Integrity Index for Public Institutions: evaluating Colombia’s health sector – @transparenciaco

“Since 2002, Transparencia por Colombia, the Colombian chapter of Transparency International, has produced an annual Integrity Index for Public Institutions, comparing levels of corruption risks in the country’s public institutions. The aim of the index is to provide a tool for civil society to monitor transparency, integrity and efficiency of public institutions. Since institutions are individually evaluated, it is possible to use the index to assess vulnerabilities to corruption of a particular sector. Here we provide an overview of the index and examples of how it can be used to assess corruption risks in the health sector.
The index ranks public institutions according to 20 indicators, all of which are objective measures.2 The indicators fall into three groups:

  • Transparency. This measures visibility of the organisation to the general public, assessed using the following indicators: information found on the institution’s web page; mechanisms for filing complaints; transparency of contracting processes; compliance with the national contracting information system (SICE); accountability mechanisms; transparency, accessibility and clarity of bureaucratic processes; anti-corruption efforts and access to information.
  • Control and punishment. This measures the level of sanctions or decisions taken by control bodies against officials of public bodies by looking at sanctions for fiscal irregularities; disciplinary sanctions; and value of decisions signalling fiscal irregularities as a proportion of the organisation’s budget. The underlying premise is that a higher number of dishonest practices is associated with institutional scenarios where preventative mechanisms are deficient or non-existent.
  • Efficiency and institutionality. This measures efficient compliance with the objectives and missions of the body. The indicators look closely at simplicity of organisational processes, and clarity and knowledge of rules and controls, as these factors limit the margin for discretion by personnel and therefore risk of corruption. The indicators include: number of complaints presented and investigations opened by public auditor and public prosecutor as a proportion of the number of officials employed; procedures for hiring staff; incentives for employees; performance of the internal control function; and evaluation of management.

Each of the three components is made up of a simple average of the indicators in the category, and the index is an average of the three, weighted against the number of indicators that make up each component.
The 2004 index evaluates 80 per cent of public entities at central government level (182 central government bodies are assessed). For the first time state government bodies are also evaluated.3

Risks of corruption in the health sector

Some 12 per cent of the public institutions assessed in the National Index correspond to the health sector. The risk of corruption is considered high in 59 per cent of these. Of particular concern are the results of health delivery bodies such as the Social State Enterprises (ESE), which were recently created in an attempt to overcome the inefficiencies and poor quality services offered by the centralised Social Security Institute (ISS). While the results for the health sector are slightly better than recorded by the 2003 index, they are poor in two of the three categories: transparency (45 on a scale of 1 to 100, where 100 indicates a low risk of corruption) and efficiency and institutionality (55 out of 100). (See Figure 22.1.)


At the state level a number of problems were also identified: the average score of health agencies responsible for directing, coordinating and monitoring the health and social security services in each jurisdiction is 49.2 out of 100, which is lower than the average score per sector. More than 35 per cent of these health agencies are considered to face a high or very high risk of corruption, while only 12.5 per cent show a moderate risk.”

Read more:  The Global Corruption Report 2006: Corruption and Health. Transparency International.

– Related Information –

1. The BMJ Campaign: Corruption in Healthcare

…The BMJ campaign aims to draw attention to corrupt practices in health systems internationally and stimulate discussion on underlying causes. We aspire to awaken the global conscience of doctors and foster initiatives to push for change….

2. Corruption tactics: outrage management in a local government scandal.

…”Studies in a wide range of areas show that perpetrators commonly use five sorts of methods to minimise public outrage (Martin 2007):

– cover up the activity
– devalue the target
– reinterpret the activity, including by lying, minimising consequences, blaming others and reframing
– use official channels to give an appearance of justice
– intimidate and bribe people involved.”…

…”This framework offers guidance for challenging corruption through increasing public outrage. Each of the five methods of inhibiting outrage can be countered:expose the activity

– expose the activity
– validate the targets and devalue the perpetrators
– interpret the activity as unfair
– mobilise public support; don’t rely on official channels
– resist and expose intimidation and bribery.”…

3. Peter Wilmshurst – The role of whistleblowers in improving the integrity of the evidence base. Evidence Live 2015.

“Peter Wilmshurst is that rare thing—a successful whistleblower. What’s more, he’s a cheerful one, despite having lost £25 000, faced bankruptcy and the loss of his house, and spent every evening, weekend, and his annual leave for three years successfully defending an egregious libel case.”… –— Richard Smith. Former editor of The BMJ.

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