Lessons from reducing bribery in Uganda’s health services

Abstract

AbstractMotivationBribery is common in Uganda’s health sector, with an estimated one in four Ugandans who engage with the sector being asked to pay a bribe for services in 2010. Health workers in the public sector are badly paid, while significant numbers of well‐trained health workers emigrate to find better‐paid work. However, between 2010 and 2015, estimated rates of bribery halved in Ugandan health services.PurposeWhy did bribery in Uganda’s health service fall so much in the 2010s? What does this mean for anticorruption research and practice?Approach and methodsIn addition to reviewing relevant literature and documents, in‐depth semi‐structured interviews with service providers, users and experts were conducted in Uganda’s Central, Eastern and Western provinces.FindingsThe establishment of the Health Monitoring Unit (HMU) in 2009 has been a major factor in reducing bribery. It used highly visible, often controversial investigations based on a principal–agent approach to anticorruption. Its approach, however, also led to negative unintended consequences, including undermining morale among frontline health providers and probably also citizens’ trust in health services. It is moreover questionable if the HMU’s approach can be sustained.Policy ImplicationsTo tackle frontline bribery effectively and sustainably, and so enhance service delivery, anticorruption interventions must consider the underlying functions and needs—such as compensating frontline staff for low wages—that bribery may help fill. Otherwise controls on corruption may result in more harm than the good they do in reducing corruption.