Transcript Anticorruption strategies and tools: Rwanda

Rwanda
Anticorruption
Strategies and Tools
Casals & Associates, Inc.
Taryn Vian, Boston University
Designing an Anticorruption
Strategy
 Nature of Corruption
 Causes,
Vulnerabilities; sound
technical analysis—
depoliticizes the
problem
 Political Will
 Stakeholders
 Champions
 Risks
 Likely Opposition
 Timeline
Anticorruption Tools
Increase
Awareness
Sanction
Prosecute
Prevent
Detect
Increase Awareness
 Assessments of corruption vulnerabilities
• Procurement
• Informal payments/service delivery
• Drug leakage
 Generate information about costs of corruption
in the health sector
Surveys: perception, victimization, costs
 Publicize results; encourage public debate
 Media Campaigns
Power of Data
National cost of
corruption survey in
Mexico
PET en Uganda
 Measured problem, Government
convinced to act
 Publicized budgets at local level
 Decreased leakage from 78% in 1996
to 18% in 2001
Vulnerability Scores in Four
Countries (WHO 2006)
Malaysia Philippines Thailand
Registration
Lao
PDR
5.6
6.8
6.8
7.0
Selection
6.1
5.7
6.1
8.0
Procurement
6.9
7.1
8.5
7.1
0.0-2.0 = extremely vulnerable; 2.1-4.1 = very vulnerable;
4.1-6.0 = moderately vulnerable; 6.1-8.0 = marginally vulnerable;
8.1-10.0 = minimally vulnerable
WHO/PSM/PAR/2006.7, p. 7
Prevention and Detection
Controls and Audit
Procurement Reform
Bureaucratic Simplification
Transparent Budgeting
Health Management Information
Systems
Social auditing and complaints
Regulatory reform
Complexity of medicines supply
in Kenya
Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate
any inaccuracies to [email protected] or telephone 2727210
Commodity Logistics System in Kenya (as of July 2006)
Commodity
Type
(colour coded)
Contraceptives and
RH
equipment
Condoms
for STI/
HIV/AIDS
prevention
STI
Drugs
W
H
O
Vaccines
and
Vitamin A
Essential
Drugs
Blood
Safety
Reagents
(inc. HIV
tests)
TB/Leprosy
Malaria
AntiRetro
Virals
(ARVs)
MOH
Equipment
Laboratory
supplies
Organization Key
Government
World Bank Loan
Bilateral Donor
Multilateral Donor
NGO/Private
JSI/DELIVER
Source of
funds for
commodities
Procurement
Agent/Body
Point of first
warehousing
Organization
responsible
for delivery to
district levels
Organization
responsible for
delivery to subdistrict levels
U
S
A
I
D
K
f
W
E
U
U
N
F
P
A
U
S
A
I
D
K
f
W
E
U
R
O
P
A
U
N
F
P
A
KEMSA
Regional
Depots
NLTP
(TB/
Leprosy
drugs
D
F
I
D
Crown
Agents
GOK
W
H
O
K
E
M
S
A
B
T
C
J
I
C
A
C
I
D
A
Government
of Kenya
KEMSA Central Warehouse
KEMSA and KEMSA Regional Depots
(essential drugs, malaria drugs,
consumable supplies)
G
A
V
I
UNICEF
G
D
F
K
N
C
V
S
I
D
A
D
A
N
I
D
A
GTZ
Japanese
Private
Company
UNICEF
MEDS
(procurement
implementation
unit)
KEPI Cold
Store
JSI/DELIVER/KEMSA Logistics
Management Unit (contraceptives,
condoms, STI kits, HIV test kits, TB
drugs, RH equipment etc)
US
Gov
GOK, WB/
IDA
C
D
C
J
S
I
MEDS
KEPI
(vaccines
and
vitamin A)
Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,
Dispensaries come up and collect from the District level
MEDS
(to Mission
facilities)
Global
Fund for
AIDS, TB
and Malaria
MSF
PSCMC
(Crown
Agents,
GTZ, JSI
and KEMSA)
MSF
NPHLS store
Provincial and
District
Hospital
Laboratory
Staff
Private
Drug
Source
Transparency and Access to
Information
Type of Disclosure
Means of Disclosure
Information
Discloser
Recipient
Duty…Trust
Civil
Servant
Manager
Facts and Figures
Mechanisms and
Processes
Justification for Decisions
Employee
Client/Patient
Donor
Health Management Information Systems
District Health Planning and Financial Management System in
South Africa
600
500
400
300
Cost per IP day
200
100
0
Tesgona
Nimane
S. Keri
N. Keri
Internal Controls
Network Cash registers in
Kenya
 Registers gave receipts of
transactions
 Possibility to track
resources
 Lower opportunities to
cheat
 Resulted in 47% increase in
revenue after 3 months
Transparency of Medicines
in Argentina
 Compiled monthly drug
procurement price data
starting in 1996 (ended in
1998)
 Highlighted highest &
lowest price paid, fed info
back to hospitals
 Prices fell 12%
 After 3 months, prices
climbed back, but never
to pre-1996 levels
Procurement Reform
•Standards and technical
specifications quoted in
bidding documents should be
generic to promote competition
•Specifications should be
based on relevant
characteristics and/or
performance requirements.
•Transparency and public
disclosure of information
•System for addressing
complaints
•Citizen participation in the
system
Integrity Pacts
Ecuador
 The NGO community wanted to
be involved in the oversight of the
project
 To provide effective review during
the process, the government
entered into an Integrity Pact with
the local chapter of Transparency
International
 TI hired international consultants
that advised the stakeholders,
helping the NGO community to
become effective watchdogs
The procurement actions
surrounding the project were deemed
to be fair and transparent by all the
parties involved
In 1999, Ecuador
built a major Dam
system. The
project had a
budget of over
300 million USD
Increasing Transparency
Price Monitoring Tools
 WHO and Health Action
International, 2002
 Developed methodology
for collecting and
analyzing prices of
medicines, affordability,
availability and
component costs
 Online catalogues of
prices, so international
comparisons are
possible
Drivers of Informal Payments
Pressure
Low salaries of medical staff
Pressure from patients
Social norm
Desire for better/faster care
Inability to access care otherwise
Opportunity
Information asymmetry
Inelastic demand
Lack of controls, oversight
Rationalization
Legal; coping mechanism
“Patients want it”
Reducing informal payments
Hospitals in Cambodia
 Formalize user fees
 Increase salaries
while establishing
formal sanctions for
accepting informal
payments
 Increase
transparency and
information
What they did
 Introduced formal
fees and an equity
fund (for free care)
 Government subsidy
increased over time
 Formal fee revenue
shared among staff,
as bonuses
Takeo Provincial Hospital, Cambodia
Results
 After implementation,
utilization increased
50%
 Patients ended up
paying less than the
informal payments
Citizen Participation
Social Auditing of:
 Procurement
 Service Delivery
 Public Works
 Budget Execution
Participatory Budgeting and
Social Auditing
Community
Health Boards in
Bolivia
Citizen Report Card
Experiences: Bangalore India
Report Card for Maternal Care in
2000 Public Affairs Centre
(PAC)
Report card measured patient
satisfaction, facility
maintenance, informal
payments
only 43% of patients had
access to usable toilets
less than 40% had access to
free medicines as required
by government policy
Citizen Report Card
Experiences: Uganda
Citizen Report Card
Project in Uganda
 increased quality and
quantity of services
 increased
immunization rates
 reduced waiting time
Prosecution and Sanctioning
Judicial Reform
Special Task Forces
(Prosecutors, Judges,
Lawyers)
Anti-Corruption
Commissions
Repatriation of Assets
Effective Sanctions
Punishing Corrupt
DCEC
Anti-Corruption Agency
Botswana
Punish Corrupt
Officials
What have we learned?
There are no magic wands
Political Will is essential
Good diagnosis is essential –
interventions have to be tailored to needs
Sanctions are not effective without
prevention
Anti-corruption interventions are long
term efforts
Sustainability is important
Takeo Provincial Hospital, Cambodia
Transparent
Increasing
Decreasing unmarked
affordable flat fees Govt financing SRC subsidy to fill gap
+ Equity Fund
(contracts)
(boost at start)
Sufficient official revenues
+ rationalization
Supplementation of staff revenues based on performance
+ staff co-management
Increased staff motivation & diligence
Improved hospital management
& high quality of care
Increased utilization rate
Financial sustainability
Source: Jean-Marc Thomé, www.medicusmundi.ch
Integrity Pacts
Argentina
In 2001, a provincial
government in Argentina
wanted to make a significant
investment in computers for
office use
 Procurement guidelines required
the specifications to be generic
 The government lacked sufficient
information and market intelligence
to make the specifications generic
 The procurement office sent out the
specifications in draft form to every
IT provider before starting the
procurement action
 Major players such as IBM, Dell,
Sun Microsystems, Oracle and
Microsoft provided suggestions
and amendments, thus ensuring
that they could all compete fairly
 The procurement process was
followed and all stakeholders were
satisfied with the result