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Patterson AC. Civil service organization as a political determinant of health: Analyzing relationships between merit-based hiring, corruption, and population health. Soc Sci Med 2024; 348:116813. [PMID: 38581811 DOI: 10.1016/j.socscimed.2024.116813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Abstract
A growing literature finds that the way governments are organized can impact the societies they serve in important ways. The same is apparent with respect to civil service organizations. Numerous studies show that the recruitment of civil servants based on their credentials rather than on nepotism or patronage reduces corruption in government. Political corruption in turn appears to harm population health. Up to this time, however, civil service organization is not a recognized determinant of health and is little discussed outside of political science disciplines. To provoke a broader conversation on this subject, the following study proposes that meritocratic recruitment of civil servants improves population health. To test this proposition, a series of regression models examines comparative data for 118 countries. Consistent with study hypotheses, meritocratic recruitment of civil servants corresponds longitudinally with both lower rates of corruption and lower rates of infant mortality. Results are similar after robustness checks. Findings with regard to life expectancy are more mixed. However, additional tests suggest meritocratic recruitment contributes to life expectancy over a longer span of time. Findings also offer more support for a direct pathway from meritocratic recruitment to population health rather than via changes in corruption levels per se, although this may depend on a country's level of economic development. Overall, this study offers first evidence that civil service organization, particularly the recruitment of civil servants based on the merits of their applications rather than on whom they happen to know in government, is a positive determinant of health. More research in this area is needed.
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Affiliation(s)
- Andrew C Patterson
- Department of Sociology, MacEwan University, Edmonton, AB, T5J4S2, Canada.
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2
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Ahmad NA, Ismail NW, Sidique SFA, Mazlan NS. Air pollution, governance quality, and health outcomes: evidence from developing countries. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:41060-41072. [PMID: 36630041 DOI: 10.1007/s11356-023-25183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM2.5 and CO2 levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies.
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Affiliation(s)
- Nor Asma Ahmad
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kampus Kota, Pengkalan Chepa, 16100, Kota Bharu, Kelantan, Malaysia.
| | - Normaz Wana Ismail
- School of Business and Economics, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
| | - Shaufique Fahmi Ahmad Sidique
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
| | - Nur Syazwani Mazlan
- School of Business and Economics, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
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Glynn EH. Corruption in the health sector: A problem in need of a systems-thinking approach. Front Public Health 2022; 10:910073. [PMID: 36091569 PMCID: PMC9449116 DOI: 10.3389/fpubh.2022.910073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 01/22/2023] Open
Abstract
Health systems are comprised of complex interactions between multiple different actors with differential knowledge and understanding of the subject and system. It is exactly this complexity that makes it particularly vulnerable to corruption, which has a deleterious impact on the functioning of health systems and the health of populations. Consequently, reducing corruption in the health sector is imperative to strengthening health systems and advancing health equity, particularly in low- and middle-income countries (LMICs). Although health sector corruption is a global problem, there are key differences in the forms of and motivations underlying corruption in health systems in LMICs and high-income countries (HICs). Recognizing these differences and understanding the underlying system structures that enable corruption are essential to developing anti-corruption interventions. Consequently, health sector corruption is a problem in need of a systems-thinking approach. Anti-corruption strategies that are devised without this understanding of the system may have unintended consequences that waste limited resources, exacerbate corruption, and/or further weaken health systems. A systems-thinking approach is important to developing and successfully implementing corruption mitigation strategies that result in sustainable improvements in health systems and consequently, the health of populations.
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Affiliation(s)
- Emily H. Glynn
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
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4
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Zhang Y. The Relationship Between Corruption Perception and Depression: A Multiple Mediation Model. Psychol Res Behav Manag 2022; 15:1943-1954. [PMID: 35935461 PMCID: PMC9355336 DOI: 10.2147/prbm.s370045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yujie Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Yujie Zhang, School of International and Public Affairs, Shanghai Jiao Tong University, Huashan Road No. 1954, Xuhui District, Shanghai, 200030, People’s Republic of China, Tel +86-186-9696-0193, Email
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Abu TZ, Elliott SJ. The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya. Health Place 2022; 76:102841. [PMID: 35667223 PMCID: PMC9149240 DOI: 10.1016/j.healthplace.2022.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
Abstract
The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.
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Affiliation(s)
- Thelma Zulfawu Abu
- Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3GI, Canada; Department of Geography, Geomatics and Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3GI, Canada.
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Chen Y, Cui X, Zhuoma J, Zhu F, Luo L, Xie J, Cheng Y. How Employees in a Comprehensive Public Hospital Perceive Corruption Risks: A Survey Study in China. Healthc Policy 2022. [DOI: 10.2147/rmhp.s344782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Vian T. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Glob Health Action 2020; 13:1694744. [PMID: 32194010 PMCID: PMC7170369 DOI: 10.1080/16549716.2019.1694744] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage. Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability. Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector. Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise. Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.
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Affiliation(s)
- Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Gero K, Kim D. Prospective associations between US state-level corruption and individual-level cardiovascular risk factors among middle-aged Americans: The National Longitudinal Survey of Youths 1979. Int J Public Health 2020; 65:1737-1748. [PMID: 33048191 DOI: 10.1007/s00038-020-01497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To estimate the associations between US state-level corruption and risk factors for cardiovascular disease, one of the leading causes of mortality and morbidity in the nation. METHODS We used a US nationally-representative sample of middle-aged adults from the National Longitudinal Survey of Youths 1979 and data from the Corruption in America Survey to estimate the associations between state-level illegal (private gains) corruption and legal (political gains) corruption in 2013 and individual-level risks of incident diabetes, hypertension, obesity, and depression between 2014 and 2016. RESULTS Medium and higher levels of illegal corruption were associated with odds ratios (ORs) of 1.75 (95% CI 1.06-2.88) for incident diabetes and 1.70 (95% CI 1.15-2.51) for incident hypertension, respectively. Furthermore, a higher level of legal corruption was associated with ORs of 1.84 (95% CI 1.08-3.13) for diabetes and 1.58 (95% CI 1.05-2.38) for hypertension. No consistent associations were observed for obesity or depression. CONCLUSIONS Our findings suggest that higher levels of corruption contribute to increased risks of developing diabetes and hypertension. Investing resources into fighting corruption may be means to reduce the national burden of cardiovascular disease.
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Affiliation(s)
- Krisztina Gero
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
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Naher N, Hoque R, Hassan MS, Balabanova D, Adams AM, Ahmed SM. The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of south and south-east Asia. BMC Public Health 2020; 20:880. [PMID: 32513131 PMCID: PMC7278189 DOI: 10.1186/s12889-020-08975-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for 'corruption' in the LMICs of south and south-east Asia region. 'Corruption' works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon. METHODS A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted, using three search engines i.e., PubMed, SCOPUS and Google Scholar. A total of 15 articles and documents on corruption and 18 on governance were selected for analysis. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was filled-in to complete this report. Data were extracted using a pre-designed template and analysed by 'mixed studies review' method. RESULTS Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause. Poor salary and benefits, poor incentives and motivation, and poor governance have a damaging impact on health outcomes and the quality of health care services. These result in high out-of-pocket expenditure, erosion of trust in the system, and reduced service utilization. Implementing regulations remain constrained not only due to lack of institutional capacity but also political commitment. Lack of good governance encourage frontline health care providers to bend the rules of law and make centrally designed anti-corruption measures largely in-effective. Alternatively, a few bottom-up community-engaged interventions have been tested showing promising results. The challenge is to scale up the successful ones for measurable impact. CONCLUSIONS Corruption and lack of good governance in these countries undermine the delivery of quality essential health care services in an equitable manner, make it costly for the poor and disadvantaged, and results in poor health outcomes. Traditional measures to combat corruption have largely been ineffective, necessitating the need for innovative thinking if UHC is to be achieved by 2030.
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Affiliation(s)
- Nahitun Naher
- BRAC James P. Grant BRAC School of Public Health, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Roksana Hoque
- BRAC James P. Grant BRAC School of Public Health, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Muhammad Shaikh Hassan
- BRAC James P. Grant BRAC School of Public Health, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), Room TP 308, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Alayne M Adams
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Cote des Neiges, Room 332, Montréal, Québec, H3S 1Z1, Canada
| | - Syed Masud Ahmed
- BRAC James P. Grant BRAC School of Public Health, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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10
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Kirya MT. Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes. Glob Health Action 2020; 13:1701326. [PMID: 32194012 PMCID: PMC7170355 DOI: 10.1080/16549716.2019.1701326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/03/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers.Objectives: This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems.Methods: The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers.Results: Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes.Conclusion: Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.
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Abstract
Corruption is embedded in health systems. Throughout my life-as a researcher, public health worker, and a Minister of Health-I have been able to see entrenched dishonesty and fraud. But despite being one of the most important barriers to implementing universal health coverage around the world, corruption is rarely openly discussed. In this Lecture, I outline the magnitude of the problem of corruption, how it started, and what is happening now. I also outline people's fears around the topic, what is needed to address corruption, and the responsibilities of the academic and research communities in all countries, irrespective of their level of economic development. Policy makers, researchers, and funders need to think about corruption as an important area of research in the same way we think about diseases. If we are really aiming to achieve the Sustainable Development Goals and ensure healthy lives for all, corruption in global health must no longer be an open secret.
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12
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Witvliet MI. It Will Take a Global Movement to Curb Corruption in Health Systems Comment on "We Need to Talk About Corruption in Health Systems". Int J Health Policy Manag 2019; 8:662-664. [PMID: 31779291 PMCID: PMC6885855 DOI: 10.15171/ijhpm.2019.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
Corruption in health systems is a problem around the world. Prior research consistently shows that corruption is detrimental to population health. Yet public health professionals are slow to address this complicated issue on a global scale. In the editorial entitled "We Need to Talk About Corruption in Health Systems" concern with the general lack of discourse on this topic amongst health professionals is highlighted. In this invited commentary three contributing factors that hamper public dialogue on corruption are discussed. These include (i) corrupt acts are often not illegal, (ii) government and medical professionals continued acceptance of corruption in the health systems, and (iii) lack of awareness within the general public on the extent of the problem. It is advocated that a global movement that is fully inclusive needs to occur to eradicate corruption.
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Affiliation(s)
- Margot I Witvliet
- Department of Sociology, Social Work and Criminal Justice, Lamar University, Beaumont, TX, USA
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Kohler JC. I Know It When I See It: The Challenges of Addressing Corruption in Health Systems Comment on "We Need to Talk About Corruption in Health Systems". Int J Health Policy Manag 2019; 8:563-566. [PMID: 31657180 PMCID: PMC6815984 DOI: 10.15171/ijhpm.2019.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/08/2019] [Indexed: 11/09/2022] Open
Abstract
In this commentary, I argue that corruption in health systems is a critical and legitimate area for research in order to strengthen health policy goals. This rationale is based partly on citizen demand for more accountable and transparent health systems, along with the fact that the poor and vulnerable suffer the most from the presence of corruption in health systems. What is more, there is a growing body of literature on the impact of corruption in the health system and best practices in terms of anti-corruption, transparency and accountability (ACTA) strategies and tactics within the health system. Still, we need to support ACTA integration into the health system by having a common definition of corruption that is meaningful for health systems and ensure that ACTA strategies and tactics are transparent themselves. The 2019 Consultation on a proposed Global Network on ACTA in Health Systems is promising for these efforts.
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Affiliation(s)
- Jillian Clare Kohler
- WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS One 2019; 14:e0220583. [PMID: 31433821 PMCID: PMC6703670 DOI: 10.1371/journal.pone.0220583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022] Open
Abstract
Background Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. Methods Using survey data in adults from 32 sub-Saharan African countries in 2014–2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. Results Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70–4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77–11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. Conclusions We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures—which are needed in many countries to achieve UHC—should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC.
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Affiliation(s)
- Amber Hsiao
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
- * E-mail:
| | - Verena Vogt
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
| | - Wilm Quentin
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
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Mackey TK, Vian T, Kohler J. The sustainable development goals as a framework to combat health-sector corruption. Bull World Health Organ 2018; 96:634-643. [PMID: 30262945 PMCID: PMC6154071 DOI: 10.2471/blt.18.209502] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/27/2022] Open
Abstract
Corruption is diverse in its forms and embedded in health systems worldwide. Health-sector corruption directly impedes progress towards universal health coverage by inhibiting people’s access to quality health services and to safe and effective medicines, and undermining systems for financial risk protection. Corruption is also a cross-cutting theme in the United Nations’ sustainable development goals (SDGs) which aim to improve population health, promote justice and strong institutions and advance sustainable human development. To address health-sector corruption, we need to identify how it happens, collect evidence on its impact and develop frameworks to assess the potential risks and put in place protective measures. We propose that the SDGs can be leveraged to develop a new approach to anti-corruption governance in the health sector. The aim will be to address coordination across the jurisdictions of different countries and foster partnerships among stakeholders to adopt coherent policies and anti-corruption best practices at all levels. Combating corruption requires a focused and invigorated political will, better advocacy and stronger institutions. There is no single solution to the problem. Nevertheless, a commitment to controlling corruption via the SDGs will better ensure the integrity of global health and human development now and beyond 2030.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, San Diego, United States of America (USA)
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Jillian Kohler
- Leslie Dan School of Pharmacy, Dalla Lana School of Public Health, and Munk School of Global Affairs, University of Toronto, Ontario, Canada
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16
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Agyepong IA, Sewankambo N, Binagwaho A, Coll-Seck AM, Corrah T, Ezeh A, Fekadu A, Kilonzo N, Lamptey P, Masiye F, Mayosi B, Mboup S, Muyembe JJ, Pate M, Sidibe M, Simons B, Tlou S, Gheorghe A, Legido-Quigley H, McManus J, Ng E, O'Leary M, Enoch J, Kassebaum N, Piot P. The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa. Lancet 2017; 390:2803-2859. [PMID: 28917958 DOI: 10.1016/s0140-6736(17)31509-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Accra, Ghana; Ghana College of Physicians and Surgeons, Public Health Faculty, Accra, Ghana
| | | | | | | | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nduku Kilonzo
- National AIDS Control Council, Ministry of Health, Nairobi, Kenya
| | - Peter Lamptey
- FHI360, Durham, NC, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | | | | | | | | | - Sheila Tlou
- Regional Support Team for Eastern and Southern Africa, UNAIDS, Johannesburg, South Africa
| | - Adrian Gheorghe
- London School of Hygiene & Tropical Medicine, London, UK; Oxford Policy Management, Oxford, UK
| | - Helena Legido-Quigley
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Edmond Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jamie Enoch
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK.
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17
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Mackey TK, Kohler JC, Savedoff WD, Vogl F, Lewis M, Sale J, Michaud J, Vian T. The disease of corruption: views on how to fight corruption to advance 21 st century global health goals. BMC Med 2016; 14:149. [PMID: 27680102 PMCID: PMC5041569 DOI: 10.1186/s12916-016-0696-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Division of Global Public Health, University of California, San Diego School of Medicine, Department of Medicine, San Diego, CA, USA. .,Global Health Policy Institute, 6256 Greenwich Drive, Mail Code: 0172X, San Diego, CA, 92122, USA. .,WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector, University of Toronto, Toronto, Ontario, Canada.
| | - Jillian Clare Kohler
- WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, Munk School of Global Affairs, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Frank Vogl
- Transparency International, Secretariat, Berlin, Germany.,The Partnership for Transparency Fund, Washington, DC, USA
| | - Maureen Lewis
- Georgetown University, Washington, DC, USA.,Aceso Global, Washington, DC, USA
| | - James Sale
- Transparency International UK, London, UK
| | - Joshua Michaud
- Kaiser Family Foundation, Washington, DC, USA.,Johns Hopkins University School of Advanced International Studies, Washington, DC, USA
| | - Taryn Vian
- Boston University School of Public Health, Boston, MA, USA
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18
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Return Migrants' Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090924. [PMID: 27657096 PMCID: PMC5036757 DOI: 10.3390/ijerph13090924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.
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19
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Mostert S, Njuguna F, Olbara G, Sindano S, Sitaresmi MN, Supriyadi E, Kaspers G. Corruption in health-care systems and its effect on cancer care in Africa. Lancet Oncol 2015; 16:e394-404. [PMID: 26248847 DOI: 10.1016/s1470-2045(15)00163-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 01/09/2023]
Abstract
At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Solomon Sindano
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Mei Neni Sitaresmi
- Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Pediatric Hematology-Oncology Division, Department of Pediatrics, Gadjah Mada University, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, Netherlands
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20
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Thornquist E, Kirkengen AL. The quantified self: closing the gap between general knowledge and particular case? J Eval Clin Pract 2015; 21:398-403. [PMID: 25266335 DOI: 10.1111/jep.12239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/13/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES This paper addresses the movements 'evidence-based' (EBM) and 'personalized' (PM) medicine. The former is being criticized for failing to do justice to clinical complexity and human individuality. The latter aims at tailoring medical knowledge for every patient in a personalized fashion. Instrumental to this effort is the technological development engendering unlimited amounts of data about bodily fragments. The aim of this article is to stimulate a debate about the notion of the body and knowledge in medicine. METHODS An authentic sickness history is used as a vantage point for a more comprehensive account of biomedicine. RESULTS The analysis of the sickness history demonstrates how biomedical logic guided all approaches in the care for this particular patient. Each problem was identified and treated separately, whereby neglecting the interaction between body parts and systems, and between the woman's bodily condition and her experiences. The specialists involved seemed to look for phenomena that fit categories of disorders 'belonging' to their field. These approaches engendered unintended effects: chronification, poly-pharmacy and multi-morbidity, leading to an unsustainable increase in medical costs. CONCLUSIONS The article elucidates how the status that professionals ascribe to the body has vital implications for what they regard as relevant and how they interpret the information they have collected. On this ground, we challenge both the prevailing and tacitly accepted separation between the physical body and human experience and the view of knowledge underpinning EBM and PM. The growing molecularization of the body veils decisive sources of human illness.
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Affiliation(s)
- Eline Thornquist
- Department of Physiotherapy, University College of Bergen, Bergen, Norway; Nesttunhjørnet, Psychomotor Institute, Bergen, Norway
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21
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Witvliet MI, Stronks K, Kunst AE, Mahapatra T, Arah OA. Linking Health System Responsiveness to Political Rights and Civil Liberties. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 45:622-42. [DOI: 10.1177/0020731415585980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Responsiveness is a dimension of health system functioning and might be dependent upon contextual factors related to politics. Given this, we performed cross-national comparisons with the aim of investigating: 1) the associations of political factors with patients’ reports of health system responsiveness and 2) the extent to which health input and output might explain these associations. World Health Survey data were analyzed for 44 countries (n = 103 541). Main outcomes included, respectively, 8 and 7 responsiveness domains for inpatient and outpatient care. Linear multilevel regressions were used to assess the associations of politics (namely, civil liberties and political rights), socioeconomic development, health system input, and health system output (measured by maternal mortality) with responsiveness domains, adjusted for demographic factors. Political rights showed positive associations with dignity (regression coefficient = 0.086 [standard error = 0.039]), quality (0.092 [0.049]), and support (0.113 [0.048]) for inpatient care and with dignity (0.075 [0.040]), confidentiality (0.089 [0.043]), and quality (0.124 [0.053]) for outpatient care. Positive associations were observed for civil liberties as well. Health system input and output reduced observed associations. Results tentatively suggest that strengthening political rights and, to a certain extent, civil liberties might improve health system responsiveness, in part through their effect on health system input and output.
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Affiliation(s)
- Margot I. Witvliet
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanmay Mahapatra
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Onyebuchi A. Arah
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- UCLA Center for Health Policy Research, Los Angeles, California, USA
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22
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Ciccone DK, Vian T, Maurer L, Bradley EH. Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries. Soc Sci Med 2014; 117:86-95. [DOI: 10.1016/j.socscimed.2014.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 06/16/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
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23
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Foubert J, Levecque K, Van Rossem R, Romagnoli A. Do welfare regimes influence the association between disability and self-perceived health? A multilevel analysis of 57 countries. Soc Sci Med 2014; 117:10-7. [PMID: 25016461 DOI: 10.1016/j.socscimed.2014.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/16/2022]
Abstract
Disability is usually associated with poorer self-rated health. However, as many people with disabilities do not consider themselves unhealthy, the association may not be as straightforward as it appears. This study examines whether the relationship between disability and self-rated health is dependent on a country's welfare regime. Welfare regimes can play a significant role in securing the needs of disabled people and lessening their social exclusion. However, welfare regimes also label disabled people accordingly, before they become entitled to specific provisions and services. Being given a low status label and being dependent on welfare provisions might trigger a negative self-evaluation of health. Using data from 57 countries of the World Health Survey of 2002-2004, the multilevel regression analyses show that people with a disability tend to rate their health worse than people without any disability. Moreover, the strength of this negative association varies significantly across countries and is affected by a country's welfare regime. The association is the strongest in the various Welfare State regimes (mostly European countries) and the weakest in Informal-Security regimes (Latin-American and Asian countries) and in Insecurity regimes (African countries). Disabled people living in Welfare States regimes tend to rate their health worse than people in other regimes. These findings confirm that welfare regimes play a role in shaping the health perception of disabled people and that processes of labeling may result in unintended and negative consequences of welfare programs. Research on the nexus between disability and self-rated health that neglects this macro-social context of welfare regimes may lead to undifferentiated and even incorrect conclusions.
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Affiliation(s)
- Josephine Foubert
- Department of Sociology, Ghent University, Korte Meer 3-5, 9000 Ghent, Belgium.
| | - Katia Levecque
- Department of Sociology, Ghent University, Korte Meer 3-5, 9000 Ghent, Belgium; Research Foundation Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium.
| | - Ronan Van Rossem
- Department of Sociology, Ghent University, Korte Meer 3-5, 9000 Ghent, Belgium.
| | - Alessia Romagnoli
- Department of Sociology, Ghent University, Korte Meer 3-5, 9000 Ghent, Belgium.
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24
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Brodwall K. Korrupsjon og helse. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013. [DOI: 10.4045/tidsskr.13.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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