Prof Dina Balabanova (LSHTM) & Dr Pallavi Roy (SOAS)

This is an exciting opportunity to obtain a PhD studentship to conduct novel research examining the complex relationship between health system corruption and responses to disease outbreaks. The PhD student will work with Prof Dina Balabanova (LSHTM) and Dr Pallavi Roy (SOAS) as co-supervisors who have led extensive research and advocacy on health sectors corruption in low and middle income countries(LMICs). The student will also be supervised by Prof. Susannah Mayhew (LSHTM), an expert on outbreak responses, health systems resilience and governance and Dr Eleanor Hutchinson (LSHTM), anthropologist working on informality and corruption.

Corruption (the abuse of public power for private gain) threatens health in LMICs, especially among the poor is increasingly seen as a major barrier to Universal Health Coverage. WHO estimated that corruption accounted for 7.3% of global spending in 2008. It is regressive, pushing people into poverty. Corrupt practices undermine trust underpinning effective, equitable, and responsive health care; a 2011 study attributed 140,000 child deaths annually to it.[1] Some argue that increasing national wealth and maturity of institutions will change incentives for rule enforcement, eliminating corruption, while others see it as reflecting social norms. Yet, there has been little health systems debate and research so far, particularly testing proposed solutions. A Cochrane review found nothing that reliably reduced corrupt practices, in health while other initiatives have achieved limited or short-lived success at scale.

The Covid-19 pandemic put corruption at the forefront of the global and national health policy, and it emerged as an important factor influencing outbreak responses. It is also recognised that policies related to Covid-19 may have created spaces for illicit practices. This was also reported in high income countries despite highly formalised and well-enforced rules and regulation [3]. However, rigorous analyses of how and why the pandemic responses may have enabled corruption, and vice-versa are relatively scarce, particularly vis-à-vis how these practices manifest at primary health care level, and how they affect users and communities.

The overall aim of the PhD is to examine the complex (bi-directional) interrelationship of health system corruption and effective responses to outbreaks. It will specifically: a)explore the manifestations, responses and consequences of corruption during public health outbreaks (at national/ district/ facility level), b)consider the role of corruption on perpetuating harmful practices during outbreaks affecting access to and quality of care for the most vulnerable populations, c)examine current power configurations and historical events that have shaped the anti-corruption responses during disease outbreaks seeking to identify actors who have power, capabilities and interests to act against particular types of corruption drawing on Khan and Roy’s conceptualisation[4], d) formulate policy recommendations for the country-level and international stakeholders involved in efforts to improve the accountability of the crises-responses. The research will consider formal and informal drivers of corruption, and how these drivers are shaped by the political economy and social landscapes.

The PhD will involve a country case study (possibly Zimbabwe, Nigeria or elsewhere). We envisage that the study will use mixed methods and this will be shaped by the research questions which will be fine-tuned at the start of the studentship period. We anticipate these may include qualitative research (in-depth interviews, focus group discussions, observations) to understand the unique features of corruption during outbreaks and how these manifest at community and PHC level, and then influence the health system and its ability to deliver essential services as well as outbreak-focused activities. Discourse or framing analysis of policy documents and media accounts and analysis of quantitative secondary data will be also conducted where relevant. Interpretation will be facilitated through consensus exercises with key formal and informal actors (community members, practitioners, civil society representatives, policy makers etc.)

The PhD student will benefit from access to data, networks and theoretical advances under existing projects–SOAS ACE (co-directed by Dr.P.Roy, health work led by Prof.Balabanova), LSHTM’s Accountability in Action project (PI Balabanova with University of Nigeria specialised in health systems and corruption research) and the NIHR Global Health Research Group on Building Partnerships for Resilience: strengthening responses to health shocks from the grassroots led by Prof.Mayhew. We will also link to the forthcoming Lancet Commission on Anti-corruption in Health (2014-26), the Global Network for Anti-corruption, Transparency and Accountability in Health (GNACTA) convened by WHO (Balabanova/Roy involved), and Health System Global’s Thematic Group on Action on Accountability and Anti-corruption for SDGs at (co-led, Balabanova).We will support the student in facilitating access to country specific information and to the field in the chosen country. The student will gain experience in presenting to international fora, engage in policy processes, and build their scientific networks.

The PhD will run in Sept.2024-2028. Person expectations. We are seeking a PhD candidate with a background in health systems/policy research, political economy or development studies, ideally with knowledge and interest in health sector corruption. They should have a strong background in research methods, predominantly qualitative and mixed methods and a track record in conceptualising a study, conducting research, analysing and writing up findings – particularly in LMICs.  The ability to work collaboratively with study country teams is essential for this studentship, and being agile to learn and implement new conceptualisations and methods. An experience of communicating confidently (orally and in writing) with different audiences (policy makers, health care professional, communities) is important and the student will be supported to enhance their skills to do so during the degree period.

Closing date for applications is: 29th February 2024 

Further details about the project may be obtained from: Prof Dina Balabanova (LSHTM) Dina.Balabanova@lshtm.ac.uk or Dr Pallavi Roy (SOAS) pr16@soas.ac.uk

Further information about PhDs at LSHTM is available from: 

Research degrees and Doctoral College | Study with us | LSHTM 

How to Apply

https://www.lshtm.ac.uk/study/fees-and-funding/funding-scholarships/research-degree-funding

Key References

[1]Hanf,M.,et al. Corruption kills: estimating the global impact of corruption on children deaths. PLoS One,2011,6(11) 

[2]Hutchinson,E,[…],Balabanova D. Targeting anticorruption interventions at the frontline: developmental governance in health systems.BMJ Glob Health.2020;5(12):e003092. 

[3]Thompson N[…],Balabanova D. The PPE procurement scandal-who pays and who profits?BMJ.2022 Oct 18. 

[4]Khan, M.[…],Roy P. Anti-corruption in adverse contexts:strategies for improving implementation.2019