Social norms drive graft in East Africa
IN EAST Africa, there are concerns over widespread petty corruption in some of the countries’ health and medical services. This makes access to them conditional on who you know or who you can pay, to the detriment of everyone else who doesn’t have the money or connections.
In Uganda and Tanzania, health service providers are ranked as some of the most bribery-prone institutions in the country. By contrast, health and medical services in Rwanda are ranked as the least bribery-prone.
We wanted to understand the behavioural drivers, such as the role of social norms and beliefs, in spurring petty corruption. To do this, we investigated the decisions of those seeking medical treatment and of health service providers that fuel petty corruption in Tanzania, Uganda and Rwanda.
We focused on these three East African countries, which share a common border west of Lake Victoria, because we wanted the opportunity to compare attitudes and experiences. All three countries have robust anti-corruption legislation and institutions in place but all yielded different results.
Our research found evidence that social norms and shared beliefs spur corruption. People are swayed by social pressure to help relatives, share contacts or reciprocate favours received from their networks. Many also believe corruption is normal.
This was very evident in Uganda and Tanzania, but to a much lesser extent in Rwanda. This highlights our findings on why this behaviour comes about in the first place: people engage in corruption when health services are less available or accessible. In Rwanda, effective government social programmes exist. For example, Ubudehe provides targeted support to the poorest and most vulnerable groups. The programme has reduced the reliance of citizens on informal social networks by ensuring access to public services and social benefits.
We hope our research provides insights into the importance of incorporating behavioural insights into anti-corruption policymaking.
However, unless basic problems of accessibility and quality of public services are addressed, it will be extremely difficult to eradicate informal strategies to obtain the desired health care.
The research was conducted between January 2016 and August 2017. We carried out interviews, focus group discussions and surveys. Our target communities were providers and receivers of health care. For those seeking treatment, we targeted women of child-bearing age, young men, and elderly and disabled people.
The evidence suggests that social norms and networks play a role in fuelling and reproducing practices of petty corruption. Users of public health facilities in Uganda and Tanzania often turned to their social network, family, friends, and friends of friends when seeking medical services.
When personal connections are absent, offers of unsolicited bribes and gifts are used to create a relationship with the provider. The expectation is that having a “provider friend” helps facilitate access to treatment.