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Published in: BMC Health Services Research 2/2011

Open Access 01-12-2011 | Research article

Auditing Nicaragua’s anti-corruption struggle, 1998 to 2009

Authors: Jorge Arosteguí, Carlos Hernandez, Harold Suazo, Alvaro Cárcamo, Rosa Maria Reyes, Neil Andersson, Robert J Ledogar

Published in: BMC Health Services Research | Special Issue 2/2011

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Abstract

Background

Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services.

Methods

In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit.

Results

Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period -- with the possible exception of Managua between 2006 and 2009 -- but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption.
Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds.

Conclusions

Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and -- perhaps most importantly -- on making citizens feel they are well-informed participants in the work of government.
Literature
1.
go back to reference Andersson N: Building the community voice into planning: 25 years of methods development in social audit. BMC Health Services Research. 2011, 11 (Suppl 2): S1-PubMedCentralCrossRefPubMed Andersson N: Building the community voice into planning: 25 years of methods development in social audit. BMC Health Services Research. 2011, 11 (Suppl 2): S1-PubMedCentralCrossRefPubMed
2.
go back to reference Paredes-Solís S, Andersson N, Ledogar RJ, Cockcroft A: Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe. BMC Health Services Research. 2011, 11 (Suppl 2): S12-PubMedCentralCrossRefPubMed Paredes-Solís S, Andersson N, Ledogar RJ, Cockcroft A: Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe. BMC Health Services Research. 2011, 11 (Suppl 2): S12-PubMedCentralCrossRefPubMed
3.
go back to reference Paredes-Solís S, Villegas-Arrizón A, Ledogar RJ, Delabra-Jardón V, Álvarez-Chávez J, Legorreta-Soberanís J, Nava-Aguilera E, Cockcroft A, Andersson N: Reducing corruption in a Mexican medical school: impact assessment across two cross-sectional surveys. BMC Health Services Research. 2011, 11 (Suppl 2): S13-PubMedCentralCrossRefPubMed Paredes-Solís S, Villegas-Arrizón A, Ledogar RJ, Delabra-Jardón V, Álvarez-Chávez J, Legorreta-Soberanís J, Nava-Aguilera E, Cockcroft A, Andersson N: Reducing corruption in a Mexican medical school: impact assessment across two cross-sectional surveys. BMC Health Services Research. 2011, 11 (Suppl 2): S13-PubMedCentralCrossRefPubMed
7.
go back to reference Transparency International: Los sistemas nacionales de integridad: Estudio de país - Nicaragua. Transparency International. 2008 Transparency International: Los sistemas nacionales de integridad: Estudio de país - Nicaragua. Transparency International. 2008
11.
go back to reference Andersson N, Ajwani MK, Mahashabde S, Tiwari MK, Muir MK, Mehra V, Ashiru K, Mackenzie CD: Delayed eye and other consequences from exposure to methyl isocyanate: 93% follow up of exposed and unexposed cohorts in Bhopal. British Journal of Industrial Medicine. 1990, 47 (8): 553-558.PubMedCentralPubMed Andersson N, Ajwani MK, Mahashabde S, Tiwari MK, Muir MK, Mehra V, Ashiru K, Mackenzie CD: Delayed eye and other consequences from exposure to methyl isocyanate: 93% follow up of exposed and unexposed cohorts in Bhopal. British Journal of Industrial Medicine. 1990, 47 (8): 553-558.PubMedCentralPubMed
12.
13.
go back to reference Andersson N, Mitchell S: Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. International Journal of Health Geographics. 2006, 5: 1-10.1186/1476-072X-5-1.PubMedCentralCrossRefPubMed Andersson N, Mitchell S: Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. International Journal of Health Geographics. 2006, 5: 1-10.1186/1476-072X-5-1.PubMedCentralCrossRefPubMed
14.
go back to reference Woolf B: On estimating the relation between blood group and disease. Ann Hum Genet. 1955, 19: 251-253. 10.1111/j.1469-1809.1955.tb01348.x.CrossRefPubMed Woolf B: On estimating the relation between blood group and disease. Ann Hum Genet. 1955, 19: 251-253. 10.1111/j.1469-1809.1955.tb01348.x.CrossRefPubMed
15.
go back to reference Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959, 22: 719-48.PubMed Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959, 22: 719-48.PubMed
16.
go back to reference Bossert T, Bowser D, Corea L: Studies of decentralization of the health system in Nicaragua: Final report. USAID and Harvard School of Public Health. 2001 Bossert T, Bowser D, Corea L: Studies of decentralization of the health system in Nicaragua: Final report. USAID and Harvard School of Public Health. 2001
17.
go back to reference Jack W: Contracting for health services: an evaluation of recent reforms in Nicaragua. Health Policy and Planning. 2003, 18 (2): 195-204. 10.1093/heapol/czg024.CrossRefPubMed Jack W: Contracting for health services: an evaluation of recent reforms in Nicaragua. Health Policy and Planning. 2003, 18 (2): 195-204. 10.1093/heapol/czg024.CrossRefPubMed
Metadata
Title
Auditing Nicaragua’s anti-corruption struggle, 1998 to 2009
Authors
Jorge Arosteguí
Carlos Hernandez
Harold Suazo
Alvaro Cárcamo
Rosa Maria Reyes
Neil Andersson
Robert J Ledogar
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue Special Issue 2/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-S2-S3

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