Global Health, Aid and Corruption: Can We Escape the Scandal Cycle?

Global health action has been remarkably successful at saving lives and preventing illness in many of the world’s poorest countries. This is a key reason that funding for global health initiatives has increased in the last twenty years. Nevertheless, financial support is periodically jeopardized when scandals erupt over allegations of corruption, sometimes halting health programs altogether. This paper reviews four cases involving the World Bank, USAID, the Global Fund, and European donors in terms of the severity of abuses, the quality of evidence, the responses of funders and recipients, and the impact on health and institutions. It argues that, from a funder’s perspective, the main way to address the dynamics of the scandal cycle is to make sure that the decision of whether or not to disrupt health aid is influenced as much by program results as by the amount and character of corruption. It suggests three strategies to accomplish this goal: (1) communicate using program results; (2) differentiate responses by program results; and (3) disburse program funding in proportion to results.