Wierzynska Aneta, Steingrüber Sarah, Oroxom Roxanne, Bauhoff Sebastian
Ethics Office, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
Independent Global Health Expert, Berlin, Germany.
Glob Health Action. 2020;13(sup1):1701327. doi: 10.1080/16549716.2019.1701327.
Policy-makers, implementing organizations, and funders of global health programs aim to improve health care services and health outcomes through specific projects or systemic change. To mitigate the risk of corruption and its harmful effects on those initiatives, health programs often use multiple anti-corruption mechanisms, including codes of conduct, documentation and reporting requirements, and trainings. Unfortunately, the introduction of anti-corruption mechanisms tends to occur without an explicit consideration of how each mechanism will affect health services and health outcomes. This may overlook potentially more effective approaches. In addition, it may result in the introduction of too many controls (thereby stymying service delivery) and a focus on financial or procurement-related issues (at the expense of service delivery objectives). We argue that anti-corruption efforts in health programs can be more effective if they prioritize addressing issues according to their likelihood and level of harm to key program objectives. Recalibrating the anti-corruption formula in this way will require: (i) extending responsibility and ownership over anti-corruption from subject experts to public health and health system specialists, and (ii) enabling those specialists to apply the Fraud Risk Assessment methodology to develop tailored anti-corruption mechanisms. We fill a documented gap in guidance on how to develop anti-corruption mechanisms by walking through the seven analytical steps of the Fraud Risk Assessment methodology as applicable to health programs. We then outline best practices for any anti-corruption mechanism, including a focus on quality health delivery; the alignment of actors' incentives around the advancement of health objectives; and being minimally corruptible by design.
全球卫生项目的政策制定者、实施组织和资助者旨在通过特定项目或系统性变革来改善医疗服务和健康成果。为降低腐败风险及其对这些举措的有害影响，卫生项目通常会采用多种反腐败机制，包括行为准则、文件记录和报告要求以及培训。不幸的是，反腐败机制的引入往往没有明确考虑每种机制将如何影响卫生服务和健康成果。这可能会忽视潜在更有效的方法。此外，这可能导致引入过多控制措施（从而阻碍服务提供），并将重点放在财务或采购相关问题上（以牺牲服务提供目标为代价）。我们认为，如果卫生项目的反腐败工作能够根据问题对关键项目目标的可能性和危害程度来优先处理问题，那么这些工作会更有效。以这种方式重新调整反腐败方案将需要：（i）将反腐败的责任和所有权从主题专家扩展到公共卫生和卫生系统专家，以及（ii）使这些专家能够应用欺诈风险评估方法来制定量身定制的反腐败机制。我们通过梳理适用于卫生项目的欺诈风险评估方法的七个分析步骤，填补了关于如何制定反腐败机制的指导方面的一个记录空白。然后，我们概述了任何反腐败机制的最佳实践，包括注重高质量的卫生服务提供；使行为者的激励措施与促进健康目标保持一致；以及在设计上具有最小的可腐败性。
