BOSTONUNIVERSITYSCHOOL OF PUBLIC HEALTH

IH 757

Fighting Corruption through Transparency and Accountability

Course Syllabus

Instructor:Taryn Vian, M.Sc., Ph.D.Telephone: 414-1447

Assistant Professor of Public HealthE-mail:

Office Hrs: Tuesdays 1-3 p.m. and by appointment

Meeting Time:January 11, 13, 15, 20, 22, 25 and 27, 9:00 a.m. – 12 p.m.

Meeting Place:CT-305, CrosstownBuilding, 3rd floor, 801 Mass Ave.

Credits: 2

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Course Rationale:

Corruption and lack of accountability in government are concerns in all countries, but they are especially critical problems in developing and transition countries where public resources are already scarce and corruption can cripple growth and development. In international health work, most public health practitioners will encounter corruption at some point and will need to make ethical and management decisions about how to work within corrupt systems and how to prevent corruption from occurring. This course is designed to introduce students to the problem of corruption and provide them with skills for assessing vulnerabilities to corruption in the health sector. The course also builds confidence, knowledge and skills needed to become an effective advocate for anti-corruption strategies and health system reforms that promote accountability and transparency.

Course Materials and Web Site

Achebe, Chinua. No Longer at Ease. New York: Anchor Books, Doubleday (originally published 1960. This is the 1994 edition).

Klitgaard, Robert, Ronald Maclean-Abaroa, H. Lindsey Parris. Corrupt Cities: A Practical Guide to Cure and Prevention. Washington, DC: World Bank Institute. 2000.

Transparency International, Inc. 2006. Global Corruption Report 2006: Special Focus Corruption and Health. London and Ann Arbor, MI: Pluto Press. 2006 Available online for free download at

Course Reader, containing articles and other assigned readings from various sources.

Optional: Di Tella and Savedoff, editors.Diagnosis Corruption: Fraud in Latin America’s Public Hospitals. Washington, DC: Inter-American Development Bank. 2001. This book summarizes research conducted in six countries on risks of corruption in hospitals, and what factors are associated with higher rates of corruption.

Registered students have permission to access the blackboard web site for this course at The site has readings and other materials that may be of help when completing the writing assignments. There are also many links to other related web sites, including BU’s “ACT for Health” web site (Accountability and Transparency for Health) .

Overall Course Objectives:

At the end of this course, students will be able to:

  1. Define corruption and the types of corrupt activities that occur in the health sector.
  1. Explain why corruption occurs, applying the “fraud triangle”, principle-agent theory, and other explanatory models.
  1. Assess vulnerability to corruption in health programs
  1. Discuss cultural differences in defining morality and corruption, including the blurred line between corruption and trading favors, giving gifts, using contacts, etc.
  1. Describe the core elements of corruption prevention programs.
  1. Given a particular country situation or program, examine how corruption and vulnerabilities to corruption can be reduced in drug supply, financial systems, and informal payment for health services.
  1. Evaluate the benefits and drawbacks of whistle-blowing as an anti-corruption strategy.
  1. Become an effective advocate for anti-corruption strategies and reforms to promote accountability and transparency in health programs.

Book Discussion

During the class session on culture and corruption, we will discuss the novel No Longer at Ease, by the Nigerian author Chinua Achebe, a required reading for the course. This book explores how an African civil servant must deal with corruption in life and work.

Grading/Student Assessment:

Student assessment will be based on a homework assignments, a “active learning” project, and class attendance and participation.

80%Homework assignments (3)

10%Active Learning Exercise (will be handed out in class; part of this is a group grade and part is an individual grade)

10%Class preparation, attendance & participation

Format for Homework Assignments

  • Essays should be typed, 12-font, double-spaced, 1 inch margins on all sides, number pages.
  • For Assignments 1-3, put ID number on paper, not your name. I will grade “blindly,” then I will match ID number to name in order to return assignments. I will not grade blindly for the Active Learning Project, because we need to discuss findings in class before grading is completed.
  • References should be formatted in a consistent manner using one of the writing standards suggested by the IH department, i.e. numbered (Vancouver style) or Author-Date. See the IH Capstone Guide for instructions, available from professor Jen Beard ()
  • Spell-check the document and review for correct grammar.
  • Page length (double-spaced) is noted in syllabus on date when homework is assigned
  • Clear writing is a criterion for grading all the assignments. Other criteria are below:

Assignment / Assigned/Due / Criteria for grading
1. Definitions and principal-agent / Assigned Mon. 1/11
Due Weds. 1/13 / 1. Clear definitions, with relationships identified and explained.
2. Principal-agent theory is correctly explained through example
2. Newspaper article analysis / Assigned Weds. 1/13
Due Weds. 1/20 / 1. Well chosen article which illustrates corruption situation or vulnerability.
2. Correctly and concisely identifies and analyzes the components requested (e.g. type, scope & seriousness, winners & losers).
3. Analysis of corruption situationin one country / Assigned Fri.1/15
Due Mon. 1/25 / 1. Clear description of situation and identification of one specific problem or issue
2. Correctly and insightfully applies theory and principles from the course in analyzing causes and consequences of the problem
3. Applies theory and methods introduced in course to propose actions to address problem, demonstrating logic, clarity, cultural and political sensitivity, and awareness of feasibility issues
4. Active Learning Project Part I / Assigned Mon. 1/11
Due Friday 1/15 via email () before class / 1. Includes the requested data which was collected & analyzed
2. Clear, reasonable, supported explanation and interpretation of findings
5. Active Learning Project Part II / Assigned Fri. 1/15
Due Friday 1/22 via email () before class / 1. Fulfilled steps of assignment (contacted store, expressed concerns).
2. Clear explanation of what transpired and how issues were described and explained by both parties (student and store).
3. Clear and insightful analysis of accountability and transparency issues, demonstrating application of theory from class and providing sound recommendations for further actions.

Class Participation

You and your peers will learn more from each other if everyone is participating. Your enthusiasm, questions, and willingness to take risks (such as trying to answer questions in class) are important. Please note that I do call on students in class to answer questions, even if they have not raised their hand. I tend to call on people who have not participated recently, to give them a chance to offer a contribution to the discussion. If you are not prepared, please say so and I will move on to the next person, as my intention is not to embarrass you.

You will start out with an A for class participation. Your grade will be decreased by a half-grade (i.e. A to A-) for each a) unexcused absence, b) session where you are present but are disruptive, inattentive, or I can tell you are unprepared. Class participation will be assessed for each session.

Academic and Professional Conduct

Academic honesty is essential for students to attain the competencies the University and School expect of graduates, and any action by a student that subverts these goals seriously undermines the integrity of the educational programs at the School. Students at the Boston University School of Public Health are expected to adhere to the highest standards of academic honesty.

Academic misconduct is any intentional act or omission by a student which misrepresents his or her academic achievements, or attempts to misrepresent these achievements. While not an exhaustive list, the following acts constitute academic misconduct:

  • Cheating on examinations. The use or attempted use of any unauthorized books, notes or other materials in order to enhance the student’s performance in the examination, copying or attempting to copy from another student’s examination, permitting another student to copy from an examination or otherwise assisting another student during an examination, or any other violation of the examination’s stated or commonly understood ground rules.
  • Plagiarism. Any representation of the work of another person as one’s own constitutes plagiarism. This includes copying or substantially restating the work of another person in any written or oral work without correctly using quotation marks or citing the source, or collaborating with another person in an academic endeavor without acknowledging that person’s contribution.
  • Submitting the same work in more than one course without the consent of all the instructors
  • Misrepresentation or falsification of data
  • Allowing another student to represent your work as his or her own
  • Violating the rules of an examination or assignment

Charges of academic misconduct will be brought to the attention of the Associate Dean for Education, who will review all such cases and decide upon the appropriate action.A student who is found guilty of academic misconduct may be subject to disciplinary action, up to and including dismissal from the School.

I also believe in honesty. I expect that if you must be late to class, miss class, or cannot fulfill the assignments of this course in a timely manner, you will be honest about the reasons.

Session Schedule Chart

Session / Date / Topic
1 / 1-11-10 / Course Overview, Introduction to Corruption in Health
2 / 1-13-10 / Anti-Corruption Toolkit (part 1), guest Rich Feeley
3 / 1-15-10 / Anti-Corruption Toolkit (part 2)
4 / 1-20-10 / Physician-Pharma Relations (guest Roy Poses) and Corruption in Medicines Supply Systems
5 / 1-22-10 / Culture and Corruption
6 / 1-25-10 / Informal Payments in the Health Sector
7 / 1-27-10 / Public Finance Reform, Wrap up


Session 1:Course Overview, Corruption in the Health SectorM1/11/10

Objectives:

  1. Define corruption and describe types of corrupt activities in the health sector;
  2. Define the costs of corruption;
  3. Explain two models for how corruption is caused;
  4. Apply concepts of transparency and accountability to identify vulnerabilities to corruption.

Readings and Preparation:

Klitgaard, Robert, Ronald Maclean-Abaroa, H. Lindsey Parris. Chapters 1-3 (pages 1-46) in Corrupt Cities: A Practical Guide to Cure and Prevention. Washington, DC: World Bank Institute. 2000.

Vian, Taryn. 2008 “Review of corruption in the health sector: Theories, methods, and interventions.” Health Policy & Planning. 23:83-94. Available online:

Savedoff, William D. and Karen Hussmann. 2006. “Why are health systems prone to corruption?” from Chapter 1 in Transparency International, Inc.’s Global Corruption Report 2006. London and Ann Arbor, MI: Pluto Press, pp. 3-16. Available online:

Transparency International Corruption Perceptions Index 2009. Berlin: Transparency International (TI). Go to the TI web site to view or download . Look up the rating for countries where you have lived, worked, or traveled. What does this Index mean? Do you trust it? Optional: Listen to the video by Huguette Labelle, Chair of TI. View the multimedia “Infographic”.

Vian, Taryn. 2008. Note on Principal-Agent Theory (4 pages, on web site).

Assignment #1 (due at start of session 2):

Using the course readings, internet, library or other sources, answer the following questions. Length should be 3-4 pages total. See page 3 of syllabus for formatting instructions.

1.Provide definitions for all 6 terms on this list: bribery, kickbacks, fraud, embezzlement, conflict of interest, and patronage.

2. Pick one term, and discuss potential differences in how the term may be perceiveddifferently depending on the country or social context.

3. Explain principle-agent theory, using an example from the readings for session 1 or 2, or from a newspaper.

Active Learning Assignment Part I is distributed (due Friday, Jan. 15th, via email before class, )


Session 2:The Anti-Corruption Toolkit (part 1)Wed.1/13/10

Guest Speaker: Prof. Rich Feeley,JD “Regulatory Approaches to Fighting Corruption”

Objectives:

  1. Describe the costs of corruption in the public health sector;
  2. Use alternative methods to assess vulnerability to corruption;

3.Describe core elements of corruption prevention programs.

4.Given a specific situation, apply theory to identify vulnerabilities and suggest intervention strategies to reduce or prevent corruption.

Readings:

DiTella, Raphael and William Savedoff. “Shining Light in Dark Corners” (Chapter 1)in Diagnosis Corruption: Fraud in Latin America’s Public Hospitals. Washington, DC: Inter-American Development Bank. 2001, pages 1-26.

Health Systems 20/20. 2008. Health governance: Concepts, experience, and programming options. Bethesda, MD: Abt Associates Inc. for USAID.

Sparrow, Malcolm K. 2006. “Corruption in health care systems: the US experience.” From Chapter 1 in Transparency International, Inc.’s Global Corruption Report 2006. pp. 16-24.

Vian, Taryn. “Corruption in the Health Sector in Albania. Consultant Report.” Tirana, Albania: Management Systems International, USAID Civil Society Corruption Reduction Project. March 2003. Download from web site.

The Case of Narnia: A Role for the Private Sector in the Treatment of AIDS? (2 pages, by Rich Feeley)

Optional:

Lewis, Maureen. 2006. “Governance and corruption in public health care systems.” Working Paper Number 78. Washington, DC: Center for Global Development.

Vian, Taryn. November 23, 2007. “A peculiar notion of board transparency” Letter to the Editor. Boston Globe.

Assignment #1 is due (hard copy, use your ID and not name)

Assignment #2 (due at start of session 4):

Find an article in a newspaper about corruption. The article should be a news report, not an opinion piece.Analyze the problem and write a problem statement (2-3 pages) describing the following points:

1)what type of corruption is it?

2)What is the scope and seriousness?

3)Who are the beneficiaries and losers?

Hand in both the original article, and your problem analysis.

Session 3:The Anti-Corruption Toolkit (part 2)Fri 1/15/10

Objectives:

  1. Give examples of strategies for controlling and preventing corruption.
  2. Analyze factors which affect the feasibility and effectiveness of anti-corruption strategies in specific settings.

Readings:

Klitgaard, Robert, Ronald Maclean-Abaroa, H. Lindsey Parris. Chapters 4-6 (pages 49-102) in Corrupt Cities: A Practical Guide to Cure and Prevention. Washington, DC: World Bank Institute. 2000.

Gray-Molina, George, Ernesto Perez de Rada and Ernesto Yáñez. 1999.“Transparency and Accountability in Bolivia: Does Voice Matter?”Working Paper R-381. Washington, DC: Inter-American Development Bank.

Dubner, S. J. and S.D. Levitt. “Tax honesty comes not from altruism but from fear.” Boston Globe. April 2, 2006.

Morrison, M. “How they uncovered the truth.” Parade Magazine. Boston Sunday Globe. January 25, 2004. See also “The Importance of State and Local Freedom of Information Laws”

Woolhouse, M. “River sleuth smells trouble.” Boston Globe. December 2, 2004.

Paulson, M. “Churches oppose bill on disclosure.” Boston Globe. December 9, 2004.

Preparation: In the readings for today, what “core prevention element” is being used in each case? What are the circumstances needed to make this anticorruption strategy effective?

Active Learning Assignment #1 is due via email () before class.

Active Learning Assignment Part 2 is distributed (due before session 5, Friday 1/22)

Assignment #3 (due at start of session 6, Monday 1/25):

This assignment provides an opportunity to consider one country or type of corruption problem in more detail. Recall a situation from your experience in a particular country (preferably involving the health sector) where you thought something was corrupt. This could be your personal experience, the experience of a friend or colleague, or something you read about in a country. Describe the situation and the type of corruption. Analyze the corruption using techniques from the course, explaining the causes and consequences. Select one or more strategies thatwouldbe appropriate toreduce or control thecorruption you described, and explain why these strategies are appropriate and how they would work.

If you cannot think of a situation you have experienced, you might want to interview someone who has had more international experience. You should identify a key informant (an IH professor, doctoral or MPH student, or a professional working in international health). Interview him or her over the phone or in person, to learn about their problems or experiences. This can help you frame your paper.

Length: 6-8 pages

Session 4:Physician-Pharma Relations and Corruption in Medicines Supply

Guest speaker: Roy M. Poses MD, BrownUniversityWed.1/20/10

Objectives:

  1. Explain how physician-industry interactions can create vulnerabilities to corruption;
  2. Describe strategies to increase accountability and integrity of medical decisions;
  3. Identify factors which make pharmaceutical systems vulnerable to corruption;
  4. Analyze a country’s drug procurement system and make suggestions to improve governance and transparency.

Readings:

Wazana A. 2000. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 283(3):373-380.

Wilson, D. 2010. Harvard Teaching Hospitals Cap Outside Pay. January 2. New York Times. (See also an article in Boston Globe which basically covers same topic: Kowalczyk, L. 2010. MGH Parent Curbs Fees to Staff from Drug Makers. January 3. Boston Globe. )

If you like, peruse Dr. Poses’s blog, «Health Care Renewal» at

Transparency International. Ch 5, “Corruption in pharmaceutical sector” GCR 2006, p85-101.

Jillian Clare Cohen, Monique F Mrazek and Loraine Hawkins. Tackling corruption in the pharmaceutical systems worldwide with courage and conviction. Clinical Pharmacology & Therapeutics. 2007; 81(3): 445-449.

Brenda Waning and Taryn Vian. 2007. “Transparency and Accountability in an Electronic Era: The Case of Pharmaceutical Procurement”. UtsteinAnti-CorruptionResourceCenter (U4), Bergen, Norway.

Case: Hospital Procurement in Bulgaria (web site). Prepare questions at end of case.

Optional: Peruse Dr. Poses’s blog, «Health Care Renewal» at

Assignment #2 is due (hard copy, use your ID and not name)

Session 5:Culture and CorruptionFri.1/22/10

Objectives:

  1. Give examples of cultural differences in defining corruption;
  2. Explore factors that influence attitudes and behaviors toward corruption;
  1. Analyze how culture and history may affect the progress of reforms to reduce corruption and increase accountability of officials toward citizens.
  2. Through a case study, evaluate the benefits and drawbacks of whistle-blowing as an anti-corruption strategy.

Readings: