Good governance and corruption in the health sector: lessons from the Karnataka experience

Abstract

Strengthening good governance and preventing corruption in health care are universal challenges. The Karnataka Lokayukta (KLA), a public complaints agency in Karnataka state (India), was created in 1986 but played a prominent role controlling systemic corruption only after a change of leadership in 2001 with a new Lokayukta (ombudsman) and Vigilance Director for Health (VDH). This case study of the KLA (2001-06) analysed the:Scope and level of poor governance in the health sector; KLA objectives and its strategy; Factors which affected public health sector governance and the operation of the KLA. We used a participatory and opportunistic evaluation design, examined documents about KLA activities, conducted three site visits, two key informant and 44 semi-structured interviews and used a force field model to analyse the governance findings. The Lokayukta and his VDH were both proactive and economically independent with an extended social network, technical expertise in both jurisdiction and health care, and were widely perceived to be acting for the common good. They mobilized media and the public about governance issues which were affected by factors at the individual, organizational and societal levels. Their investigations revealed systemic corruption within the public health sector at all levels as well as in public/private collaborations and the political and justice systems. However, wider contextual issues limited their effectiveness in intervening. The departure of the Lokayukta, upon completing his term, was due to a lack of continued political support for controlling corruption. Governance in the health sector is affected by positive and negative forces. A key positive factor was the combined social, cultural and symbolic capital of the two leaders which empowered them to challenge corrupt behaviour and promote good governance. Although change was possible, it was precarious and requires continuous political support to be sustained.

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…119 Corruption is an important area to address in any recommendations for the future of health in Africa. 120,121 Tackling corruption in the health sector requires a stronger stance from sub-Saharan governments and local health leaders that translates beyond rhetoric and into implementation. The governments of high-income countries and other donors also need to do the same.…”

Interventions to reduce corruption in the health sector

“…The other four were from Germany, India, Kyrgyzstan and South Korea (Germany 2008; India 2001-2005; Kyrgyzstan 2001-2010; South Korea 2007). …”

“…The included studies considered the following types of interventions: dissemination of information (Germany 2008); improved detection and enforcement (South Korea 2007; USA 1994-1998); establishment of an independent agency and improved detection and enforcement (India 2001-2005; USA 1993-2001; USA 2005-2014); and increased transparency and accountability (Kyrgyzstan 2001-2010; USA 2002-2006; USA 2006). …”

“…The studies reported outcomes that included: physicians' attitudes (Germany 2008); number of complaints received and convictions (India 2001-2005); informal payments (Kyrgyzstan 2001-2010); overbilling (false or fraudulent claims) (South Korea 2007; USA 1993-2001); hospital utilisation, health outcomes and healthcare expenditures (USA 1994-1998); pharmaceutical company spending on gifts (USA 2002-2006); reports of fraud (USA 2006); money recovered from false or fraudulent claims, return on investment, new cases investigated, convictions, individuals and entities excluded from billing, and estimated programme savings (USA 2005-2014). …”

“…The other three studies lacked both a comparison group and data from before the intervention (India 2001-2005; USA 2002-2006; USA 2005-2014). …”