This U4 Practice Insight examines a European Union–funded development programme to support the mainstreaming of transparency and integrity into the Colombian health sector in order to improve sector performance and recover public trust in the country’s health system. The project, ACTUE Colombia (Proyecto Anticorrupción y Transparencia de la Unión Europea para Colombia), provided comprehensive support to a multi-actor strategy aimed at reinforcing transparency and integrity instruments in health policies and institutions.

ACTUE Colombia sought to strengthen the anti-corruption capacities of Colombian state institutions through an approach that was comprehensive, sectoral, multi-actor, and transversal. Making use of strategic entry points in the pharmaceutical subsector, the project helped develop and test innovative initiatives related to drug price regulation and rational use of medicines. It also helped develop an institutional ‘island of integrity’ centred in the national food and drug oversight agency, Invima. The objective was to lay the foundations for a health sector transparency policy and to position transparency in the public debate on the country’s health system. ACTUE Colombia prioritised flexible responses to new opportunities and changing needs and sought to promote continuity during a change in national government.

The project led to important lessons learned. The door-opener approach through the National Pharmaceutical Policy generated a positive spill-over effect, promoting transparency in the health sector more broadly. ‘Radical’ transparency is necessary but not sufficient, and a set of corruption prevention measures applied jointly is key to transformative change (transparency, participation, accountability, conflict of interest management). Most of the transparency instruments had important potential for change, but coordination of the different elements was lacking, and monitoring of expected results fell short. And despite promising results, the initiatives faced challenges after a change of national government, which coincided with the closure of the project.

Based on this experience, the following recommendations for governments and donors are offered to guide similar integrity mainstreaming efforts at sector level.

Recommendations for governments

• Establish a high-level coordination function or mechanism for integrity at sector and institutional levels that will continue beyond a single political cycle.
• Use transparency measures as an entry point to promote transformative change, but complement these measures with mutually reinforcing integrity and accountability measures.
• Pursue institutional ‘island of integrity’ approaches in key health sector entities.
• Ensure the early involvement of intended users and beneficiaries in the design and implementation of the integrity/transparency initiatives.
• Guarantee regular budget allocations so that innovative initiatives can be sustained over time.
• Foster inter-institutional, intersectoral coordination between health sector and non-health sector entities.

Recommendations for development partners

• Ensure that the lifespan of anti-corruption projects or programmes transcends the term of a single government.
• Use general anti-corruption and integrity programmes to integrate a strong component aimed at mainstreaming anti-corruption/integrity in priority sectors, including health.
• Provide funding and technical support for assessments that yield independent information and knowledge about corruption and integrity initiatives in the health sector.
• Connect the dots and break down ‘silos’ so that integrity measures have real impact.
• Support meaningful compliance with integrity norms to strengthen health sector management.
• Ensure the creation and maintenance of a publicly accessible repository of information and knowledge.
• Support and work with relevant organisations in civil society, academia, and the private sector.
• Coordinate with other donor agencies for complementarity, drawing on comparative advantages of their respective focus areas and aid modalities.
• Ensure continuous high-level political support from the funding agency to promote change and foster sustainability of results.