Presentation on theme: "Defining Corruption: cultural aspects in health workers: ethical aspects and dimensions Global Gerecht Gesund Berlin, September 17, 2010 Sylvia Sax, RN."— Presentation transcript:
1 Defining Corruption: cultural aspects in health workers: ethical aspects and dimensions Global Gerecht Gesund Berlin, September 17, 2010Sylvia Sax, RN BSN MPHDoctoral StudentInstitute Public Health, University of Heidelberg
3 Pakistan: Country Profile Area 796,096 sq KmMultiethnic & linguistic diversity4 provinces & 2 territoriesPopulation ~ 145 millionHistory: Rich cultural heritage+ natural & human resourcesProductive agriculture sectorStrategic trade locationPer capita income: US$Literacy rate: 38.9%Population doubling time: 25 yearsExpenditure on health: 0.7% GNP70-80-% of health expenditure is onhuman resources33% urban
4 ResearchCase Study of North West Frontier Province, Pakistan (Khyber Pakhtoonkhwa)Health Services QualityContextual factors that influence mechanisms for quality improvementQualitative and Quantitative methods
5 Nurses station in a district hospital Dust at base of tapNo soapNo hand towelsNo guideline for washing handsNo waterAre there issues of quality in the health services?And there were no sinks with these commodities near this ward
9 Key Health System Issues Critical shortage of health service providersBut not sure of the numbers (3 doctors/1 nurse)External and internal brain drain (rural & donor)Urban/rural discrepenciesIncreasing reliance on paramedicals and ‚ward boys‘Weak regulatory frameworkLimited registration of health facilities and providers with lack of regulatory mechanismsProfessional groups weak influence on membersCorruptionPolitical interference in transfers and postingsPrivate medical schools proliferating without transparent processesYoung graduates without supervision, private medical schools proliferating without clear standards, curricula etc., 1/3 of the nursing curricula is now focused on English language
10 The darker the red – the higher the corruption perception index
11 Ease of Corruption in the Health Sector Uncertainty about what services should be delivered and at what level of qualityInvolvement of private and public actors like payers, providers, suppliers, consumers, and regulatorsAsymmetric information among different actors and their individual interestsExtent to which private providers are entrusted with important public rolesAdapted from Savedoff 2006
12 CorruptionThe abuse of entrusted power for private gain (Transparency International)according to rule- corruption where payments/bribe is paid to receive preferential treatment for something that the bribe receiver is required to do by law.Against the rule- where a bribe is paid to obtain services that the bribe receiver is prohibited from providing.IMF and World Bank define corruption as misuse or abuse of public force (office) for private gainUsually has to do with moneyUsually involves individuals focused on profit
13 SifarishIn our research we consistently heard about the practice of Sifarish (patronage, nepotism, favouratism)Most interviewees identified Sifarish as a system, with specific practices which are not described or prescribedThose who reported on Sifarish usually described harmful results of the practice
14 Culture and Corruption Variations of levels of Corruption may bedue in part to variations in the socialnorms and preferences that have beeninternalized by the citizens of thatcountry( Barr & Serra 2006)
15 Sifarish – a moral system? It is a moral system which is accepted andthose participating are often not aware of thepracticeMorality can be defined as: a system of rules for guiding human conduct, and principles for evaluating those rules.Individual acts within a cultural and social systemEven modern management recognizes that persuasion and influence are needed to get results and encourage managers to develop these skills. But Sifarish is not a skill that can be honed, learned or developed it is part of a cultural and moral system.
16 If Sifarish is not recognized as part of the moral fabric of the cultural system andunderstood as such-then, how can we develop tools whichwill maximize accountability andtransparency?
17 What can we do?Recognize that it is a social norm, a pattern in society and not simply an individual actInclude transparent discussion of the different kinds of acts and their resultsDiscuss the concept of harm to society and encourage research on not only corruption but also related topics such as Sifarish1. get rid of the shame and blame,Recognize corruption as a practice, get away from the more abstract concepts, focus on the detailsEncourage research – increase research and training health researchers to enable gathering of evidence in specific contexts on local practices that can harm society
19 Selected ReferencesBarr A. & Serra D Culture and Corruption. Global Poverty Research Group accessed on 21 June, 2010Nichtar, S Corruption: the need-greed equation. News International, Islamabad, December 09.Savedoff WD The causes of corruption in the health sector: a focus on health care systems. In: Transparency International. Global Corruption Report 2006: Special focus on corruption and health. London: Pluto Press.Taryn Vian, 2008, Review of corruption in the health sector: theory, methods and interventions. Health Policy and Planning, Vol. 23, ppTaryn Vian, 2002, Corruption and Health care Sector. Transparency international: Sectoral prospective of corruption, pp 1-35Transparency International :http://www.transparency.org/ accessed on 19th February 2010