Abstract

Despite the substantial resources devoted to the health sector in Sénégal, the health of the population remains precarious. As in the majority of African countries, the sector faces persistent problems of corruption and dishonesty. Sénégalese authorities, aware of the scale of abuses, have adopted a national good governance policy. In the health sector, experience has shown that there is little chance that public policy reforms will be successful if they are not based on facts and the need for greater equity. This grant will enable Le Forum Civil (Transparency International) to carry out opinion surveys to better understand the problem of corruption in the health sector. The team will highlight mismanagement and corruption, and assess healthcare policies from the perspective of good governance. The results will be analyzed in a workshop that will bring together decision-makers, professionals, users' associations, nongovernmental organizations (NGOs) and unions working in the field of health.

Post-Project Summary

A multidisciplinary team consisting of sociologists, jurists and economists examined "petit corruption" in the lower levels of the Senegalese health system. The study took place in six villages and covered six hospitals, ten heath centres, five health posts, a private health facility and a mutual health facility. Three-quarters of the facilities were public and one-quarter private. The social scientists attempted to determine the extent and impetus of corruption in the health sector by means of interviews, focus group discussions and observation of hospital services. They examined the practices of the various actors within the health structure (medical, paramedical, administrative and support), focusing on conflicts of interest, areas of contention (power struggles), interactions with patients and private entities involved in the provision of health services. The economists sought to understand the links between the parallel traffic in pharmaceuticals and the network of corruption. And, the jurists compared existing health legislation with the situation on the ground, and endeavored to document the pertinence of anti-corruption legislation to the health sector.

The study revealed a "pathogenic governance of health structures," featuring "profound distortions" in the hierarchy and the system of control. The result is that the health system operates according to the logic of alliances and affinities rather than clearly delimited roles and responsibilities. The review of health legislation and regulation (1960-2003) revealed that some laws and regulations were out of date, others were unsuited to the current environment and still others were good but simply not enforced. Petty corruption was found among all categories of professional. Sometimes this involved abuse of position (usurping privileges, selling prescriptions, selling drug samples, etc.), in other cases putting private before public interest (inflating orders from the national pharmacy and selling the excess to the underground drug market). Rarely did it involve an individual acting alone, but rather operating as a link in an organized chain from which each profits according to his or her place in the hierarchy, with the tacit agreement of colleagues who are similarly involved. So widespread was petty corruption as to be considered banal and beyond sanction by the perpetrators. This banality is due in large part to the fact that the users of the system are kept in ignorance about the rules by which it is supposed to operate - in other words, lack of transparency.

This project was one of the first systematic field studies on corruption ever carried out in an African country. It was made possible by high-level political support and the overall political climate in Sénégal at the time. With the help of IDRC's Governance, Equity and Health (GEH) Research Matters project (102283) the project findings were repackaged (including on DVD) and delivered to different audiences (decision-makers, media, professional associations, unions, etc.). They were presented at a workshop in Berlin, Germany (November 2005) and a national forum in Dakar (March 2006). There was significant coverage of the release of the report in the media (television, radio and a series of nine articles in the major newspapers in the country). As a result of the project, a number of hospitals (e.g. Hôpital Regional de Thiès) have begun to change their procedures regarding recruitment and sanction of inappropriate behaviour.

Recipient Institution(s)