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 mainly engaged in the sectors of land, natural resources, public finance and local governance. It undertakes concrete actions aimed at reducing corruption across the country. TI-IM is expanding its area of expertise to the healthcare sector, starting with 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

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Global Partners:
European Union
National Partners:
Governmental Institution

Theory of Change

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



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

To inform the project, TI-Madagascar conducted an assessment to identify how different types of corruption impacted different types of health services. This involved a study of the legislative environment; a literature review on existing evidence of corruption, and qualitative research to assess impact of corruption on individuals.

The research's findings were used to develop a new typology of corruption cases in the healthcare sector in Madagascar. The study identified the circumstances in which cases of corruption are rare to non-existent, as well as corruption "hotspots" that are more likely to be experienced by users of the national health system. The study also established the socio-demographic profile of those citizens most affected by corruption.

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


The study focused exclusively on the analysis of healthcare delivery at the patient level. To do so, the study conducted:

  1. A review of the legal framework for health.
  2. A collection of testimonials based on anthropological research techniques.
  3. A socioeconomic survey of 3302 individuals, conducted by 60 investigators for 15 days


  1. In the six Madagascan provincial capitals, 84% of individuals agree that corruption exists in the health sector.
  2. The majority of the population (63%) recognises the need to file a complaint about a corruption case. However, only few actually choose 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 for access to appointments.


  1. The law must hold organisations legally liable if their staff members are found guilty of corruption, particularly if the case of corruption resulted in a patient's deaths.
  2. Organisations such as health facilities should be allowed to impose sanctions for individual offences.
  3. The government should regularly conduct or commission audits and performance evaluations of health facilities at a national, regional and local level.

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