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How Big Is The Problem?
USD 1 000 000 000 000(USD 1 trillion) Each year….
6 x Sweden’s Gvt debt 152 x Nicaragua’s public debt
Disposition: What is corruption? (4-6) How to fight corruption at various
levels (7-13) Corruption in procurement (14-16) Corruption in Health Sector (17-18)
interaction with patient (19-20) medical supplies (21-22) resources management (23-25)
What Is Corruption?
• Misuse of entrusted power for private gain (Transparency International)
• Institutions, corporations or individuals obtaining inappropriate gain through their position in operations, thereby causing damage or loss (Sida’s anti-corruption rule)
Examples of Corruption (1)
• Bribes (given and received) But also
• Extortion• Favouritism and nepotism• Conflict of interests
Anti-corruption Work
Four levels:
• Individual officers
• Organisation
• Structures of the country
• Global development/initiatives
Individual Officers
• Public Administration Acts• Organisational rules• Systems for internal control • Organisational atmosphere
• (including examples, incentives, sanctions)
In The Organization• Assessment of capacity and risk of corruption
• Mitigate risks (in procurement and monitoring mechanisms: reporting, audit, information to target group)
• Extra audits (not just financial/regularity)
• Take action
Structures of Country (1)• Financial management systems
- plans (revenue forecasts, medium term)- budgets- international control- payment systems- revenue (tax, customs, etc)- accounting- audit- parliament’s scrutiny
Structures of Country (2)
• - statistical systems
- cadastre
- police, prosecutors and courts
- ombudsmen
- election processes incl. political parties
- anti-corruption commissions
- decentralisation processes
• Corruption studies and support to anti-corruption strategies
• Independent media • Watchdog organisations (TI local chapter)
Structures of Country (3)
Global Development• Ratification and implementation of UN:s anti-
corruption convention, • Regional convention (Convención Interamericana
Contra la Corrupción), • OECD regulations, etc• Support to international organisations, methods
development, lobbying(www.transparency.org)
(www.corisweb.org)
Where Corruption Occurs in The Procurement
Process
• Decision to procure• Specifications in tender documents• Access to tender documents• Qualification of tenderer• Evaluation of tenders• Award decision• Contract negotiation and design• Contract administration/implementation
Preventing Corruption In Contracting (1)
• Controls can be expensive, ineffective and/or too late
• No single solution for a complex problem
- Laws and Institutions
- Education/training
- Access to information by media, watchdog
NGOs
- Codes of Ethics
• Based on transparency- Facilitate monitoring and participation- Encourage accountability
• Integrity pacts, publish what you pay• OECD Convention- illegal bribing of foreign
officials• Increase risk of detection and “cost” if caught• Change of attitudes
Preventing Corruption In Public Contract (2)
Corruption in Health Sector - Causes and consequences
Imbalance in information High degree of discretion Low productivity without
accountability Decentralisation without
monitoring Vulnerability
Health worker/patient interaction - problems
Informal payments Private practices/self-referral Training/accreditation Health care fraud Conflict of interest
Health worker/patient interaction - actions
Salaries Official user fees Accountability, improved
management Code of ethics Access to information Voice based strategies
Management of medical supplies - problems
Availability Registration of drugs Drug selection Procurement Distribution/misappropriation
Management of medical supplies - actions
Regulatory authorities/procedures List of essential medicines WHO principles Inventory control
Resources management - problems
Budget process Lack of accountability Budget leakages Multiple/large funding Promotion
Resources management - actions
Improved systems Budget transparency, participation Decentralisation Privatisation Tracking resource flows WHO ethical guidelines Information campaigns
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