Understanding the normalization of corruption among public health facility users in nigeria: implications for health systems strengthening and universal health coverage
1
College of medicine, Health policy research group, university of nigeria, Enugu, Nigeria
2
Global health and development, London school of hygiene & tropical medicine, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
corruption in the health sector remains a major impediment to achieving universal Health coverage (UHC) and strengthening health systems in low- and middle-income countries. In nigeria, corruption in the health sector has become increasingly normalized, eroding accountability, trust, and equitable access to healthcare. understanding which population groups are more likely to view corruption as normal is critical for designing effective anti-corruption and health promotion interventions. this study examined the demographic and contextual factors that influence the normalization of corruption among users of public health facilities in nigeria.
METHODS:
the cross-sectional study was conducted in enugu and kano states, nigeria. data were collected from 1659 purposively selected households using a pre-tested structured questionnaire. descriptive, bivariate, and multivariate analyses were employed to assess respondents’ socio-demographic characteristics and the factors influencing perceptions of corruption normalization in public healthcare settings.
RESULTS:
findings showed that residence in kano state (p = .002), living in semi-urban areas (OR = 0.66, p < .001), being male (OR = 0.32, p = .01), living with a spouse (OR = 0.47, p = .04), and lacking formal education (OR = 0.53, p = .03) were significantly associated with higher normalization of corruption. conversely, being a male head of household (OR = –0.40, p = .02) and utilizing district or general hospitals (OR = –0.38, p = .03) were associated with lower normalization tendencies.
CONCLUSIONS:
addressing the normalization of corruption is essential for fostering transparency, accountability, and people-centered healthcare delivery. targeted health promotion and governance interventions that address these social and behavioral determinants can strengthen health systems, enhance service quality, and accelerate progress toward U.H.C. in nigeria and similar contexts. community accountability mechanisms, such as local oversight committees, should be established at primary healthcare centers to increase transparency and reduce opportunities for informal payments.
corruption in the health sector remains a major impediment to achieving universal Health coverage (UHC) and strengthening health systems in low- and middle-income countries. In nigeria, corruption in the health sector has become increasingly normalized, eroding accountability, trust, and equitable access to healthcare. understanding which population groups are more likely to view corruption as normal is critical for designing effective anti-corruption and health promotion interventions. this study examined the demographic and contextual factors that influence the normalization of corruption among users of public health facilities in nigeria.
METHODS:
the cross-sectional study was conducted in enugu and kano states, nigeria. data were collected from 1659 purposively selected households using a pre-tested structured questionnaire. descriptive, bivariate, and multivariate analyses were employed to assess respondents’ socio-demographic characteristics and the factors influencing perceptions of corruption normalization in public healthcare settings.
RESULTS:
findings showed that residence in kano state (p = .002), living in semi-urban areas (OR = 0.66, p < .001), being male (OR = 0.32, p = .01), living with a spouse (OR = 0.47, p = .04), and lacking formal education (OR = 0.53, p = .03) were significantly associated with higher normalization of corruption. conversely, being a male head of household (OR = –0.40, p = .02) and utilizing district or general hospitals (OR = –0.38, p = .03) were associated with lower normalization tendencies.
CONCLUSIONS:
addressing the normalization of corruption is essential for fostering transparency, accountability, and people-centered healthcare delivery. targeted health promotion and governance interventions that address these social and behavioral determinants can strengthen health systems, enhance service quality, and accelerate progress toward U.H.C. in nigeria and similar contexts. community accountability mechanisms, such as local oversight committees, should be established at primary healthcare centers to increase transparency and reduce opportunities for informal payments.
| eISSN: | 2654-1459 |
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