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Anticorruption Strategies and Tools

Rwanda. Anticorruption Strategies and Tools. Casals & Associates, Inc. Taryn Vian, Boston University. Nature of Corruption Causes, Vulnerabilities; sound technical analysis—depoliticizes the problem Political Will Stakeholders. Champions Risks Likely Opposition Timeline.

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Anticorruption Strategies and Tools

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  1. Rwanda Anticorruption Strategies and Tools Casals & Associates, Inc. Taryn Vian, Boston University

  2. Nature of Corruption Causes, Vulnerabilities; sound technical analysis—depoliticizes the problem Political Will Stakeholders Champions Risks Likely Opposition Timeline Designing an AnticorruptionStrategy

  3. Anticorruption Tools

  4. Increase Awareness Assessments of corruption vulnerabilities Procurement Informal payments/service delivery Drug leakage Generate information about costs of corruption in the health sector Surveys: perception, victimization, costs Publicize results; encourage public debate Media Campaigns

  5. Power of Data National cost of corruption survey in Mexico PET en Uganda Measured problem, Government convinced to act Publicized budgets at local level Decreased leakage from 78% in 1996 to 18% in 2001

  6. Vulnerability Scores in Four Countries (WHO 2006) 0.0-2.0 = extremely vulnerable; 2.1-4.1 = very vulnerable; 4.1-6.0 = moderately vulnerable; 6.1-8.0 = marginally vulnerable; 8.1-10.0 = minimally vulnerable WHO/PSM/PAR/2006.7, p. 7

  7. Prevention and Detection Controls and Audit Procurement Reform Bureaucratic Simplification Transparent Budgeting Health Management Information Systems Social auditing and complaints Regulatory reform

  8. Complexity of medicines supply in Kenya

  9. Transparency and Access to Information Type of Disclosure Means of Disclosure Information Discloser Recipient Duty…Trust Employee Client/Patient Donor Civil Servant Manager Facts and Figures Mechanisms and Processes Justification for Decisions

  10. Health Management Information SystemsDistrict Health Planning and Financial Management System in South Africa

  11. Internal Controls Network Cash registers in Kenya • Registers gave receipts of transactions • Possibility to track resources • Lower opportunities to cheat • Resulted in 47% increase in revenue after 3 months

  12. Compiled monthly drug procurement price data starting in 1996 (ended in 1998) Highlighted highest & lowest price paid, fed info back to hospitals Prices fell 12% After 3 months, prices climbed back, but never to pre-1996 levels Transparency of Medicines in Argentina

  13. Procurement Reform • Standards and technical specifications quoted in bidding documents should be generic to promote competition • Specifications should be based on relevant characteristics and/or performance requirements. • Transparency and public disclosure of information • System for addressing complaints • Citizen participation in the system

  14. Integrity Pacts Ecuador • The NGO community wanted to be involved in the oversight of the project • To provide effective review during the process, the government entered into an Integrity Pact with the local chapter of Transparency International • TI hired international consultants that advised the stakeholders, helping the NGO community to become effective watchdogs The procurement actions surrounding the project were deemed to be fair and transparent by all the parties involved In 1999, Ecuador built a major Dam system. The project had a budget of over 300 million USD

  15. WHO and Health Action International, 2002 Developed methodology for collecting and analyzing prices of medicines, affordability, availability and component costs Online catalogues of prices, so international comparisons are possible Increasing TransparencyPrice Monitoring Tools

  16. Drivers of Informal Payments • Pressure • Low salaries of medical staff • Pressure from patients • Social norm • Desire for better/faster care • Inability to access care otherwise • Opportunity • Information asymmetry • Inelastic demand • Lack of controls, oversight • Rationalization • Legal; coping mechanism • “Patients want it”

  17. Formalize user fees Increase salaries while establishing formal sanctions for accepting informal payments Increase transparency and information What they did Introduced formal fees and an equity fund (for free care) Government subsidy increased over time Formal fee revenue shared among staff, as bonuses Reducing informal payments Hospitals in Cambodia

  18. Takeo Provincial Hospital, Cambodia Results • After implementation, utilization increased 50% • Patients ended up paying less than the informal payments

  19. Citizen Participation Social Auditing of: Procurement Service Delivery Public Works Budget Execution

  20. Community Health Boards in Bolivia Participatory Budgeting and Social Auditing

  21. Citizen Report Card Experiences: Bangalore India Report Card for Maternal Care in 2000 Public Affairs Centre (PAC) Report card measured patient satisfaction, facility maintenance, informal payments • only 43% of patients had access to usable toilets • less than 40% had access to free medicines as required by government policy

  22. Citizen Report Card Experiences: Uganda Citizen Report Card Project in Uganda • increased quality and quantity of services • increased immunization rates • reduced waiting time

  23. Prosecution and Sanctioning Judicial Reform Special Task Forces (Prosecutors, Judges, Lawyers) Anti-Corruption Commissions Repatriation of Assets Effective Sanctions

  24. Punishing Corrupt DCEC Anti-Corruption Agency Botswana Punish Corrupt Officials

  25. What have we learned? • There are no magic wands • Political Will is essential • Good diagnosis is essential –interventions have to be tailored to needs • Sanctions are not effective without prevention • Anti-corruption interventions are long term efforts • Sustainability is important

  26. Takeo Provincial Hospital, Cambodia Transparent affordable flat fees + Equity Fund Increasing Govt financing (contracts) Decreasing unmarked SRC subsidy to fill gap (boost at start) Sufficient official revenues + rationalization Supplementation of staff revenues based on performance + staff co-management Increased staff motivation & diligence Improved hospital management & high quality of care Increased utilization rate Financial sustainability Source: Jean-Marc Thomé, www.medicusmundi.ch

  27. Integrity PactsArgentina In 2001, a provincial government in Argentina wanted to make a significant investment in computersfor office use • Procurement guidelines required the specifications to be generic • The government lacked sufficient information and market intelligence to make the specifications generic • The procurement office sent out the specifications in draft form to every IT provider before starting the procurement action • Major players such as IBM, Dell, Sun Microsystems, Oracle and Microsoft provided suggestions and amendments, thus ensuring that they could all compete fairly • The procurement process was followed and all stakeholders were satisfied with the result

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