Taking on the Beast – Assessing and Mitigating Corruption to Strengthen Health Systems and Improve Health Outcomes in Middle East and North Africa: The Case of Lebanon and Jordan

Background: Corruption is a pervasive problem in all health system that reduces health care accessibility and effectiveness and poses a significant risk to the achievement of Universal Health Coverage and the Sustainable Development Goals. High levels of corruption have been linked to poorer health outcomes including higher infant and child mortality and lower life expectancy, particularly affecting the most vulnerable groups.

We define corruption as a set of behaviors that divert the health system from its core aims and benefit individuals, groups and organizations. Corruption can only be understood within its institutional and socio-political context, thus our key first step is to agree country-specific definitions.

Aims and objectives: While evidence has been increasing about types and impacts of health sector corruption worldwide, less is known about the situation in the Middle East and North African (MENA) region. We seek to elicit the nature, drivers, and impacts of health system corruption specific to Lebanon and Jordan, and feasible risk-mitigating measures in order to inform health system strengthening efforts.

Our focus is on Lebanon and Jordan because both countries have weakened health systems due to crises; health sector corruption is endemic; we can identify patterns when comparing corruption drivers and risks in two countries with very different health systems, societal structures and norms, but similarly high levels of corruption; and critically, there are windows of opportunity with key actors and groups committed to act on corruption.

Methods: We will undertake a three-year research program that brings together a multi-disciplinary team, having contextual knowledge, HPSR and corruption expertise. Five interlinked work packages (WPs) will be implemented drawing on methodologies from health systems research, political economy, risk analysis and population health sciences. We will first foster consensus on definitions and scope of stakeholders’ assessment of the types of health system corruption (criminal acts, administrative misdeeds, unethical practices etc.) and their drivers (WP1), assess and prioritize corruption risks and islands of integrity in health systems, and distill options to reduce these risks (WP2) that are aligned with the political economy (WP3).

We will derive evidence-based and contextually-fit anti-corruption strategies (WP4), and address the evidence to policy gap through co-creation and knowledge translation processes (WP5). The WPs have emerged from our engagement with the communities, NGOs, policymakers and practitioners in both countries. Community engagement and involvement will be integrated in the governance structures, research processes (WPs) and capacity building activities.

Strengthening capacity at different levels to prevent and respond to health system corruption risks is also a key priority in our work.

Anticipated impact: Given the challenges around addressing corruption globally, our proposed research programme will be a much-needed step forward in enabling country-led conversations and actions. Our focus on prevention rather than sanctions and on islands of integrity can unite a diversity of stakeholders around a common reform agenda. Through this programme, we seek to generate awareness, increase knowledge, and foster agenda-setting and anti-corruption policy designs and actions in our study countries, but also to contribute to anticorruption efforts in MENA.