Tessera

Our new paper in @lancetrh-europe.bsky.social w/ @dinabalabanova.bsky.social argues that new EU Anti‑Corruption Directive is major opportunity for health systems. It brings harmonised rules, stronger penalties, & better cross‑border enforcement. Read it here: www.thelancet.com/journals/lan...

Why the EU’s new Anti-Corruption Directive matters for health

thelancet.com

You can read our policy brief here: eurohealthobservatory.who.int/publications...

How can we better prepare health systems to resist corruption?

Policy Brief 75 by the European Observatory on Health Systems and Policies. Corruption in health systems has significant effects on health. It: undermines health outcomes; disproportionately harms the...

eurohealthobservatory.who.int

7/ We provide evidence that system reforms can cut corruption and improve equity (e.g. procurement reform, formal co‑payments with exemptions, disclosure of industry payments). But we must treat corruption as a public health issue: fix systems, not just people — and protect the poorest first.

6/ IWhat does work better: ✅ system‑wide financing reform ✅ reliable salaries & working conditions ✅ transparent digital procurement ✅ enforceable rules ✅ civil society oversight — all adapted to local context.

5/ This means transparency or punishment alone won’t work (although it has an important role). Standalone audits, sanctions, or naming‑and‑shaming often fail, or simply displace corruption elsewhere.

4/ Why corruption persists: • Underfunded systems • Low or delayed salaries • Political patronage • Weak accountability • Normalised “survival practices” • Silence & fear of speaking out Punishment alone won’t fix this.

3/ Key insight: stop seeing corruption as only “bad individuals” (although they exist, even at highest levels of govt). It’s a system failure, often driven by poor pay, weak accountability, political incentives, underfunding, and normalised “survival practices”.

🧵1/ Corruption in health systems isn’t rare or marginal. It harms health outcomes, deepens inequality, wastes money, and erodes trust, in all countries, rich and poor alike.Our new @obshealth.bsky.social policy brief, led by @dinabalabanova.bsky.social explains what actually works. 👇

5/5 Key takeaway: tackling absenteeism isn’t only about monitoring attendance. It requires fair scheduling, supportive supervision, and recognition of emotional labour, all critical for resilient health systems everywhere. Read the full paper here www.frontiersin.org/journals/psy...

Frontiers | The hidden toll of colleague absenteeism: exploring its impact on emotional strain and burnout among frontline health workers in Nigeria

BackgroundAbsenteeism among health workers is a persistent challenge in resource-constrained health systems, increasing workloads for those who remain presen...

frontiersin.org

4/5 Informal power structures, favoritism, and gendered expectations shape who can be absent without consequence, and who absorbs the costs. These dynamics are not unique to Nigeria.

3/5 Absenteeism doesn’t just disrupt services. It redistributes emotional labour. Workers report exhaustion, frustration, isolation, and moral distress, especially where accountability is weak or uneven.

2/5 Using qualitative research in Nigerian PHC facilities we found that unscheduled colleague absenteeism dramatically increases workload, emotional strain, and burnout for remaining staff.

Dina Balabanova @dinabalabanova.bsky.social · 5mo ago

🧵1/5 Health worker absenteeism is usually framed as a governance failure. But what about its hidden costs for those who still show up? Our new study with @dinabalabanova.bsky.social and Nigerian colleagues shifts the lens to the frontline workers left behind.

Join us for this excellent event - highly relevant to many countries experiencing crises and governance disruptions. We look forward to constructive dialogue @martinmckee.bsky.social

Governance & Integrity Anti-Corruption Evidence (GI ACE)@giace.bsky.social · 5mo ago

📣 Join us this Thursday (16 April) for a #GIACE online seminar: ‘Addressing corruption in crisis situations: towards effective crisis-responses in the Malawian health system’. 🗓️ Thursday 16 April 🕰️ 1pm to 2pm (UK) 🔗 Register now: bit.ly/4bOGhx4

11/ The bottom line: Fix governance → strengthen accountability → reduce corruption → improve PHC performance. Without this chain, PHC reforms will not deliver. You can read the whole paper here: www.tandfonline.com/toc/khsr20/5/4

Health Systems & Reform

Financing Common Goods for Health, sponsored by the World Health Organization, Department of Health Systems Governance and Financing. Volume 5, Issue 4 of Health Systems & Reform

tandfonline.com

10/ As Nigeria moves to implement the Supreme Court ruling granting local government areas fiscal autonomy, these findings are timely—and essential. Strengthening subnational governance is the foundation for effective PHC.

9/ We argue that investments like the government's Basic health care Provision fund must be accompanied by reforms in governance, accountability, HR systems, and financing mechanisms. Otherwise, resources risk being wasted.

8/ The result? A system where corruption is not an individual failing but a structural outcome of weak subnational governance. Reforms that ignore this reality, however well‑intentioned, will fall short.

7/ Fourth, erratic PHC financing. With little statutory financing from subnational authorities, many facilities survive on user fees and “private practice” by those in charge This de facto privatization creates perverse incentives and deepens inequities.

6/ Third, dysfunctional human resource management. Chronic absenteeism, unchecked use of informal “volunteers,” and non‑tenured facility managers turning facilities into personal enterprises, all thrive in the absence of oversight.

5/ Second, weak rules and enforcement. Regulations exist on paper but are rarely communicated, operationalised, or enforced. Many facilities have no functional SOPs, enabling impunity, absenteeism, and arbitrary decision‑making.

4/ First, low political interest in PHC. Local authorities often deprioritize PHC because it brings few political rewards. Budgets are unpredictable, planning is weak, and investments favor visible infrastructure over basic services.

3/ We interviewed senior PHC managers and identified four major governance deficiencies driving corruption and weak service delivery at the frontline. These problems are systemic, predictable, and fixable.

2/ Led by Prince Agwu, with Charles Orjiakor, Aloysius Odii , Pamela Ogbozor, @eleanorhutch.bsky.social Obinna Onwujekwe & @dinabalabanova.bsky.social & funded by UK FCDO, MRC, and @wellcometrust.bsky.social