Corruption can cause healthcare deprivation: Evidence from 29 sub-Saharan African countries

Abstract

The WHO estimates that nearly half of the world’s population lacks access to essential healthcare, and that the proportion of the population with catastrophic out-of-pocket health spending (10% or more of the household budget) is on the rise. Meanwhile, the United Nations’ General Assembly has recently identified corruption as a vital factor undermining efforts to accomplish universal health coverage. We examine how corruption may lead to healthcare deprivation in the context of 29 sub-Saharan African countries, employing the fifth, sixth and seventh waves of the Afrobarometer survey spanning 2011–2018. Applying an instrumental variable framework, we find that the experience of corruption in the form of bribe payments as well as the frequency of bribe payments within the healthcare sector increases the likelihood of healthcare deprivation. Moreover, corruption experienced in other sectors, such as education, the police, public utilities and identification authorities, have spill-over effects affecting healthcare deprivation adversely. Further analysis reveals that the experience of corruption in multiple sectors simultaneously worsens healthcare deprivation. Our findings suggest that mitigating corruption in the healthcare sector alone may not be sufficient to end the adverse effect of corruption on effective healthcare access in SSA countries. Finally, through mediation analysis, we show that loss of income and loss of trust are two channels through which corruption influences healthcare deprivation.