How does corruption influence health system efficiency? A case study of two counties in Kenya

ABSTRACT Objective Efficiency gains are one potential pathway to unlocking additional resources for the health sector. Given that corruption has been cited as a key cause of inefficiency in the health sector, the objective of this study was to examine the influence of corruption on the efficiency of county health systems in Kenya. Design, setting and analysis We conducted a qualitative case study in two counties in Kenya. We developed a conceptual framework from a literature review to guide the development of tools and analysis. We collected qualitative data through in-depth interviews (n=26) with county, sub-county, and health facility level respondents across the two counties. We analyzed the data collected using a framework approach. Results Corrupt practices reported in the case study counties included non-merit-based recruitment and training of health workers, supply of substandard goods, equipment and infrastructure; theft, embezzlement and misuse of public funds and property; and informal payments. These practices were perceived to impact negatively on health system efficiency by leading to a direct loss of health sector resources, increase in operational costs, poor quality of care, reduced staff motivation and productivity, and reduced access to healthcare services. Conclusion The efficiency of county health systems could be enhanced by implementing anti-corruption strategies to tackle the identified corrupt practices. Strengths and limitations of this study To the best of our knowledge, this paper is the first of its kind to focus on how corruption affects attainment of health sector goals in Kenya Our reported findings focus on only two out of forty-seven counties in Kenya. Transferability of our findings ought to be interpreted with consideration to contextual factors that shaped reported corruption practices We found study respondents to be cautious when reporting their experiences and perceptions on health sector corruption. It is possible that social desirability bias affected response from our study participants Given the sensitivity and difficulty of corruption as a study topic, this study was not able to evaluate the effectiveness of existing anti-corruption strategies in Kenya