22 August 2025 – Guest blog by Michele Coleman

Public procurement in the health sector is often riddled with corruption, particularly in low- and middle-income countries. While efforts like Open Contracting for Health (OC4H) have made strides to increase transparency, intentionally addressing gender equality in these efforts can get overlooked. A recent gender analysis study of the OC4H initiative in Zambia offers crucial lessons on how integrating gender can enhance anti-corruption outcomes, service delivery, and community empowerment.

How corruption and gender inequality intersect

Globally, it is estimated over $450 billion is lost to fraud and corruption in healthcare every year. In Zambia, public health scandals have drawn national attention, including the awarding of a $17 million medical supply contract to an unregistered company. These issues undermine healthcare delivery and disproportionately affect vulnerable populations, including women.

Yet, women are often left out of the solution. Barriers such as lack of financial resources, digital access, and decision-making power mean that women rarely benefit from or participate in public procurement. Public procurement is the purchase of goods and services by the government and accounts for up to half of government spending in low-to-middle-income countries. Addressing corruption here, such as through open contracting initiatives examined in this study, can have a staggering impact on outcomes. But without intentional inclusion, open contracting risks reproducing the very inequalities it seeks to resolve.

What we learned from OC4H in Zambia

OC4H was launched by Transparency International’s Global Health to increase transparency and reduce corruption in Zambia’s health sector. The initiative introduced digital procurement systems and trained various stakeholders to monitor procurement processes.

While OC4H was not initially designed with gender in mind, a retrospective gender analysis revealed several key insights:

• Training participation was skewed male. Across all sectors, men participated in training sessions at nearly double the rate of women.
• No gender-targeted outreach was made to engage women-owned businesses.
• Cultural norms and male-dominated networks continued to define who accessed tenders and contracts.
• Information was not made equally accessible—for example, by targeting markets or community spaces where women were more likely to be present.

Unsurprisingly, while women were well represented among the staff implementing OC4H, they were underrepresented in leadership roles within the government and private sector — where the real procurement decisions are made. One interviewee articulated this sentiment:

“Whatever pertains to decision-making, we find that it is male-dominated. When we go to users, it is female-dominated. We haven’t seen deliberate strategies that integrate women in decision-making.”

Women’s access to procurement opportunities: a missed step

Procurement is often viewed in terms of tangible assets: financial capital, registration, or infrastructure. But informants in Zambia emphasized that intangible assets, such as information and networks, were even more critical and more difficult for women to access.

While some women did attend OC4H trainings, no specific effort was made to close the gender gap. Even the electronic procurement system lacked gender-sensitive outreach, missing an opportunity to overcome barriers posed by traditional, male-dominated procurement networks. Moreover, tenders were typically advertised through platforms that many women may not access due to digital divides or time constraints. 

Why participation alone isn’t enough

While some women were involved in implementation roles and held leadership positions within the OC4H team, they were still underrepresented in decision-making roles in government agencies and the private sector. For example, district health officers were usually men, while women tended to occupy lower-status procurement roles.

Participation also doesn’t always translate into empowerment. As one informant shared:

“We don’t feel we have the capacity to do certain things… You start off and then in the middle of it, you just get discouraged.”

This reflects broader gender norms: men are often more encouraged (and expected) to pursue high-stakes business ventures, while women internalize limitations.

Empowering women empowers communities

Beyond individual benefit, empowering women in procurement has community-wide ripple effects. One male respondent in Zambia summarized it powerfully:

“If we encourage women to participate, we are empowering women, empowering the community, we are empowering the family… even the children stand a better chance in life.”

Studies show that when women have access to income and assets, they reinvest more in their families’ health and education, producing long-term societal gains.

What needs to change: Gender is not optional

The analysis highlighted that gender-blind policies — those that ignore differences between men and women — risk reinforcing systemic inequalities. To ensure women are not sidelined in anti-corruption efforts, the following actions are crucial:

• Apply a gender lens from the start. Design projects that consider the specific barriers women face.
• Collect gender-disaggregated data. Knowing who is participating (and who isn’t) is the first step to accountability.
• Engage women-owned businesses. Outreach and support are essential to level the playing field.
• Invest in training and leadership. Empower more women to occupy decision-making roles within procurement agencies.

Why this matters for anti-corruption efforts

Including women in public procurement isn’t just about fairness,  it’s about improving outcomes. Women tend to reinvest in families and communities, and their participation can strengthen trust and accountability in public systems.

Open contracting has the potential to make procurement systems more transparent and accountable. But for it to be truly transformative, it must be gender-responsive. Governments, NGOs, and funders must prioritize gender equality in every stage of public procurement reform.

Let’s not miss the opportunity to fight corruption and inequality at the same time.