This is a guest blog post by NS Prashanth, one of the Emerging voices, on corruption in health service delivery – an endemic problem in many LMICs. We hope this will spark a vital discussion. See for his personal blog.

Corruption and hypocrisy ought not to be inevitable products of democracy, as they undoubtedly are today

-Mahatma Gandhi

Some things are better assumed and neglected, than acknowledged and attended to. In public health research, these often find a passing mention in Discussion section where findings are explained, and worse still, may be as a contextual element. Prime among this is corruption. Corruption in health services is nothing new. Perhaps merely a sub-set of the general corruption prevalent in administration of public services, the corruption in health is much more than merely a contextual element to be taken into consideration in planning and implementing health programmes. Nor is it merely a feature that may explain some of the poor health outcomes that we often find. Corruption is directly, causally linked to poor health service delivery. We KNOW this and we SEE it. Yet, when I read several reports and documents at national and global levels, there is an obvious glossing over of this feature – as if this is some minor itch that governments will eventually get to.

In writing this comment to the Lancet, I had the privilege of partnering with somebody who has led a tirade against corruption in health services in my state, Karnataka in South India. As a chairman of a government appointed committee on health care for our state, he took a bold and courageous step in putting corruption as the main problem that the health services ail from. As I describe in the comment, this led to a long chain of events including the strengthening of the Lokayukta, an ombudsman institution that helps uncover corruption.

Yet, this is not enough! Over a decade of very active ombudsmen in Karnataka have not achieved much beyond making corruption a public issue. It continues to parasitise the reforms and innovations that we so fondly and techincally design for health systems strengthening. Of what use is a good HR policy if people accept money for transfers? Of what benefit is drug price control orders if there is collusion among officials and companies for mutual benefit at the cost of the system?

I really do not know what it is – lack of evidence? lack of resolve? In fact, I wonder sometimes, if corruption is a feature of the system or a bug?

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4 Responses to The truth that dare not speak its name : Corruption in health services in LMICs

  1. Kristof Decoster says:

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