Anti-corruption in the Health Sector: Reducing Vulnerabilities to Corruption in User Fee Systems

This case-based brief illustrates how one hospital was able to introduce policy and system changes to reduce corruption and increase responsible stewardship of user fee revenues for the public good. Although typically user fees generate no more than 5-10% of recurrent costs in health facilities1, these small, continuously occurring cash transactions provide a temptation to collection staff, as well as higher level government agents. One scenario is when a patient is charged the official fee for services received, but some or all the fee goes into the fee collector’s pocket, rather than benefiting the institution. In systems with pervasive corruption, fee collectors may be pressured to kickback some of the fees to their supervisors. Exemption systems may also be manipulated, with collection