There is no one-size-fits-all solution to eradicating corruption
. A society is less vulnerable to corruption when there is rule of law, transparency, trust, and strong accountability mechanisms
. Anti-corruption measures must be tailored to each community and country’s needs, political context, and health care system
Preventative measures against corruption can include procurement guidelines, inspection for quality of medical technologies and drugs, codes of conduct for individuals, institutions and industries, and transparency and monitoring procedures
Study participants called for policies that would deter corrupt behaviors.
“We need to lobby the government to change the attitude towards theft [in the health care setting]. And if we can exclude theft [in the hospitals], we can then tell the government with certainty we used all [the supplies] we have, that it wasn’t enough, and we need more for legitimate reasons and not because staff is stealing.” [Health care professional]
 describes three phases in overcoming corruption. First, raising awareness through education of the public, and of decision and policy makers. Second, conducting analyses of points most vulnerable to corruption. Last, determining what prevention strategies would be most effective. To prevent corruption that hinders access to orthopaedic care and medical devices, several mechanisms might need to be developed.
Reducing incentives of corrupt practices by health care workers
Corrupt behaviors such as absenteeism, theft, fraud, and acceptance of bribes and informal payments have been shown to decrease when health care professionals are paid decent wages proportional to their education, skills and training
. Governments can also reduce the occurrence of corruption by monitoring payment schemes, adopting codes of conduct
, increasing the role of community committees and public scrutiny, and performing analyses of and providing report cards for public services are suggested mechanisms
Anti-corruption strategies in the pharmaceutical and medical device industries
The corruption literature identifies several strategies for preventing corrupt behaviors in the pharmaceutical sector. These could also be applied to the medical device industry and include:
Criteria for selection and pricing based on global standards (eg WHO)
Professional and public scrutiny of device selection committees
Transparent, written, explicit procurement criteria
Media publication of tender results
Industry codes of conduct
Licensing and inspection of pharmaceutical and medical device suppliers
Of particular concern in Uganda is that all medical devices and drugs for the public health system must be procured and distributed through the government’s National Medical Stores. This system is vulnerable to corruption. The government is the sole regulator. If improperly used or controlled this could enable corruption, whereas if properly used and managed it can discourage corruption. Clarification of chains of authority and accountability processes should be encouraged to ensure ethical business practices
Strategies for improving transparency
The literature on corruption in health care and participants of the Ugandan case study both call for effective mechanisms for improving accountability and transparency in the health sector. The 2006 Global Corruption Report from Transparency International suggested several immediate strategies
. Transparency could be improved with regular publishing of information on health budgets and performance at the national, local and health delivery center levels; independent audits of health funds, coordination of international donor support to the health sector with regular evaluations of their programs in terms of health outcomes, and not level or speed of disbursement. There could also be mechanisms for implementing public oversight of government policies, practices and expenditures. Improved transparency and accountability will ideally discourage embezzlement, theft of medical equipment, and fraud and bribery among government officials, law enforcement officers and health care workers.
Strategies for creating and implementing codes of conduct
Codes of conduct for health care workers, government officials and industry are required to define appropriate practice in the health care sector, and to deter or punish corrupt behaviour. Codes of conduct should be implemented and promoted through continued training and enforcement
. These codes should make explicit reference to preventing corruption and conflicts of interest
. Codes of conduct will be meaningless however, if health care workers are not being paid a fair living wage for their work
Governments should introduce whistleblower protection for individuals in procurement bodies, health authorities, health service providers and suppliers of medicines and equipment
. Pharmaceutical and medical device companies should do the same. Corrupt practices by individuals, government or industry should be punished, and where relevant these actors should be excluded from participation in future tendering processes with the government
. Conversely, good behavior should be rewarded and publicized
Reducing incentives for corruption through alternative funding of the health care budget
With a limited health care budget, hospitals and the governments are susceptible to corruption. The participants’ suggestions of innovative strategies for funding orthopaedic care may provide new opportunities for financing health care that promote better transparency and accountability.
“We could put a levy on fuel and vehicles, as drivers and riders are those most involved in road traffic crashes. This money would go directly into orthopaedics for implants and other [OMDs], for salaries to increase motivation and increase the working hours, and for improved call coverage to sustain a 24hour operating theatre.” [Health care professional]
“We can use profits from private surgeries in government hospitals to raise funds for public care. Public hospitals can generate their own money through a private wing.” [Health care professional]
These innovative funding strategies may not in themselves prevent corruption, but if coupled with improved accountability and transparency, significant progress can be made.