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Title How do patients and providers navigate the 'corruption complex' in mixed health systems? The case of Abuja, Nigeria.
Full text https://hdl.handle.net/1842/41342; http://dx.doi.org/10.7488/era/4077
Date 2024
Author(s) Wakdok, Sabastine Stephen
Contributor(s) Hellowell, Mark; Anders, Gerhard
Abstract INTRODUCTION: Over the last decades, scholars have sought to investigate the causes, manifestations, and impacts of corruption in healthcare. Most of this scholarship has focused on corruption as it occurs in public health facilities. However, in Nigeria, in which most residents attend private health facilities for at least some of their care needs, this focus is incomplete. In such contexts, it is important to understand corruption as it occurs across both public and private settings, and in the interactions between them. This study seeks to address this gap. It aims to examine how corruption is experienced by, and impacts upon, patients and providers as they navigate the 'corruption complex' in the mixed health system of Abuja, Nigeria. OBJECTIVES: This over-arching aim is addressed via three interrelated objectives, as follows: 1.To investigate the experiences of patients and providers concerning the causes, manifestations, and impacts of corruption in public health facilities, in Abuja, Nigeria. 2.To investigate patients / provider experiences of corruption as they relate to private health facilities in Abuja, Nigeria. 3.To investigate how, and the extent to which, corruption is enabled by the co-existence of and interactions between public and private health facilities in the context of the mixed health system of Nigeria ' and of Abuja in particular. METHODS: All three objectives are addressed via a qualitative exploratory study. Data was collected in Abuja, Nigeria's Federal Capital Territory (between October 2021 to May 2022) through: (i) in-depth interviews with 53 key informants, representing a range of patient and provider types, and policymakers; and (ii) participant observation over eight months of fieldwork. The research took place in three secondary-level public health facilities (Gwarinpa, Kubwa, and Wuse General hospital) and three equivalent-sized private health facilities (Nissa, Garki, and King's Care Hospital) in Abuja. The empirical data was analysed using Braun and Clarke's (2006) reflexive thematic analysis approach and presented in a narrative form. Abuja was selected as the research setting, as the city is representative of the mixed health system structures that exist in Nigeria, especially in the country's larger urban areas. RESULTS: Objective 1: Corruption in public health facilities is driven by a shortage of resources, low salaries, commercialisation of health and relationships between patients and providers, and weak accountability structures. Corruption takes various forms which include: bribery, informal payments, theft, influence- activities associated with nepotism, and pressure from informal rules. Impacts include erosion of the right to health care and patient dignity, alongside increased barriers to access, including financial barriers, especially for poorer patients. Objective 2: Corruption in private health facilities is driven by incentives aimed at profit maximisation, poor regulation, and lack of oversight. Corruption takes various forms which include: inappropriate or unnecessary prescriptions (often driven by the potential for kickbacks), forging of medical reports, over-invoicing, and other related types of fraud, and under/over-treatment of patients. Impacts include reductions to the quality of care provided and exacerbation of financial risks to patients. Objective 3: The nature of public-private sector interactions creates scope for several forms of corruption. For example, these interactions contribute to the causes of corruption in the public sector - especially the problem of scarcity of resources. Related manifestations include dual practice, absenteeism, and theft (e.g., diversion of patients, medical supplies, and equipment from public to private facilities). The impacts of such practices include inequities of access, for example, due to delays in and denials of needed services and additional financial barriers encountered in public facilities, alongside reductions to quality of care, pricing transparency and financial protection in private facilities. CONCLUSION: Patients experience corruption in both public and private health facilities in Abuja, Nigeria. The causes, manifestations and impacts of corruption differ across these settings. In the public sector, corruption creates financial and non-financial barriers to care ' aggravating inequities of access. In the private health sector, corruption undermines quality of care and exacerbates financial risks. The public-private mix is itself implicated in the problem ' giving rise to new opportunities for corruption, to the detriment of patients' health and welfare. For policymakers in Nigeria to address the problem of corruption, a cross-sectoral approach - inclusive of the full range of providers within the mixed health system ' will be required.
Subject(s) corruption complex; mixed health systems; Abuja, Nigeria; private health facilities; public health facilities; secondary-level public health facilities
Language en
Publisher The University of Edinburgh
Type of publication Thesis or Dissertation; Doctoral; PhD Doctor of Philosophy
Format application/pdf
Repository Edinburgh - University of Edinburgh
Added to C-A: 2024-01-17;09:29:25