented, which will help to understand the challenges this type of collective action faces and the processes through which this coalition attempted to overcome these constraints. The report is based on maintaining and analysing notes of all meetings and workshops of the AC Coalition and Working Group. These include the proceedings and decisions of high-level meetings with government policymakers.
