Toward a new framing of corruption in health systems in LMICs: what questions should we be asking?

Abstract

Abstract Understanding and addressing corruption is critical for equitable and socially just development, and is therefore central to the realisation of the SDGs including the creation of responsive and trusted heath systems. Some conventional definitions of corruption do not reflect the complex reality in LMICs. Corruption is often conflated with poor governance, weak accountability or inefficiency but each manifestation has different structural and institutional causes, triggers and so requires different strategies to address it. 'Survival corruption' can be an informal coping strategy, other forms are manifest as reciprocal social exchanges within networks which may benefit wider groups of people and mask or contain health system dysfunctions. A proposition is made that we ask new questions that move away from a focus on the individual transaction towards locating it within health system and societal contexts that ultimately consider power and individual actor motivation.