Main points

• A gap exists between policy and practice. While the devastating cost of health sector corruption is well known, the research found that funding from development partners and strategic focus on the issue remain critically low.
• A bilateral development partner’s official strategy is the single biggest factor for action. The research identified three types of development partners: those with integrated health and anti-corruption strategies (eg Norway, Sweden, the US); those who treat them as separate priorities (eg the UK, Germany); and those with no explicit focus on the link between them at all. Without an integrated strategy, the issue is consistently sidelined.
• Multilateral agency approaches usually follow a political neutral framing, with few organisations explicitly integrating anti-corruption, transparency, and accountability (ACTA) into their health strategies. Instead, they work towards safeguarding their own funds rather than undertaking direct, programmatic anti-corruption work.
• Even with an official strategy, progress is blocked by persistent barriers. Development partners are often hesitant to act due to the political sensitivity of corruption, the principle of aligning with partner governments who rarely prioritise the issue, and a perceived lack of evidence linking anti-corruption work to better health outcomes.
• Internal silos are a major obstacle. A disconnect between a development partner’s headquarters and its country missions, and a lack of collaboration between internal health and governance teams, prevent high-level policies from being translated into effective programmes at the community level.
• Context is crucial, and adaptable approaches are needed. The case studies show that in a country with high political will, the challenge is turning policy into action. In a context with low political will, development partners must work indirectly by supporting civil society and technical reforms.
• Recommendations for bilateral development partners include developing strategies to integrate anti-corruption measures into the health sector; working to ensure recognition of the issue and the need for action in high-level meetings and UN resolutions; and leveraging existing, politically neutral health objectives as entry points to introduce anti-corruption principles. They must also improve the quality and consistency of the funding data they publish to the International Aid Transparency Initiative (IATI) and engage better with country missions and programmes on anti-corruption in health.
• Recommendations for multilateral agencies include the need to: integrate specific, actionable anti-corruption measures into their core strategies and country programming; and work to actively strengthen weak national systems by investing in public financial management and procurement systems. Proactively using technical language and working towards the outcomes of anti-corruption (efficiency, value etc.) – rather than emphasising the issue of corruption itself – is also important.
• All agencies should consider support for anti-corruption coalitions and civil society to increase bottom-up pressure for change, and invest in research to unlock action on health sector corruption and what works to mitigate it. They can also leverage technical assistance for country missions to address corruption risks.
• To make progress, development partners must break down internal silos. Fostering collaboration between health and anti-corruption teams is essential to designing effective programmes. They should also use their influence on the boards of multilateral institutions to push for stronger safeguards and a greater focus on the issue.