We are an international research initiative that explores how leadership, power and political processes drive or block successful development
DLP has produced a vast catalogue of working papers, research papers and research briefs on the topic of leadership and development.
About the
Developmental Leadership Program (DLP)
We are an international research initiative that explores how leadership, power and political processes drive or block successful development
Filter by..
Australia and New Zealand
Central Africa
Central America
Central Asia
Eastern Africa
Eastern Asia
Eastern Europe
Northern Africa
Northern America
Northern Europe
South America
South-eastern Asia
Southern Africa
Southern Asia
Southern Europe
Western Africa
Western Asia

Uganda’s Health Sector as a ‘Hidden’ Positive Outlier in Bribery Reduction

01 May 2018

This case study is part of a research project that used a novel mixed-methods approach to identify potentially unrecognised instances of development progress – specifically, of bribery reduction. Analysis of Transparency International’s Global Corruption Barometer flagged Uganda’s health sector as a potential ‘positive outlier’ because its bribery rate had halved between 2010 and 2015, which did not fit bribery patterns in other sectors of the country.

Qualitative fieldwork then examined whether and how bribery had been reduced in Uganda’s health sector. It highlights the work of a relatively newly established Health Monitoring Unit (HMU). The HMU’s corruption control strategy exemplifies a ‘principal-agent theory-inspired approach’. Principal-agent theory suggests that it is possible to control corruption when potentially corrupt actors (agents) are made to be fearful of their respective principals holding them to account for engaging in corruption. Principal-agent theory-inspired anticorruption efforts have attracted criticism recently for being largely ineffective. Nevertheless, this study finds that requests for bribes for health services had decreased as a likely consequence of the HMU’s efforts, especially its high-profile publicised raids, which made health workers more fearful of being caught.

However, apparent unintended consequences mean that this may not be a simple success story. Principal-agent theory anticorruption approaches that target frontline service workers may bring unintended consequences that outweigh the benefits of bribery reduction. There is evidence that the HMU’s activities may be harming morale among health workers and undermining citizens’ trust in the sector. Moreover, the HMU’s approach has not sought to address bribery’s function as a mechanism through which health workers supplement extraordinarily low wages. The HMU’s successes in reducing bribery may therefore be difficult to sustain.

Discover more about developmental leadership. Get the latest research and insights delivered straight to your inbox.

    Join 1,500+ development practitioners, policymakers and researchers on our mailing list
    DLP has been enormously influential in shaping my thinking and teaching about leadership and change. It combines conceptual clarity, with usable tools in areas such as political analysis, and case studies that are invaluable in bringing complex arguments to life.
    Picture of Duncan Green, Oxfam
    Duncan Green
    The Developmental Leadership Program has deeply influenced my work in supporting locally-led reform in the Pacific.
    Picture of Anna Gibert smiling
    Anna Gibert