iiinova — where your digital self keeps evolving

7/ We provide evidence that system reforms can cut corruption and improve equity (e.g. procurement reform, formal co‑payments with exemptions, disclosure of industry payments). But we must treat corruption as a public health issue: fix systems, not just people — and protect the poorest first.

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6/ IWhat does work better: ✅ system‑wide financing reform ✅ reliable salaries & working conditions ✅ transparent digital procurement ✅ enforceable rules ✅ civil society oversight — all adapted to local context.

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5/ This means transparency or punishment alone won’t work (although it has an important role). Standalone audits, sanctions, or naming‑and‑shaming often fail, or simply displace corruption elsewhere.

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4/ Why corruption persists: • Underfunded systems • Low or delayed salaries • Political patronage • Weak accountability • Normalised “survival practices” • Silence & fear of speaking out Punishment alone won’t fix this.

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3/ Key insight: stop seeing corruption as only “bad individuals” (although they exist, even at highest levels of govt). It’s a system failure, often driven by poor pay, weak accountability, political incentives, underfunding, and normalised “survival practices”.

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🧵1/ Corruption in health systems isn’t rare or marginal. It harms health outcomes, deepens inequality, wastes money, and erodes trust, in all countries, rich and poor alike.Our new @obshealth.bsky.social policy brief, led by @dinabalabanova.bsky.social explains what actually works. 👇

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Frontiers | The hidden toll of colleague absenteeism: exploring its impact on emotional strain and burnout among frontline health workers in Nigeria

5/5 Key takeaway: tackling absenteeism isn’t only about monitoring attendance. It requires fair scheduling, supportive supervision, and recognition of emotional labour, all critical for resilient health systems everywhere. Read the full paper here www.frontiersin.org/journals/psy...

frontiersin.org

BackgroundAbsenteeism among health workers is a persistent challenge in resource-constrained health systems, increasing workloads for those who remain presen...

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4/5 Informal power structures, favoritism, and gendered expectations shape who can be absent without consequence, and who absorbs the costs. These dynamics are not unique to Nigeria.

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3/5 Absenteeism doesn’t just disrupt services. It redistributes emotional labour. Workers report exhaustion, frustration, isolation, and moral distress, especially where accountability is weak or uneven.

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2/5 Using qualitative research in Nigerian PHC facilities we found that unscheduled colleague absenteeism dramatically increases workload, emotional strain, and burnout for remaining staff.

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Dina Balabanova @dinabalabanova.bsky.social · 13/04/2026

🧵1/5 Health worker absenteeism is usually framed as a governance failure. But what about its hidden costs for those who still show up? Our new study with @dinabalabanova.bsky.social and Nigerian colleagues shifts the lens to the frontline workers left behind.

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Join us for this excellent event - highly relevant to many countries experiencing crises and governance disruptions. We look forward to constructive dialogue @martinmckee.bsky.social

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Financing Common Goods for Health, sponsored by the World Health Organization, Department of Health Systems Governance and Financing. Volume 5, Issue 4 of Health Systems & Reform

11/ The bottom line: Fix governance → strengthen accountability → reduce corruption → improve PHC performance. Without this chain, PHC reforms will not deliver. You can read the whole paper here: www.tandfonline.com/toc/khsr20/5/4

tandfonline.com

Health Systems & Reform

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10/ As Nigeria moves to implement the Supreme Court ruling granting local government areas fiscal autonomy, these findings are timely—and essential. Strengthening subnational governance is the foundation for effective PHC.

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9/ We argue that investments like the government's Basic health care Provision fund must be accompanied by reforms in governance, accountability, HR systems, and financing mechanisms. Otherwise, resources risk being wasted.

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8/ The result? A system where corruption is not an individual failing but a structural outcome of weak subnational governance. Reforms that ignore this reality, however well‑intentioned, will fall short.

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7/ Fourth, erratic PHC financing. With little statutory financing from subnational authorities, many facilities survive on user fees and “private practice” by those in charge This de facto privatization creates perverse incentives and deepens inequities.

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6/ Third, dysfunctional human resource management. Chronic absenteeism, unchecked use of informal “volunteers,” and non‑tenured facility managers turning facilities into personal enterprises, all thrive in the absence of oversight.

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5/ Second, weak rules and enforcement. Regulations exist on paper but are rarely communicated, operationalised, or enforced. Many facilities have no functional SOPs, enabling impunity, absenteeism, and arbitrary decision‑making.

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4/ First, low political interest in PHC. Local authorities often deprioritize PHC because it brings few political rewards. Budgets are unpredictable, planning is weak, and investments favor visible infrastructure over basic services.

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3/ We interviewed senior PHC managers and identified four major governance deficiencies driving corruption and weak service delivery at the frontline. These problems are systemic, predictable, and fixable.

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2/ Led by Prince Agwu, with Charles Orjiakor, Aloysius Odii , Pamela Ogbozor, @eleanorhutch.bsky.social Obinna Onwujekwe & @dinabalabanova.bsky.social & funded by UK FCDO, MRC, and @wellcometrust.bsky.social

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Martin McKee @martinmckee.bsky.social · 10/12/2025

🧵1/ Our new study in Health Systems & Reform describes how poor accountability and corruption in Nigeria’s primary healthcare (PHC) are rooted in subnational governance failures, and not just actions by those working on the frontline. This matters hugely for current reforms.

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🧵 1/ Our new study in BMJ Global Health looks at the role of social capital in tackling - or fuelling - in healthcare systems. With @dinabalabanova.bsky.social and Nigerian colleagues. In Nigeria, we show how personal networks often determine who gets care. Here’s what we found.

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Dina Balabanova @dinabalabanova.bsky.social · 30/11/2025

I am incredibly privileged to have led the #AccountabilityinAction project with Obinna Onwujekwe and the wonderful team in Health Policy Research Group, Uni Nigeria. How does the group acts on health sector corruption? A thread @martinmckee.bsky.social @eleanorhutch.bsky.social @lancetgh.bsky.social

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Martin McKee @martinmckee.bsky.social · 20/11/2025

1/ How does the COVID Inquiry's Module 2 report align with what we said in @independentsage.bsky.social at the time? A 🧵on Transparency, Early & Decisive Action, Scientific Advice, Integration of Social & Economic Harms, Communication and Behavioural Science, Governance, Data and Preparedness

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Jan Rosenow @janrosenow.bsky.social · 07/11/2025

We often forget how far we have come: Today almost 3/4 of EU electricity generation is from non-fossil energy sources. It is not long ago that fossil fuels dominated the EU's electricity mix. This year their share is approaching 1/4 of EU electricity generation. Source is @ember-energy.org

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Dina Balabanova @dinabalabanova.bsky.social · 06/11/2025

Our new paper (by @petravarkonyi.bsky.social) shows a link b/n perceived corruption and health outcomes in central & eastern Europe. Expanded coverage isn’t enough—informal payments persist. Real change needs anti-corruption/ACTA tinyurl.com/2ky3rbkc @martinmckee.bsky.social @obshealth.bsky.social

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Governance & Integrity Anti-Corruption Evidence (GI ACE) @giace.bsky.social · 06/11/2025

Crises like pandemics, cholera outbreaks & climate disasters don’t just strain health systems — they amplify corruption risks. New #GIACE blog by Claudia Baez Camargo & @dinabalabanova.bsky.social explores how overlapping emergencies in Malawi opened space for corruption. 🔗 bit.ly/BaselGIACEBlog

bit.ly

Addressing Corruption in Crises Matters: Towards effective crisis-responses in the Malawian health system - Governance & Integrity Anti-Corruption Evidence

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Tolib Mirzoev @tolibmirzoev.bsky.social · 30/10/2025

Excellent opening ceremony for @pen-connect.bsky.social with a reminder of the project aim from Prof Ana Mocumbi

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Tolib Mirzoev @tolibmirzoev.bsky.social · 30/10/2025

Prof Kerstin Klipstein-Grobusch highlights @who.int PEN & PEN Plus in Mozambique inform @pen-connect.bsky.social bridging levels of NCD care. Support from @ec.europa.eu @gacdmedia.bsky.social 🙏 @martinmckee.bsky.social @dinabalabanova.bsky.social @hsglobal.bsky.social @alliancehpsr.bsky.social

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Martin McKee @martinmckee.bsky.social · 29/10/2025

The search for an internet connection… with thanks to @tolibmirzoev.bsky.social

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Martin McKee @martinmckee.bsky.social · 29/10/2025

And one of our first actions was to create a @bsky.app account (of course!) Follow us @pen-connect.bsky.social if interested in non-communicable disease manage in low and middle income countries @dinabalabanova.bsky.social @tolibmirzoev.bsky.social @eleanorhutch.bsky.social

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Dina Balabanova @dinabalabanova.bsky.social · 29/10/2025

Very exciting and advanced project with our colleagues at @utrechtuniversity.bsky.social and Universidade Eduardo Mondlane uem.mz. We would like to find patient centred and systemic solutions to the growing burden of NCD @tolibmirzoev.bsky.social

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Dina Balabanova @dinabalabanova.bsky.social · 11/06/2025

Important paper for our forthcoming #LancetGlobalHealthCommissiononAnti-corruption. A lot can be gained by using AI-enabled approaches but there is a need for new skills, capacities and power to use it for good We need a nuanced argument @eleanorhutch.bsky.social @anticorruption.bsky.social

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6️⃣ The way forward Invest in: • Skilled personnel 👩‍💻 • Data interoperability 📂 • Participatory oversight mechanisms 🗳️ • Ethical AI policies 🌐 AI should support—not replace—human judgment.

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5️⃣ AI’s dual nature AI can uncover hidden fraud or enable corruption on an unprecedented scale. Success hinges on who controls the data and tools—governments, civil society, or private entities.

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4️⃣ Governance is key For AI to be effective, we need: • Transparent algorithms ⚖️ • Strong human oversight 🧑‍⚖️ • Legal and ethical frameworks 🛡️ Poor implementation risks false accusations and perpetuating inequities.

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3️⃣ But risks abound… AI isn’t neutral. Biases in data and algorithms can reinforce corruption rather than combat it. Authoritarian misuse of AI can suppress dissent while protecting elites.

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2️⃣ How AI helps: Anti-Corruption Tools (ACTs) • Detect anomalies in procurement & billing 📊 • Spot counterfeit medicines 🔍 • Enhance transparency via blockchain integration 🔗 Examples: AI bots flagging suspicious expenses, detecting bid-rigging, or mapping drug supply chains.