Whistleblowing as an anti-corruption strategy in health and pharmaceutical organizations in low- and middle-income countries: a scoping review

Untangling the corruption maze: exploring the complexity of corruption in the health sector

BACKGROUND

Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels.

OBJECTIVE

The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures.

METHOD

We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility.

FINDINGS

Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services.

CONCLUSIONS

The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.

Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: A scoping review and thematic analysis

PROBLEM

Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited.

BACKGROUND

Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures.

AIM

To identify and synthesise available literature addressing the experiences of healthcare professionals enacting whistleblowing in maternal and newborn care settings.

METHODS

This scoping review followed Arksey and O'Malley's framework. Five academic databases were systematically searched for documents published between January 2013 and October 2023 with additional searches of Google Scholar and related reference lists.

FINDINGS

Whilst 35 papers from international sources were identified, the majority originated from the United Kingdom, where recent high-profile incidents have occurred. Thematic analysis identified three main themes: 'Structural Power', 'Perfectionism' and 'Bravery, Hope and Disappointment', each with sub-themes.

DISCUSSION

Whistleblowing is frequently an altruistic act in a hierarchical system. It exposes poor practices and disrupts power dynamics, especially in challenging workplace cultures. Open disclosure, however, requires psychological safety. Obstacles persist, emphasising the need for a culture of trust and transparency led by individuals who embody the desired values.

CONCLUSION

Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.

Positive Effect of Narcissism on Employees' Whistleblowing: The Role of Felt Accountability and Ethical Environment

Purpose

This study aims to develop a model to explore the effect of narcissism on whistleblowing through felt accountability and to examine the moderating role of organization's ethical environment on this relationship.

Methods

The study was a two-wave study involving MBA students. Two surveys were distributed to individuals who work full time at two different times (roughly two weeks apart). A total of 261 individuals completed both questionnaires. Hierarchical linear regression analyses were conducted using SPSS 22.0 to test the hypotheses.

Results

The results supported the prediction that felt accountability mediates the positive relationship between narcissism and whistleblowing. The findings also showed that the indirect effect of narcissism on whistleblowing through felt accountability was stronger when individuals perceived organizational environment to be unethical.

Conclusion

The study contributes to our understanding of the bright side of narcissism by combining it with research on whistleblowing and explicates how and when narcissistic individuals engage in whistleblowing.

Differences of corruption types in selected Western and central-eastern health systems during the COVID-19 pandemic: a rapid review

Objectives

To identify, describe, and classify the cases of health corruption present in selected Western [the Netherlands and the United Kingdom (UK)] and Central-Eastern European (Poland and Slovakia) countries during the COVID-19 pandemic.

Methods

A rapid review of the literature was conducted, evaluating data from 11 March 2020 to 15 April 2021. Information sources included MEDLINE via WoS, IBSS via ProQuest, Scopus, and gray literature.

Results

Thirteen cases were identified across the four countries. The primary type of health corruption in Western European countries was procurement corruption, while misuse of (high) level positions was the most prevalent in Central-Eastern European countries. Actors from central governments were most involved in cases. The rule of law and anti-corruption watchdogs reported most cases in the United Kingdom and the Netherlands, while the media reported cases in Poland and Slovakia.

Conclusion

The differences in types of corruption in WE and CEE countries emphasize the need to contextualize the approach to tackle corruption. Thus, further research in preventing and tackling corruption is a vital and necessary undertaking despite the inherent of conducting health corruption research.