This article is part of the supplement: Social audit: building the community voice into health service delivery and planning
Research article
Auditing Nicaragua’s anti-corruption struggle, 1998 to 2009
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* Corresponding author: Robert J Ledogar rledogar@ciet.org
1 CIETinternational in Nicaragua, Plaza la Palmera, Modulo 3, Managua, Nicaragua
2 Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino, Colonia El Roble, Acapulco, Guerrero, Mexico
3 CIETinternational, 511 Avenue of the Americas #132, New York, NY 10011, USA
BMC Health Services Research 2011, 11(Suppl 2):S3 doi:10.1186/1472-6963-11-S2-S3
Published: 21 December 2011Abstract
Background
Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services.
Methods
In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit.
Results
Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period -- with the possible exception of Managua between 2006 and 2009 -- but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption.
Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds.
Conclusions
Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and -- perhaps most importantly -- on making citizens feel they are well-informed participants in the work of government.