Contribution and influence of social capital on corruption in the health sector: a view through the lens of service users

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BACKGROUND: The interplay between social capital and health system corruption in healthcare systems is underexplored, yet vital, a major barrier to advancing universal health coverage is underexplored. While social capital can support anticorruption by enabling collective action, it may also perpetuate corruption when networks are used to bypass procedures or access care unfairly. This study explores how social capital contributes to corrupt practices complex relationships play out in practice in Nigerian health facilities. METHOD: We conducted a cross-sectional study across two Nigerian states, surveying 1659 households using a pretested interviewer-administered questionnaire. A composite measure of social capital was developed from key variables. We examined the relationship between social capital and engagement in corrupt practices, controlling for variables such as gender, age, education and group memberships. Data were analysed using univariate, bivariate and multivariate methods. RESULTS: Among respondents, 60.3% were female, over 90% had formal education, and 75.6% lived with their spouse. Nearly half (49.6%) had experienced corruption when accessing healthcare. Of those who used connections to receive care, 11.8% did so specifically to secure treatment. Individuals relying on family and friends (69.7%) were more likely to engage in corruption, and those using political connections always did. Non-membership in professional associations and political parties significantly reduced the likelihood of corrupt behaviour by 57% and 36%, respectively (p<0.01). Active participation in religious organisations was linked to lower corruption, while involvement in political parties, governance structures and professional bodies increased the likelihood. Higher education was associated with a 90% increased chance of engaging in corrupt practices (p<0.01). CONCLUSION: Social capital has both enabling and constraining effects on corruption in Nigeria's healthcare system. Understanding its context-specific nature is crucial for designing effective anti-corruption strategies in health service delivery.

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