Claudia Baez Camargo (Head of Prevention, Research & Innovation, Basel Institute on Governance) and Dina Balabanova, Professor of Health Systems and Policy, London School of Hygiene and Tropical Medicine share early insights from research on Malawi’s crisis responses, examining how health and climate emergencies amplify corruption risks – and what practical, low-cost safeguards could look like.
Corruption in the health sector is driven by weakened institutions, entrenched interests and pervasive social norms – this is often seen as a part and parcel of the routine practices in many countries. Yet crises (disease outbreaks, climate emergencies etc.) are an increasing threat to global health. Many low- and middle-income countries (LMICs) suffer from successive and chronic crises, while high-income countries have faced unexpected and high-impact crises. When a crisis strikes, opportunities for corruption are heightened and new corrupt practices emerge, compromising the effectiveness of the response and leading to loss of life and depleted resources.
When Malawi faced a combination of the COVID‑19 pandemic, raging cholera outbreaks and the devastating Cyclone Freddy, the country’s disaster response and health systems were stretched to their limits. Amid the scramble for resources and relief efforts, new and old forms of corruption threatened to derail life‑saving actions. This research project seeks to examine these hidden patterns and chart a way forward. Below, we unpack the emerging findings and why they matter, as well as proposing some ideas about what practical steps they point toward.
Corruption during Crises: Why does it Matter?
Corruption – the abuse of entrusted power for private gain – can take many forms such as bribery, embezzlement, nepotism, and fraud. In a crisis, the same actions can become even more damaging because:
- Lives are at stake – missing or diverted aid inputs and medicines can mean the difference between saving lives and preventable casualties.
For example, during the COVID 19 crisis, protective gear was sometimes diverted and did not reach the health workers providing care to infected patients, putting them at an unnecessarily high risk. This not only endangered their personal safety but also compromised the overall response, as sick or absent caregivers were unable to tend to infected patients. - Equity is lost – those already vulnerable (the poor, rural communities) are the most likely to be ignored or cheated.
For example, during the cholera outbreaks, wealthier patients were given preferential treatment, even being treated at their homes, whereas lower income patients were forced to stay in inadequately equipped quarantine centers and without food and family support. - Trust erodes – people may stop seeking care or essential commodities, following public‑health advice or, ultimately, trusting the state and its institutions.
For example, victims of Cyclone Freddy described feeling hopeless after being added to lists of eligible relief recipients but then failing to receive any of the incoming resources.
Therefore, understanding which kinds of corruption appear, how they manifest, and where they are most likely to happen is a critical first step to strengthening the crisis response capability of the state, generally, and the health system, particularly.
How the Study is Being Done
The project focuses on three crises that Malawi has experienced in recent years, namely: the COVID‑19 pandemic, the recurrent and increasingly aggressive cholera outbreaks and Cyclone Freddy. Each of these crises had unique characteristics and the nature of the crisis response – the types of inputs needed to provide relief to victims – differed. For example, for the COVID-19 pandemic, an emphasis was on preventive measures and specialised health services requiring dedicated wards with oxygen services and procurement of vaccines. Whereas for the cholera outbreaks, in addition to medical services, there is need to procure a variety of sanitation inputs such as buckets for clean water and chlorine for water purification. For Cyclone Freddy, the response involved providing help to displaced populations, ensuring they had access to medical care, lodging, food supplies etc.
Bearing these differences in mind, the project has set out to identify how corruption has been experienced, querying whether the types of corruption will vary depending on the nature of the crisis and whether they are patterns of corruption unique to crises or rather mirror the corruption that occurs during non-crisis times in health systems.
To find answers to these questions, the project has conducted:
- Qualitative interviews – 95 interviews with key respondents, including members of the Malawi Red Cross, police, health‑care workers, patients and community members who survived the crises, managers and community actors.
- Theoretical framing – a theoretical framework of corruption in crises has guided the qualitative analysis, ensuring that patterns can be identified in a rigorous manner.
- Additional AI-assisted analysis – To make the most of the wealth of data that has been collected, AI-assisted queries on corruption typologies and associated drivers complement the human-led analysis of data.
The work is still in progress, but the first wave of insights is illuminating.
Crisis-Specific Corruption and Corruption that Emerges during all Crises
The preliminary analysis shows that during COVID 19; bribery was particularly acute – for example in relation to accessing services and obtaining vaccine certificates. Similarly, during the response to Cyclone Freddy, reports of sexual corruption were recorded in a manner not seen during the other crises.
The analysis has also uncovered that there are certain types of corruption that happened across all three crises. Because they are recurring across COVID, cholera and Cyclone Freddy, they underscore that the disaster response and health system’s vulnerabilities are systemic rather than event‑specific. These forms of corruption that arise across all forms of crises are:
- Diversion of Resources appears to be pervasive and takes place through different forms of fraud (e.g. manipulating lists of victims and inflating budgets) or outright theft. Often favouritism and clientelism drive these practices, as when relief items are non-transparently redistributed by powerful locals to friends, relatives and political clients.
- Unnecessary Training and Allowance Abuse are another common form of fraud. During cholera outbreaks health workers demand training on skills they already have for the purpose of receiving allowances. During COVID, it was reported that high-level public officials signed up to perform basic janitorial functions just to receive allowances (which they would accrue according to their seniority level).
- Bribery Health workers and relief workers receive money in exchange for services and access to relief materials. Sometimes the bribe extorted is of a sexual nature, as observed in camps for internally displaced victims.
- Abuse of Position Misuse of entrusted power (or neglect of duty) was a cross-cutting theme intersecting with other types of corruption. This included authorities and staff seeking to benefit from the crisis – for instance, some officials allegedly diverted aid to benefit their political and social networks (e.g. sending supplies to areas they favoured or using ambulance fuel for private errands). In other cases, staff neglected their duties and did not attend patients, officials delayed responding to emergency needs or various responders selling goods and emergency supplies.
Why Does Corruption Happen?
The emerging findings also shed light on some of the underlying factors that incentivise and enable corruption to happen. These include:
- Crisis management and health systems weaknesses
- Staff are overwhelmed with work and not properly compensated
- Sudden inflows of aid without sufficient capacity to control its appropriate use
- Lack of ongoing crisis preparedness embedded in routine systems
- Emergency procurement loopholes, where the timeline for vetting of single-source and high-value tenders is unrealistically short
- Lack of donor coordination.
- Socio-political relationships
- Patient-initiated corruption when people believe bribing is the only way to be helped
- Abuse of authority of community leaders arising from the desire to sustain patronage networks
- Fear due to misinformation and myths.
Turning Findings into Action
In the next project phase, we will co-design, implement and evaluate interventions that could curb corruption in future crises. The emerging findings suggest the desirability of designing interventions at the community level but linked to structures and processes at district and national level. This is likely to include strengthening management systems, including real-time data to identify needs and to rationalise the management of resources and relief inputs in a transparent manner for accountability purposes. This will also require oversight by coalitions of actors to prevent dominant interests distorting emergency relief, and embedding anti-corruption measures in crises responses.
Why Policymakers Should Care
- Health outcomes – Better management of crisis relief inputs directly translates into fewer preventable deaths.
- Economic cost – Corruption inflates the cost of emergency aid, diverting funds that could support long‑term health infrastructure.
- Resilience-building – By institutionalising anti‑corruption measures, Malawi can transform its crisis response into a model for other low‑ and middle-income countries.
In short, tackling corruption is not a “nice‑to‑have” – it is a public‑health imperative with direct impact on lives and wellbeing of the population.
Looking Ahead
The project is still underway, but the early findings already have a clear message: if we want Malawi’s health system to withstand future shocks, we must embed transparency and accountability and effective anti-corruption measures into its very core. After the co-production, the research team plans to pilot some of the intervention components in select districts over the next 12 months and will publish a comprehensive report by mid-2026. We will convene national and international validation exercises to interpret the findings and ensure that they impact on international processes.
For the people of Malawi, and for anyone watching how health and climatic crises unfold worldwide, these findings remind us that the emergency management and health systems of a country are the backbone for ensuring equity in those times of most need, protecting the most vulnerable from unnecessary suffering.
This blog draws on the GI ACE project “Addressing corruption in the crisis response of the Malawian health system”. Find out more about the project here.