When there is no transparency, data from DHIS2 can potentially be co-opted by powerful groups for private gain. When managed and disseminated properly, health data becomes a strategic resource that can be used for better policy choices, which could lead to better health outcomes. Exploring the linkages between HMIS, corruption, and anti-corruption are therefore required to understand better how data analytics can advance integrity, transparency, and accountability in the health sector.
This U4 Issue examines how corruption manifests within HMIS and assesses the potential of DHIS2 to advance anti-corruption and integrity in the health sector, especially in developing countries.
I think you are barking up the wrong tree here, in a way. I have over 25 years working with the DHIS - from designing version 1.0 in Cape Town in 1997 to using DHIS2 in many countries and large organisations. I have never come across a case of corruption caused by the DATA being “co-opted by powerful groups for private gains”.
I have seen many countries/scenarios where (in my humble opinion, not provable per se) Free and Open Source software like the DHIS are reducing the potential impact of proprietary solutions that are corruption ridden. FOSS solutions are never cost-free, obviously, but costs are predominantly linked to human work (training, backstopping, collaborative work) and those are not so easy to fake (at least not compared to opaque, large systems projects)
Note that I am saying reducing and not stopping, because most corruption-ridden health IT projects are transactional EMR/EHR systems. As an example, South Africa spent around R 15 billion (around USD 2 bill over that time) on large hospital information systems from 1995 to 2010 - nearly all of them ending up linked to corruption. The Minister’s moratorium on new systems in 2010 put an end to most of that waste. So the mere existence of the DHIS - at the time mostly used for aggregate data - did not BLOCK all these dubious project.
Another example from Norway: The previous conservative government, as a result of all the weaknesses in municipal/regional/national HIS revealed during the Covid-19 pandemic, decided to push a new unified system at a cost of USD 2 billion “to integrate everything”. It was met with massive resistance due to the high cost, though, and even more so when a major newspaper revealed that consultants from PCW were sitting on both sides of the table when taking conceptual design decisions… So that is another type of what many see as a form of corruption - that private companies are too cozy with their government counterparts (or one and the same) when a country invests billions into new systems.
Who have ACCESS to data and who determines how data should be analysed, reported or acted upon do have possible negative ramifications compared to an idealised situation where all citizens have full access to all relevant public health data, where said citizens generally agree on respecting FACTS and EVIDENCE-BASED action. But it is a stretch to regard limited access, or the fact that various groups are using data/information in organisational and/or political “games” as CORRUPTION, IMHO. Ensuring access and ensuring free and rational analysis of data/information is a crucial challenge for any democracy - but limitations are not caused by corruption.
Again, I cannot recall cases where users/groups refused access to public health data have been able to get access using bribes. Yes, you could say that donors and consultant companies sometimes get access BECAUSE they fund some activity, but again such tit-for-tat “deals” are not and should not be seen as corruption. To some extent influence peddling and donor countries using “soft power”, yes - but it’s not corruption as people understand that term.
Dear @Calle_Hedberg , thank you for your response. In the paper, you will see a couple of country examples where pay-for-performance schemes were co-opted by corrupt actors to extract profit through data manipulation and other examples of data misuse which can increase corruption risks generally if not accounted for. The paper defines corruption in HMIS as data manipulation and data misuse. While bribes are a form of corruption, that is not the only one, and when thinking through the lens of HMIS, we focus on other types, as mentioned above. This is in line with current WHO guidance on corruption in the health sector. As you mention, DHIS data could be used to enable progress on transparency, accountability, and participation in decision-making. This is a conclusion we also share and made in the paper.
However, this potential can only be realized if it is properly considered in data governance decisions around the development and deployment of HMIS such as DHIS2. As you mention, DHIS2 cannot take care of all corruption schemes. That is why we suggest in the paper that some health indicators could be used as proxies to identify potential corruption risks at different levels of the health system (with the caveat that it is a proxy and we are not implying direct causation!). For example, within the procurement and contracting of health equipment the difference between the quantity (stock) of infrastructure and the related public spending (funds) could tell us something about the likelihood of embezzlement, diversion, or theft occurring in the system. Although these proxies do not capture corruption directly, they serve as valid proxies and invite further scrutiny. We have more examples in the paper.
Political games are considered a form of grand corruption, for example, state or policy capture, when the public office abuses its position for private gain. HMIS can be at the center of these “games”. However, depending on how you view these higher-level deals as corruption or not is also a valid critique as in many countries different forms of lobbying are legal and illegal. I invite you to read this U4 issue paper on Lobbying, corruption, and climate finance, which presents the challenges and complexities of lobbying as an important part of democracy and a gateway to policy capture (if you are interested in learning more about this fascinating topic).