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Background and focus of the study

It is important to understand how corruption, climate change, and health intersect. Corruption and climate change add a double hit to health systems and public health outcomes. Climate-related stress weakens health systems’ preparedness and response capacities, contributing to an increase in illnesses, deaths, and displacements.61ee9865ff32 Additionally, corruption manifestations such as state capture, collusion, undue influence, embezzlement, and corruption in procurement, among others, cause detrimental inefficiencies in the health sector and contribute to unequal access to health services, which also adversely affect public health outcomes.cef104f1ac5a

Together, the climate-related costs to health systems and the losses already accrued by corruption in the health sector present a bigger challenge to attain Universal Health Coverage (UHC) by 2030. While the direct damage costs of climate change to health are estimated to be between US$ 2–4 billion per year by 2030fc7ddb8bc976; corruption is estimated to account for 10–25% of the global spending on public healthcare.601490a2defd

Building climate-resilient health systems is becoming an increasingly important issue in the global agenda on climate and health. At the COP 28, member states passed the first Declaration on Climate and Health, committing to several objectives, including ‘strengthening the development and implementation of policies that maximise the health gains from mitigation and adaptation actions and prevent worsening health impacts from climate change’.cc7819b19fe5 As the global uptake for climate adaptation strategies for health systems grows, it is important to identify the corruption risks that may arise from these efforts.

One of the most frequent interventions for strengthening health systems to climate change is the development of National Health Adaptation Plans (NAHP).a27c25bd18f8 80e917ef90c4 However, progress varies significantly across countries.61ef4638a7c1 As of 2024, only 27% of the 81 countries surveyed had completed or updated their NHAPs since 2020, while 49% had not yet developed any sector-specific plans. Moreover, the integration of anti-corruption measures and good governance practices within these plans is similarly inconsistent. Most NHAPs mention governance only in passing. Two exceptions are Tanzania and Bangladesh, which consider good governance as a key building block.c1b378b6a71a

Nonetheless, there is little evidence to date on how and whether anti-corruption, transparency and accountability (ACTA) has been successfully mainstreamed in NHAPs, and if their inclusion has contributed to mitigating corruption risks in the health sector. With this study, we aim to support bilateral donors and policymakers to enhance their anti-corruption efforts when designing, implementing, monitoring, and evaluating climate-related adaptation strategies for health systems. This is particularly relevant for their work in LMICs, where NHAPs have yet to start but donor funding for the climate-health nexus is already being disbursed and earmarked.

This study aims to develop one or two country case studies to explore how ACTA can be integrated into NHAPs and whether anti-corruption mainstreaming can help advance corruption mitigation practices in the health sector.

Research questions and lines of inquiry

This U4 study seeks to address the following questions by conducting one or two case studies of countries with clear ACTA commitments under their NHAPs.

1. What are the opportunities and challenges to integrate ACTA commitments in NHAPs?
2. To what extent can anti-corruption mainstreaming help mitigate corruption risks in the implementation of national adaptation efforts that seek to make health systems more resilient to climate change?
3. What lessons can be learned on ACTA mainstreaming in NHAPs, which can help countries currently developing their strategies?

The consultant will develop the draft study into a U4 Issue.73ed472fa3df The study will be supervised by U4’s thematic advisers Daniela Cepeda Cuadrado and Daniel Sejerøe Hausenkamph

Methodological approach

This study should develop one or two country case studies to explore how anti-corruption can be integrated into NHAPs and whether anti-corruption mainstreaming can help advance corruption mitigation practices in the health sector.

The methods will include (i) literature review/desk-based research on relevant documentation behind the development of the NHAPs; (ii) key informant interviews with stakeholders who have played a role in the design, implementation, and monitoring of the country’s NHAP. These informants are expected to be civil servants from the MoH, donor partners, and multilaterals such as the WHO.

In our research, U4 found that Bangladesh and Tanzania have ACTA commitments under the NHAPs. Therefore, we would like to propose the consultant(s) to work on either one or both countries. Nonetheless, applicants are also welcome to propose a different country that meets the same criteria.

The consultant(s) should outline their methodological approach and justify their selection of case study(ies) in the proposal.

Deliverables

Inception report

The selected consultant will be expected to submit an inception report with further details and information on the methodology, timelines, and overall approach to the study.

U4 Issue (publication)

The consultant will deliver a publication in the U4 Issue series of max. 10 000 words and a short version of up to 1 000 words, in line with U4’s publication policy and style guide.

We propose the following outline, but we also welcome applicants to propose a different outline that reflects their approach to the study’s lines of research in their inception report.

Introduction

Section 1. Relevance of this U4 Issue

1. Corruption and climate change: double hits affecting public health outcomes and health systems.
2. Corruption and climate change exacerbate health inequities across and within countries (gender and human rights considerations will be addressed here).
3. UEA Declaration of health and climate change without consideration of corruption vulnerabilities.
   

Section 2. The current state of the global outlook on climate and health

1. Discussion on mitigation vs. Adaptation, incl. development funding.
2. The impact of the declaration.
3. Lack of consideration of corruption risks.
   

Section 3. Climate-resilient health systems: National Health Adaptation Plans and potential to mainstream ACTA.

1. One or two case studies:
   1. Description of the NHAP and its ACTA commitments.
   2. Political Economy analysis to explain the process of ACTA mainstreaming (identification of challenges and windows of opportunity).
   3. From policy design to implementation: assessment of implementation of ACTA commitments within the NHAPs.
   4. Identification of other corruption vulnerabilities the NHAP may have not considered/integrated.
   5. Impact assessment of NHAPs’ ACTA efforts and lessons learned.

Recommendations

1. How to strengthen national health adaptation plans with an ACTA lens: Recommendations for health, climate and anti-corruption communities, as well as bilateral donors.

Reference list

Paper presentation (virtual event)

The consultant(s) will present the draft paper at a U4 Partner Forum, tailored to U4 partner agencies and their staff working on anti-corruption, health and/or climate action. The virtual session is expected to last for 1 hour, including a 30-minute presentation by the consultant; answering questions from the audience, engaging in an interactive discussion with participants, and taking their comments on board for the final version of the report. This session is tentatively planned for spring 2025.

Qualifications of the consultant(s)

• Substantial knowledge of climate initiatives in the health sector.
• Substantial knowledge of anti-corruption mainstreaming in climate and/or health programming.
• Substantial awareness and understanding of the aid sector, in particular bilateral and multi-lateral aid.
• Substantial knowledge and expertise of the political economy of Bangladesh, Tanzania, and/or any other LMIC country the applicant(s) would like to focus on.
• Demonstrated experience with structuring and conducting desk-based research, managing the logistics of and conducting semi-structured interviews as well as data collection and analysis.
• Demonstrated ability to produce clearly written, focused analysis and well-substantiated recommendations based on that analysis.

How to apply

We welcome proposals from companies or collaborating teams of individual consultants.

E-mail address
Please send your application/proposal electronically to u4@cmi.no

E-mail subject line
Please set thee-mail subject to: Application: Anti-corruption integration in NHAPs

Deadline
Please send your application/proposal on or before 15 August 2024.

Documents
We will only consider applications that contain all of the following documents:

1. Curriculum Vitae with two (2) references and a list of similar assignments undertaken.
2. A cover letter detailing relevant experience and suitability for the post.
3. Technical and budget proposal with a clear methodological approach, clear outline, description of the work plan, and itemised budget (with all-inclusive consultant(s)’ fees).
4. Sample of a relevant text written by the applicant(s).

Timeline and milestones

Data collection and protection

The consultant will conduct interviews based on semi-structured questionnaires. The consultant will develop these questionnaires in close consultation with the U4 adviser.

The research follows a do-no-harm policy, caring about not divulging confidential information and avoiding any disruption of work for interviewees. It respects the General Data Protection Regulation (GDPR), ensuring respect for personal privacy, the voluntary basis for participation and the right for participants to access data.

About CMI and U4

The Chr. Michelsen Institute(CMI) is an independent multi-disciplinary development research institute in Norway addressing issues that shape global development and generating knowledge to fight poverty, advance human rights, and promote sustainable social development.

The U4 Anti‐Corruption Resource Centre(U4) was established at CMI in 2002 to promote a better understanding of anti‐corruption issues and approaches to international development. At U4, we work to reduce the harmful impact of corruption on society by sharing research and evidence to help international development actors get sustainable results. We communicate practical entry points for countering corruption – through dialogue, publications, online training, workshops, and a helpdesk.

Questions?

Please send any questions you may have to the coordinating CMI–U4 advisers for this consultancy assignment:

Daniela Cepeda Cuadrado, daniela.cepeda@cmi.no and Daniel Sejerøe Hausenkamph, daniel.hausenkamph@cmi.no

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