Research Paper

Corruption and its Socio-Economic Impacts on the Healthcare Sector (Tsaboy Ny Gasy Project)

Chapter: Madagascar | Year: 2019

Chapter details

About the chapter:

Transparency International - Madagascar (TI-IM) is engaged mainly in in the land sector, natural resources, transparency of public finance and local governance. It undertakes concrete actions aimed at reducing corruption throughout the Malagasy territory. TI-IM is expanding its area of expertise to the healthcare sector, based on a preliminary survey carried out in September 2017 by the citizen movement Wake Up Madagascar and the organisation Liberty 32.

CPI Score: 25

CPI Rank: 152

View chapter Profile


Download Research

Theory of Change

Policy & Insititutional Change
Improved enforcement of policies
Behaviour Change
Seeking Redress Against Corruption


The Tsaboy ny Gasy Project advocates citizens'  social and economic rights, particularly by fighting corruption in the health sector in Madagascar.

To inform the project, TI-Madagascar has conducted a diagnosis into the different forms of country that impact upon health services. This has involved: a study of the legislative environment; a literature review (existing evidence of corruption) and; qualitative research into the impact of corruption upon the lives of individuals.

The research has subsequently informed a new typology of corruption cases in the healthcare sector in Madagascar. Analysis of the collected data allows for the development of a system to classify the complex reality of the cases within the sector. Considering regional specificities, the study identified the circumstances in which cases of corruption are rare or non-existent, as well as corruption "hotspots" with which users of the national health system may be confronted. The sociodemographic profiles of the citizens most affected by corruption have been established and known.

The study, and the resulting barometer developed by TI-Madagascar , will become a reference point for the annual measurement of the impact of corruption in the Malagasy healthcare sector.


The study focused exclusively on the analysis of healthcare delivery at the patient level. In order to diagnose forms of corruption and their impacts in the health field, the research mobilized complementary methodologies:

  1. A review covering the legal framework for health, performed through the collection and the analysis of laws and regulations.
  2. A collection of testimonials based on anthropological research techniques. Interviews were conducted with victims and participants in corruption, with more or less different recourse.
  3. A socioeconomic survey conducted by 60 investigators for 15 days among 3302 individuals.


  1. In the six Madagascar provincial capitals, 84% of individuals agree that corruption exists in the health field.
  2. A majority of the population (63%) recognises the need to file a complaint in a corruption case. Few, however, choice to submit a report (11%).
  3. 27 different definitions of corruption were identified. This includes: over-billing of unnecessary or unused drugs; absenteeism; inadequate but prolonged care; unnecessary operations and referrals; charging families to release the body from the mortuary and; informal payments to access appointments.


  1. The law must make institutions legally liable for the actions of their personnel found guilty of corruption, particularly in relation to the errors that led to the death of the patient.
  2. Institutions should be allowed to impose administrative sanctions for individual offences.
  3. The government should regularly conduct or commission audits and performance evaluations of health facilities at national, regional and local levels.