1. Corruption Sten Ström Sida/Asdi Embassy of Sweden, Managua

2. How Big Is The Problem? USD 1 000 000 000 000 (USD 1 trillion) Each year…. 6 x Sweden’s Gvt debt 152 x Nicaragua’s public debt

3. Disposition: What is corruption? (4-6) How to fight corruption at various levels ( 7-13 ) Corruption in procurement ( 14-16 ) Corruption in Health Sector ( 17-18 ) interaction with patient (19-20) medical supplies (21-22) resources management (23-25)

4. What Is Corruption? Misuse of entrusted power for private gain (Transparency International) Institutions, corporations or individuals obtaining inappropriate gain through their position in operations, thereby causing damage or loss (Sida’s anti-corruption rule)

5. Examples of Corruption (1) Bribes (given and received) But also Extortion Favouritism and nepotism Conflict of interests

6. Examples of Corruption (2) Embezzlement Fraud Illegal financing of political parties Impunity

7. Anti-corruption Work Four levels: Individual officers Organisation Structures of the country Global development/initiatives

8. Individual Officers Public Administration Acts Organisational rules Systems for internal control Organisational atmosphere (including examples, incentives, sanctions)

9. In The Organization Assessment of capacity and risk of corruption Mitigate risks (in procurement and monitoring mechanisms: reporting, audit, information to target group) Extra audits (not just financial/regularity) Take action

10. Structures of Country (1) Financial management systems - plans (revenue forecasts, medium term) - budgets - international control - payment systems - revenue (tax, customs, etc) - accounting - audit - parliament’s scrutiny

11. Structures of Country (2) - statistical systems - cadastre - police, prosecutors and courts - ombudsmen - election processes incl. political parties - anti-corruption commissions - decentralisation processes

12. Corruption studies and support to anti- corruption strategies Independent media Watchdog organisations (TI local chapter) Structures of Country (3)

13. Global Development Ratification and implementation of UN:s anti- corruption convention, Regional convention (Convención Interamericana Contra la Corrupción), OECD regulations, etc Support to international organisations, methods development, lobbying (www.transparency.org)www.transparency.org (www.corisweb.org)www.corisweb.org

14. Where Corruption Occurs in The Procurement Process Decision to procure Specifications in tender documents Access to tender documents Qualification of tenderer Evaluation of tenders Award decision Contract negotiation and design Contract administration/implementation

15. Preventing Corruption In Contracting (1) Controls can be expensive, ineffective and/or too late No single solution for a complex problem - Laws and Institutions - Education/training - Access to information by media, watchdog NGOs - Codes of Ethics

16. Based on transparency - Facilitate monitoring and participation - Encourage accountability Integrity pacts, publish what you pay OECD Convention- illegal bribing of foreign officials Increase risk of detection and “cost” if caught Change of attitudes Preventing Corruption In Public Contract (2)

17. Corruption in Health Sector - Causes and consequences Imbalance in information High degree of discretion Low productivity without accountability Decentralisation without monitoring Vulnerability

18. Corruption in Health Sector

19. Health worker/patient interaction - problems Informal payments Private practices/self-referral Training/accreditation Health care fraud Conflict of interest

20. Health worker/patient interaction - actions Salaries Official user fees Accountability, improved management Code of ethics Access to information Voice based strategies

21. Management of medical supplies - problems Availability Registration of drugs Drug selection Procurement Distribution/misappropriation

22. Management of medical supplies - actions Regulatory authorities/procedures List of essential medicines WHO principles Inventory control

23. Resources management - problems Budget process Lack of accountability Budget leakages Multiple/large funding Promotion

24. Resources management - actions Improved systems Budget transparency, participation Decentralisation Privatisation Tracking resource flows WHO ethical guidelines Information campaigns

25. But most importantly…. How to create a ”public ethos” (civil servants), focussed more on public good than on personal gain ?