Abstract
The call of the editorial of the International Journal of Health Policy and Management regarding the “Need
to talk about corruption in health systems” is spot on. However, the perceived difficulties of why this is so
should be explored from an actor’s perspective, as they differ for government actors, donors and the research
community. In particular, false dilemmas around definition problems should be demystified, including by
building systematic bridges between the anti-corruption/integrity and health policy communities of practice.
In addition, the focus on corruption in frontline health service delivery generating mainly problems of access to
health, needs to be complemented with addressing sophisticated kickback schemes, nepotism, and state capture
of legislative and regulatory agencies and processes draining the health systems of large amounts of resources
leading to another false dilemma of assumed sector underfunding. In terms of what can be done, comprehensive
corruption experience and risk assessments conducted by independent actors, eg, universities, aimed at
generating some basic consensus among the different actors of priority areas to be addressed on the basis of a
co-responsibility approach could provide the basis for reform. Finally, governments and private sector actors
in countries characterized by systemic corruption and clientelistic political systems will not reform themselves
without strong and sustained demand from civil society and the media.