whistleblowing in the public sector a systematic literature review

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Article contents

Policy significance statement.

• Introduction
• Literature Review on Whistleblower Protection
• Case Studies
• New Index for Evaluating the Effectiveness of Whistleblower Protection
• Conclusions

Funding statement

Competing interest, author contribution, data availability statement, evaluating the effectiveness of whistleblower protection: a new index.

Published online by Cambridge University Press:  15 August 2023

Many international organisations have recently acknowledged the significance of whistleblowing in preventing institutional corruption, particularly in the public sector. Likewise, many countries have enacted whistleblower protection laws, though a robust whistleblower protection system certainly requires much more than legislation. One challenge in developing effective protection systems is finding empirical evidence to evaluate existing systems. Can we measure the effectiveness of whistleblower protection systems accross different countries? What conditions do we need to make the whistleblower protection system work effectively in the public sector? This paper investigates two cases: South Korea and the Republic of Kosovo. South Korean data comes from the Anti-Corruption and Civil Rights Commission of South Korea, while its counterpart from Kosovo comes from a survey of 400 public officials about whistleblower protection. By analysing both datasets, this paper creates a new index that evaluates the effectiveness of whistleblower protection. Composed of quantitative and qualitative sub-indices, the index serves as a digital comparison tool for assessing whistleblower protection systems across different countries and at different times. In addition to enacting high-quality laws, this index identifies several additional measures that can strengthen whistleblower protection systems in the public sector.

Whistleblower protection systems vary accross countries based on traditions, scope, and national legislation. Due to the sensitive nature of whistleblowing, the standards for evaluating whistleblower policy effectiveness often remain vague. By examining institutional history, legislative content, and the institutions responsible for protecting whistleblowers in two case studies-South Korea and the Republic of Kosovo- this article proposes a new index to assess the effectiveness of whistleblower protection in the public sector. As a composite measure, the index facilitates cross-country comparison and can compare whistleblower protection levels in a specific country over time. The index provides methods for creating, locating, and sharing standardized data that are that are either missing or not easily accessible in different countries.

1. Introduction

Corruption presents a complex challenge for public sector organisations as it damages policy objectives and diminishes trust, especially when institutional corruption undermines the organisations themselves (Graycar, Reference Graycar 2020 ; Thompson, Reference Thompson 2017 ). Globally, many anti-corruption actors have failed to combat corruption effectively in recent decades. Current policy typologies mainly focus on dimensions such as types of tools, mechanisms of prevention, and intervention (Villeneuve et al., Reference Villeneuve, Mugellini, Marlen and Graycar 2020 ). Renewed progress is possible, but it requires new strategies stressing justice, fairness, and genuine reform (Johnston & Fritzen, Reference Johnston and Fritzen 2020 ).

To that end, international organisations like the World Bank, the United Nations, the European Commission, and the Council of Europe, among others, have reaffirmed the significance of whistleblowing as a tool, mechanism, system, and activity for preventing wrongdoing in the public sector. According to the International Organization for Standardisation (ISO) 37002: 2021 , whistleblowing is defined as reporting suspected or actual wrongdoing. In the last decade, many cases have showcased the tremendous impact that whistleblowing may yield on international issues (Di Salvo, Reference Di Salvo 2020 ). Yet so far, whistleblowing has been mainly considered as a reporting procedure (Fotaki, Reference Fotaki and Graycar 2020 ).

The United Nations Convention Against Corruption (UNCAC) encourages state parties to consider incorporating into national legislation appropriate measures to protect any person who reports in good faith, any facts concerning offenses (United Nations Office on Drugs and Crime, 2004 ). In June 2021, the United Nations held its first special session of the General Assembly against corruption, UNGASS, which approved the Political Declaration by the UN General Assembly, a document emphasizing the link between whistleblowing and anti-corruption efforts (United Nations General Assembly, 2021 ). The adoption of the Political Declaration followed a joint statement issued by the G7 UK ( 2021 ) countries condemning recent attacks on whistleblowers, media, and civil society for standing up against corruption.

As documented by Thüsing and Gerrit ( Reference Thüsing and Gerrit 2016 ) in the European Union, laws of Member States vary in their definitions of whistleblowers. The European Commission’s adoption of the EU Directive 2019/1937 on the Protection of Persons Who Report Breaches of Union Law (henceforth, the EU Directive) constituted a new opportunity to harmonize whistleblower legislation among member states. More momentum emerged when the Council of Europe and the Congress of Local and Regional Authorities adopted Resolution 444 on Protection of Whistleblowers: Challenges and Opportunities for Local and Regional Governments, calling upon local and regional authorities in the EU to establish whistleblowing policies aligned with the EU Directive. This Directive was scheduled for transposition into the national legislation of the EU member states by 17th December 2021, but it was delayed (Whistleblowing International Network, 2023 ). Soon afterwards, the European Commission issued formal notices to 24 Member States for their lack of transposition.

The UNCAC Coalition of civil society organizations has proposed several measures for implementing the Directive more effectively. Specifically, they have called upon State Parties to establish whistleblower protection systems that go beyond the standards introduced by the EU Directive: States should establish a fund to grant whistleblowers legal, financial, and psychological support. Further, they recommend monitoring and constant improvement of whistleblower protection mechanisms, particularly by tracking and transparently reporting the number of whistleblower reports filed and their respective follow-up actions (UNCAC Civil Society Coalition, 2022 ). In December 2022, the United States Congress passed the Anti-Money Laundering Whistleblower Improvement Act, a bill reforming the management of the financial rewards for whistleblowers, by establishing the minimum award “not less than 10%” whistleblowers may obtain of the collections by enforcement actions (US Congress, 2022 ).

Measuring the effectiveness of whistleblower protection is a complex task, as it depends on factors like the country’s legal framework, cultural context, and level of support for whistleblowing from the government and broader society. To better understand these factors, this paper conducts a comparative study of two cases: South Korea and Kosovo. Specifically, the Anti-Corruption and Civil Rights Commission of South Korea produces datasets that provide valuable information on the legal framework, the number of complaints, and the outcomes of the cases. By analysing these datasets, we can gain insights into the strengths and weaknesses of the South Korean system and how it compares to other countries. To complement the South Korean data, we also examine survey data from 400 public officials in Kosovo about whistleblower protection. This survey provides a unique perspective on the attitudes and perceptions of public officials towards whistleblowing, as well as their experiences with the system. By combining this information with data on Kosovo’s legal framework and the outcomes of whistleblowing cases, we can get a more comprehensive view of the situation in Kosovo.

Based on the analysis of both datasets, this paper creates a new index, called the Index for Evaluation of Whistleblower Protection (IEWP), to compare the present levels of whistleblower protection across countries, as well as to compare those levels over time in the same country. Because enacting whistleblower protection laws is not enough to protect whistleblowers, utilizing the IEWP can help governments build and maintain more effective whistleblower protection systems.

2. Literature Review on Whistleblower Protection

The nature and mechanisms of whistleblower protection vary in different countries, often based on jurisdictional differences regarding the provision of options, channels for reporting, and the scope of protection for parties and family members (Vinciguerra, Reference Vinciguerra 2018 ). Overall, whistleblower protection supports employees who wish to report corruption, fraud, or wrongdoing (Organization for Economic Cooperation and Development, 2016 ). Such protection must be meaningful and incorporated into organizational structures and policies (Fotaki, Reference Fotaki and Graycar 2020 ). In line with international principles for whistleblower legislation developed by Transparency International ( 2013 ), reporting channels must be clearly defined to facilitate disclosure, and to promote confidence in the system (Organization for Economic Cooperation and Development, 2016 ).

Up to 2015, scholarship on whistleblowing in organizations mainly drew on power and motivation theories. Later Later work has covered the impact of digitalization, particularly on the regulation of data protection and the privacy of whistleblowers. Because whistleblowers are often perceived as spies (Near and Miceli, Reference Near and Miceli 1985 ), leakers, and informers (Schwartz, Reference Schwartz 2019 ), they may not be supported by the public. As a result, individuals tend to show reluctance to report corruption because of adherence to the loyalty-betrayal paradox (Gottschalk, Reference Gottschalk 2018 ). The need to dissociate whistleblowing from organizational disloyalty constitutes an increasing emphasis on developing effective mechanisms (Fotaki, Reference Fotaki and Graycar 2020 ).

Developing protocols to ensure the confidentiality and anonymity of whistleblowers has been a top priority for mitigating the risk factors associated with retaliation (United Nations Office on Drugs and Crime, n.d. ). As recommended by the OECD ( 2016 ), laws should provide comprehensive protection against discriminatory or retaliatory personnel action, including harassment at the workplace, job demotion, reprisals, and reduction of job benefits. The Global Business Ethics Survey of 2020 found that globally, a median of 61% of employees experienced retaliation after reporting misconduct in their organizations—whether in government, for-profit, or not-for-profit sectors (ECI, 2021 ).

To assess effective whistleblowing, five factors are especially relevant: 1) the types of whistleblowing, 2) the role of mass media, 3) evidence, 4) retaliation, and 5) legal protection (Apaza and Chang, Reference Apaza, Chang, Apaza and Chang 2020 ). Roberts ( Reference Roberts 2014 ) similarly identified six categories of motivations that influence perceptions of the effectiveness of disclosures: personal, public, private, ethical, contextual factors, and psychological factors. In examining the role of societal culture in whistleblowing, scholars have highlighted the need to distinguish between disclosures of perceived wrongdoing that are in the interests of the powerful and those that serve to curb the abuse of power. (Vandekerckhove et al., Reference Vandekerckhove, Uys, Rehg and Brown 2014a , Reference Vandekerckhove, Brown and Tsahuridu b ). However, insufficient attention has been paid to managerial responses to whistleblowing (Vandekerckhove et al., Reference Vandekerckhove, Uys, Rehg and Brown 2014a , Reference Vandekerckhove, Brown and Tsahuridu b ).

2.1 Evaluating whistleblower protection effectiveness

A recent study by The Government Accountability Project and the International Bar Association analysed legislation on whistleblower protection and its enforcement in 37 countries (Feinstein et al., Reference Feinstein, Devine, Pender, Allen, Nawa and Shepard 2021 ). This study systematically examined publicly available decisions on cases brought by whistleblowers, in terms of retaliation claims, channels of reporting, and the documented remedies. The authors concluded that the development of the legal framework regulating whistleblower protection does not guarantee the protection of whistleblowers’ rights: “A duly functioning judicial and enforcement ecosystem is equally important as the existence and enforcement of legislation”. Moreover, limited access to information remains a key challenge for assessing the effectiveness of whistleblower protection and the importance of transparency about case outcomes. One option is to publish case decisions online in searchable databases (Feinstein et al., Reference Feinstein, Devine, Pender, Allen, Nawa and Shepard 2021 ). Other scholars compared various whistleblower protection laws to evaluate their effectiveness in protecting whistleblowers. For example, Bowden ( Reference Bowden 2006 ) analysed the legislation and implementation of whistleblower protection in Australia, the UK, and the US, and found significant variations among Australian states. He argued that more protections should be implemented. In addition, his paper compared the rationale for whistleblower legislation in the three countries and found that they have different approaches, such as the UK using public funds to help whistleblowers and the US granting whistleblowers the right to sue. Bowden ( Reference Bowden 2006 ) concluded that, although more whistleblower protection should be implemented in Australia, overall Australian laws worked better than those in the UK and the US.

Chordiya, Sabharwal, Relly, and Berman ( Reference Chordiya, Sabharwal, Relly and Berman 2020 ) also conducted a cross-national study including Mainland China, Malaysia, Taiwan, and the US. They examined the factors that impact employees’ perceived levels of protection within an organization after whistleblowing, based on survey data from senior employees, supervisors, and lower managers in all four countries. Specifically, they considered the role of ethics-oriented climates, ethical leadership behaviours, structural provisions for ethics management, and awareness of whistleblower protection laws in enhancing employees’ perceived protection. They found that awareness of whistleblower protection laws positively impacted perceived organizational protection for whistleblowers in all four countries. An ethics-oriented climate was effective in improving perceived protection in Mainland China, Malaysia, and the United States, while ethical leadership had a positive impact in Mainland China, Taiwan, and the United States. Structural provisions such as mandatory ethics training and codes of ethics or standards of conduct positively impacted perceived protection in the United States but negatively impacted it in Taiwan. Personal and situational factors, including the perceived likelihood of retaliation and the perceived ability to effectively report wrongdoing, also significantly influenced employees’ decisions to whistleblow.

Some scholars believe that whistleblower protection law cannot be truly effective. For example, Martin ( Reference Martin 2003 ) argued that whistleblower legislation is often ineffective and can even create an illusion of protection that is dangerous for whistleblowers. He suggested whistleblowers should develop practical skills like understanding organizational dynamics, collecting data, writing coherent accounts, building alliances, and interacting with the media instead of relying on official procedures, laws or ombudspersons. He argued that the value of such skills constitutes the focus of official procedures. Promoting the development of these skills can be a more effective way to empower and protect whistleblowers (Martin, Reference Martin 2003 ).

Providing comprehensive guidance for whistleblower legislation, 30 principles developed by Transparency International ( 2018 ) seek the goal of robust protection of whistleblowers against all forms of retaliation. To date, no law on whistleblowing aligns fully with the 30 Transparency International principles (Transparency International, 2018 ).

Relevant gaps in this literature include what differentiates actual whistleblowers from those who observe wrongdoing but do not report it (Vadera et al., Reference Vadera, Aguilera and Caza 2009 ). The Whistleblower Index (Vinciguerra, Reference Vinciguerra 2018 ) sought to explore the correlation between whistleblower protection legislation and national levels of corruption and bribery. Constraints to researching whistleblowing in organizations often include access to relevant data (Chiu, Reference Chiu 2003 ; Mesmer-Magnus and Viswesvaran, Reference Mesmer-Magnus and Viswesvaran 2005 ). In Poland, for example, it is not known how many cases of whistleblowing are filed each year (Blueprint for Speech, 2018a , b ). Blueprint for Free Speech has published EU country briefing papers on whistleblowing laws (2018). Briefing papers on individual countries contain introductory information on the following: legislation, institutions, and procedures, ongoing developments related to whistleblowing, available data and statistics on cases, public perceptions’ trends, national capacities, and knowledge centres.

Noting the lack of a measure for the efficacy of whistleblowing across jurisdictions, Goel and Nelson ( Reference Goel and Nelson 2014 ) developed an internet-based measurement of whistleblower awareness. They found that awareness of whistleblowing was relatively more effective for disclosing corruption compared to the quality of the legislation itself. However, any assessment of the effectiveness, impact, and sustainability of anti-corruption interventions should consider whether that intervention aligns with the latest and local thinking on corruption (Wathne, Reference Wathne 2022 ). According to a research brief by the IBM Centre for the Business of Government and the IBM Institute for Business Value ( 2022 ), agile methods like user-driven design, evidence-based solutions, and iterative workflows can help many agencies and departments improve the outcomes of their policies, regulations, and programs.

3. Case Studies

As described above, this study investigates two countries: South Korea and the Republic of Kosovo. There are several reasons for selecting these two countries. First, it is relatively easy for the authors––due to their professional backgrounds––to access relevant datasets on whistleblower protection. Second, these two countries contrast in significant ways. While South Korea is now a developed country, Kosovo is still a new country: it declared its independence in 2008. In the Corruption Perceptions Index 2022, South Korea was ranked 31st with a 63 score, but Kosovo was ranked 84th with a 41 score (Transparency International, 2023 ). Since these two countries also have different governance capacities, we can explore the different levels of whistleblower protection in different situations. Finally, this comparison enables us to find ways to effectively improve whistleblower protection. We can understand what we should do to protect whistleblowers effectively. Although the datasets are different enough to prevent a direct comparison, we can make a rough comparison that indicates what is missing from whistleblower protection in each country.

To that end, this paper explores the following research questions: Q1) Can we measure the effectiveness of whistleblower protection in different countries? Q2) What conditions do we need to make a whistleblower protection system work effectively in the public sector?

Assumptions for analysing the South Korea data:

• Data are either lacking or not available on the following: IEWP qualitative sub-indices such as perceptions of public officials, experts, citizens, and whistleblowers, as well as experiences of whistleblowers.

Assumptions for analysing the Republic of Kosovo data:

• Data are either lacking or not available on the following: IEWP quantitative sub-indices such as rates (of requests and acceptances) for protecting whistleblowers, and 2) qualitative sub-indices, such as perceptions of experts and citizens, as well as experiences of whistleblowers.

3.1 South Korea

In this section, we evaluate the effectiveness of whistleblower protection in South Korea. We will then delve into the Act on the Prevention of Corruption and the Protection of Public Interest Whistleblowers, and conclude the section by illustrating the state of whistleblower protection in South Korea by using relevant datasets.

The ACRC is not the first anti-corruption agency in South Korea: its forerunner, the Korea Independent Commission Against Corruption (KICAC), was established in 2002. President Kim Dae-jung, who led South Korea from 1998 to 2002, wanted to differentiate himself from former political leaders and demonstrate his commitment to fighting corruption by vigorously adopting and implementing anti-corruption policies (Ko & Cho, Reference Ko, Cho, Zhang and Lavena 2015 ). As part of these efforts, he promoted the Anti-Corruption Act, established in 2001, which provided the legal basis for the KICAC (Göbel, Reference Göbel, Sousa, Larmour and Hindess 2008 ). Kim Dae-jung’s successor, President Roh Moo-hyun (2003–2007), was also interested in fighting corruption (Min, Reference Min, Han, Pardo and Cho 2022 ). In 2004, he launched the Consultative Council of Anti-Corruption Affiliated Agencies and held council meetings to decide how to curb corruption (ACRC, 2020 ). The KICAC organized and operated the council (Min, Reference Min, Han, Pardo and Cho 2022 ). Therefore, the KICAC played a crucial and leading role in the fight against corruption in South Korea.

In 2008, President Lee Myoung-bak (2008–2012) abolished the Consultative Council of Anti-Corruption Affiliated Agencies and established the Anti-Corruption and Civil Rights Commission (ACRC) as the successor to the KICAC. The ACRC integrated the KICAC, the Ombudsman of Korea, and the Administrative Appeals Commission (ACRC, 2021 ). The ACRC is responsible for dealing with corruption cases, complaints, and administrative appeals.

In this role the ACRC has prepared several bills related to fighting corruption, including the Protection of Public Interest Whistleblowers (2011) and the Improper Solicitation and Graft Act (2015) (Min, Reference Min, Han, Pardo and Cho 2022 ). The ACRC has also implemented various anti-corruption entities, such as the Anti-Corruption Policy Consultative Council, established in 2017 as the successor to the Consultative Council of Anti-Corruption Affiliated Agencies (ACRC, 2020 ). In 2017, the ACRC also developed the Integrity Assessment tool, which estimated the level of corruption in more than 500 public agencies (ACRC, 2017 ). It has also adopted and implemented various anti-corruption policies, mainly under the Act on the Prevention of Corruption. This Act outlines the structure and function of the ACRC. According to the Act, the ACRC can handle complaints and corruption cases and implement anti-corruption policies. Additionally, the ACRC can recommend that public organizations consider improving their institutional weaknesses against corruption.

The Act includes several articles related to whistleblower protection measures, including guarantees for the whistleblower’s position, physical safety, confidentiality, prevention of disadvantages, and rewards. According to Article 62-2 of the Act, whistleblowers can ask the ACRC to take action to maintain their status in their organizations. Article 64-2 allows whistleblowers to request safety from the ACRC, which can then ask the police to provide protection. Article 64 prohibits the disclosure of whistleblowers’ personal information, while Article 62 prohibits any disadvantageous actions against whistleblowers. Finally, according to Article 68, if whistleblowers help public agencies achieve property gains or prevent damage, the ACRC can recommend that they be granted monetary rewards.

The Protection of Public Interest Whistleblowers Act also has similar provisions for protecting whistleblowers in cases related to the public interest. According to Article 17 of the Act, whistleblowers can ask the ACRC to take action to maintain their status in their organizations. Like the Act on the Prevention of Corruption, Article 13 allows whistleblowers to request safety from the ACRC, which can then ask the police to provide protection. Article 12 prohibits the disclosure of whistleblowers’ personal information, and Article 15 prohibits any disadvantageous actions against whistleblowers. Finally, according to Article 26-2, if whistleblowers help to achieve property gains or prevent damage, the ACRC can recommend that they be granted rewards.

The ACRC has used both Acts to protect whistleblowers. The protection request rate, calculated by dividing the total number of protection requests by the total number of corruption reports, is shown in Table 1 as an overall trend from 2011 to 2020. Although it decreased in 2016 and 2017, the number of petitions for protection has usually climbed over this time. In 2011, there were 11 requests for protection; in 2020, there were 124. From 2,529 in 2011 to 4,428 in 2020, the number of reports of corruption also grew. However, it varied between 2016 and 2017. Since 2016, the total number of requests for protection has often increased faster than the total number of reports of corruption.

Table 1. Request rate of South Korea from 2011 to 2020

Table 2 shows the trend of the protection acceptance rate, i.e., the number of accepted protection requests divided by the number of total protection requests from 2011 to 2020. The number of accepted requests decreased from 2012 to 2015 and then increased from 2016 to 2020. In 2016, the acceptance rate was 10, while in 2011 and 2012, it was higher than 5. However, it was below 4 in the other years.

Tables 1 – 3 and Figure 1 show the acceptance rate, request rate, and rates for protecting whistleblowers, respectively, from 2011 to 2020. In 2012, the rate for protecting whistleblowers was 10.71. It decreased from 2012 to 2015, but in 2016, it increased slightly due to the peak acceptance rate. From 2017 to 2020, the rate for protecting whistleblowers increased mainly due to the increasing request rate.

Table 2. Acceptance rate of South Korea from 2011 to 2020

Figure 1. Rates for protecting whistleblowers trends in South Korea from 2011 to 2020.

Table 3. Rates for protecting whistleblowers in South Korea from 2011 to 2020

The results of this analysis provide some meaningful insights:

1. South Korea should increase the number of requests for protection. A low number of requests could be due to a few reasons: reporters of corruption may not feel that they need protection, they may not be aware that the Act can protect them, or they may not believe that the Act can adequately protect them. If the low number of requests for protection is related to the second or third reasons, increasing the number of requests for protection could increase the number of reports of corruption. The increasing number of requests for protection positively correlates with the high request rate when the number of corruption reports remains constant. Since the number of these reports has increased, the number of requests for protection should increase faster than the number of reports of corruption.

2. The number of accepted requests should increase faster than the number of requests for protection. If this happens, both the acceptance and request rates can increase simultaneously. In 2016, for example, the acceptance rate was high, but the request rate was low. This trend is not ideal for effectively protecting whistleblowers. Therefore, both the number of accepted requests and the number of requests for protection should increase simultaneously, but the former should grow faster than the latter.

3. South Korea has already implemented various institutions for protecting whistleblowers, but it is still being determined whether these measures are working properly. Whistleblowers may not feel that these measures are sufficient to protect them adequately. To measure the effectiveness of whistleblower protection, we need a survey that helps us measure the perceptions and experiences of whistleblowers over a certain period.

3.2 Republic of Kosovo

As the youngest country in the Western Balkans, the adoption of anti-corruption policies was linked with Kosovo’s progress toward membership in the European Union. The first law aiming to regulate whistleblowing in the public sector, the Law on the Protection of Informers in Kosovo, was enacted in 2011 but it lacked clarity on many aspects related to its implementation (Fol, Reference Fol 2017 ). Seven years later, in 2018, the Kosovo Parliament approved a new Law on the Protection of Whistleblowers No. 06/L-085 (henceforth, LPW). The LPW regulates the whistleblower protection system for the public and private sectors in the country. In line with the research objectives of this article, our analyses focuses on the public sector domain.

Article 3 of the LPW defines a whistleblower as any person who reports or discloses information on a threat or damage of public interest within the context of their employment relationship in the public or private sector. Adopted in 2018, one year before the approval of the EU Directive on Protection of Persons Reporting Breaches of the European Union Laws, the LPW is in line with the principles for whistleblower legislation by Transparency International ( 2018 ). Like the EU Directive, the LPW provides three channels for reporting wrongdoing in the public sector: internal, external, and the public.

Under Article 5, the LPW scope protects reporting and disclosures on the following forms of wrongdoing: offences, failure to comply with legal obligations, miscarriage of justice, endangered health and safety, damage to the environment, misuse of official duty/authority/public resources, discriminatory/oppressive/negligent acts or omissions constituting mismanagement, and information concealed or destroyed concerning the abovementioned disclosures.

Article 13 of the LPW stipulates that (a) internal whistleblowing is disclosing wrongdoing information to the official responsible for receiving such reports inside the organization, (b) the Kosovo Anti-Corruption Agency is responsible for receiving external whistleblowing cases, (c) public whistleblowing is disclosing information to the media, to civil society or to any public meeting. In the context of this research, it is relevant to note that in July 2022, with the entry into force of the new Law 08/L-017, the Kosovo Anti-Corruption Agency mandate was altered into the Kosovo Agency for Prevention of Corruption.

According to an analysis published by the Regional Anti-corruption Initiative ( 2021 ) the LPW stands in substantial compliance with the EU Directive standards concerning the rights of whistleblowers, with some minor exceptions. Like South Korea’s legislation, Article 7 of the LPW grants the whistleblowers the right to protection of their identity. Additionally, whistleblowers are guaranteed the right to the confidentiality of reported information sources.

The LPW similarly grants protection to whistleblowers against any form of damaging action. It guarantees these rights during and after the procedures of the administrative investigation. Whistleblowers may not be subject to any civil/criminal responsibility or disciplinary procedures, as guaranteed under Article 9 of the LPW. Article 8 of the LPW provides for the protection of persons related to whistleblowers: they are entitled to the same rights as whistleblowers, including judicial protection. As per Article 24 of the LPW, for cases related to civil servants, the lawsuits shall be filed within the Department for Administrative Issues at the Basic Court in Prishtina.

Some of the most notable differences between the Kosovo whistleblower protection system and its counterpart in South Korea is the physical safety apparatus provided for whistleblowers. While in South Korea, the institutional framework provides for whistleblower protection by police upon request from the Anti-Corruption and Civil Rights Commission, in Kosovo, the LPW does not explicitly refer to any police protection. The LPW does reference protection for whistleblowers in terms of the following institutions: the employer (Articles 17 and 22), judicial protection (Articles 24 and 26), and security measures and statements of claim. Another notable difference between Kosovo and South Korea is that the LPW does not provide any form of financial reward for whistleblowers.

The adoption of the LPW was a significant milestone for strengthening the public sector in Kosovo. Yet so far, its implementation has been associated with some challenges. As noted in a report by the Kosovo Law Institute ( 2020 ), 23 public institutions have failed to meet legal deadlines to appoint officials responsible for receiving internal disclosures. In March 2020, local media reported allegations that some of the officials were appointed based on political affiliations, questioning their impartiality and independence (Sopi, Reference Sopi 2020 ). Footnote 1

Promulgated in 2018 by the President of the Republic of Kosovo, the LPW’s Article 30, on sub-legal acts, established a deadline of six (6) months for issuing sub-legal acts for the implementation of the LPW, starting from the day of entry into force of the LPW (2018). In 2020, the European Commission emphasized the need for Kosovan authorities to adopt secondary legislation for handling whistleblowing cases, as per the legal deadlines set by the LPW (European Commission, 2020 ). In 2021, the Government of the Republic of Kosovo approved Regulation No.03/2021 on Procedures for Receiving and Handling the Cases of Whistleblowing.

Figures 2 and 3 contain data on external and internal whistleblowing cases in the public sector of the Republic of Kosovo, obtained from the annual reports of the Kosovo Anti-Corruption Agency (KACA) for the years 2019, 2020, and 2021. The data indicate a rising trend of external disclosures and a declining number of internal disclosures for the year 2021. KACA’s data for the year 2022 for both internal and external whistleblowing cases are scheduled for release in March 2023.

Figure 2. External whistleblowing cases in the public sector. Source : Kosovo Anti-Corruption Agency ( 2020 , 2021 , 2022 ).

Figure 3. Internal whistleblowing cases in the public sector. Source : Kosovo Anti-Corruption Agency ( 2020 , 2021 , 2022 ).

A survey conducted from September to November 2019 sought to measure the perceptions of individual members of the civil service of Kosovo on several indicators related to whistleblowing procedures. A sample of 400 respondents was determined to represent all categories of civil service at the local and central levels of public administration, reflecting the scope of Kosovan legislation on civil service. The survey is an output of the doctoral research of one of the authors of this article (Kaciku Baljija, Reference Kaçiku Baljija 2020 ). The data were originally gathered as part of Kaçiku Baljija ( Reference Kaçiku Baljija 2020 )’s doctoral research, then later published in a journal article (Kaçiku Baljija and Rustemi, Reference Kaçiku Baljija and Rustemi 2021 ).

Data presented in Table 4 reveal a considerable lack of trust among respondents in the protection offered by the LPW. “Respondents express a considerable degree of uncertainty about the trust in the responsible official, and above 40% of respondents are not sure how the data confidentiality and anonymity will be ensured, while 30% of respondents believe that such data will be misused” (Kaçiku Baljija and Rustemi, Reference Kaçiku Baljija and Rustemi 2021 , p.152).

Table 4. Measuring levels of trust in the protection offered by the LPW

Source : Kaçiku Baljija and Rustemi ( Reference Kaçiku Baljija and Rustemi 2021 ).

Survey findings reveal that even though the LPW substantially complies with the EU Directive, civil service members do not express satisfactory trust in whistleblowing organizational indicators. Moreover, data from the Kosovo Anti-Corruption Agency shows that since the adoption of the LPW in 2018, there were only a few cases of internal and external whistleblowing disclosures in the public sector ( Tables 5 and 6 ).

Table 5. Measuring levels of trust in the officials responsible for receiving whistleblowing reports

Table 6. Measuring levels of trust in whistleblowers’ anonymity and confidentiality

Analyzing the establishment of the whistleblower protection system in Kosovo and the implementation of the legislation, the following inferences follow:

1. Adoption of legislation aligned with best practices of whistleblower protection is a significant accomplishment for any country. Yet, effective protection requires timely implementation of all inherent components of the relevant laws, including the timely adoption of accompanying secondary legislation and establishing the required mechanisms promptly, e.g., recruitment of the officials responsible for receiving internal whistleblowing disclosures.

2. Ensuring the principle of impartiality when recruiting or appointing internal mechanisms for receiving disclosures must go beyond the affirmative spirit envisioned in legislation, and an empowered civil society and media fill in the gaps for democratic requisites.

3. Given the sensitive nature of whistleblowing as an activity, maintaining an ongoing dialogue with various actors like public officials, citizens, media, experts, academia, businesses, etc., will clarify weaknesses and opportunities concerning the functioning of whistleblower protection systems. Surveys present a relevant tool for maintaining such communication. Conducting standardized surveys across countries would stregthen our collective knowledge about advancing and optimizing whistleblower protection laws and institutions, particularly by exchanging experiences, practices, and lessons learned.

4. Institutional capacities of the public sector,across countries,need to be strengthened for establishing, storing, maintaining, and sharing administrative data related to the functioning of whistleblower protection systems. In many countries, data are either scarce or missing about the rates of the protection provided to whistleblowers via various institutional structures, be they courts, employers, agencies, or police forces.

4. New Index for Evaluating the Effectiveness of Whistleblower Protection

This paper sought to evaluate public sector whistleblowing policies in two countries: South Korea and the Republic of Kosovo. First, the case study about Korea reviewed the effectiveness of whistleblower protection. We discussed the history of institutions established to protect whistleblowers, including the ACRC, which was established in 2008 as the successor to the KICAC. The ACRC has implemented various anti-corruption policies and measures, including the Protection of Public Interest Whistleblowers Act, legislated in 2011, and the Improper Solicitation and Graft Act, established in 2015. The ACRC is responsible for handling complaints and corruption cases and implementing anti-corruption policies, and it has the authority to recommend that public organizations improve their institutional weaknesses against corruption. The case study also covered the provisions of the Act on the Prevention of Corruption and the Protection of Public Interest Whistleblowers Act, which outline the protections and rewards available to whistleblowers in South Korea. The case study concluded by discussing the challenges and limitations of whistleblower protection in South Korea, including the lack of awareness of the protection measures among the public, the low number of successful cases, and the need for stronger institutional support and enforcement mechanisms.

Second, this paper assessed the whistleblower protection systems in place in the Republic of Kosovo. The analysis looked at the history of institutions, relevant policies, and current institutions responsible for providing protection. Survey data showed how public officials perceive various organizational factors like the protection guaranteed by legislation, confidentiality, and trust in the officials responsible for receiving disclosures. Conclusions suggested that, aside from the importance of enacting high-quality laws, additional measures count for strengthening the whistleblower protection system in the public sector. Timely implementation of legislation, impartiality when appointing institutional mechanisms and officials for protecting whistleblowers, and greater transparency through providing data from institutions in different parts of the system, among other factors, determine the quality of and public trust in the Kosovan whistleblower protection system. Table 7 summarizes measures for protecting whistleblowers in several countries. The benefits of whistleblower-related institutions include the guarantee of position, physical safety, and other measures. Some of these measures have already been adopted in South Korea, while others are already implemented in other developed countries, e.g., Australia. In developing countries like Kosovo and Albania, some of these measures are not yet enshrined in legislation, particularly financial rewards for whistleblowers.

Table 7. Measures for protecting whistleblowers

Source : Bowden ( Reference Bowden 2006 ).

Based on the case studies, we now present an index for evaluating the effectiveness of whistleblower protection in the public sector. As noted earlier, we call this tool the Index for Evaluation of Whistleblower Protection, or IEWP. The IEWP has quantitative and qualitative sub-indices. The quantitative sub-indices can be divided into two types: the existence of institutions and the rate for protecting whistleblowers. The qualitative indices include the perceptions and experiences of respondents. Table 8 summarizes the composition of the IEWP.

Table 8. Composition of the Index for Measuring the Effectiveness of Whistleblower Protection in the Public Sector (IEWP)

Note. The points in parenthesis are weights.

The existence of institutions has ten indicators: the guarantee of position, physical safety, confidentiality, the prevention of disadvantages, injunctions against reprisals, the right to relocate, the absolute privilege against defamation, indemnity against civil and criminal proceedings, rewards, and miscellaneous measures.

A guarantee of position means that whistleblowers should be guaranteed to keep their position in their workplace after whistleblowing. Physical safety indicates that whistleblowers should be protected from physical retaliation. Confidentiality ensures whistleblowers’ personal information is not disclosed without their consent. The prevention of disadvantages protects whistleblowers from personal and professional disadvantages resulting from their actions. This category includes not only job security but also protection against harassment and discrimination. An injunction against reprisal is a court order that requires an employer or other individuals to stop any legal actions that could harm the whistleblowers. The right to relocate allows whistleblowers to move to a safe place without worrying about the costs of relocation, if they justifiably fear for their safety. Absolute privilege against defamation means whistleblowers cannot be sued for defamation, even if the information that the whistleblowers provide is not true, as long as they believed the information was true and provided the information in good faith. Indemnity against civil and criminal proceeding ensures that whistleblowers are not held liable for legal actions resulting from their whistleblowing. Rewards are monetary incentives provided to whistleblowers. Remaining measures that do not fit into any of these categories are placed in the miscellaneous category.

Each indicator is worth three points; the value can be zero or one. For example, if the government provides physical safety for whistleblowers, then the value of the indicator for physical safety will be one, and the index score will increase by three points. If the government does not provide whistleblowers with rewards, then the indicator value for rewards will be zero, and the points will also be zero. If a whistleblower protection law has three measures on the list, then it will earn nine points.

The rate for protecting whistleblowers has two indicators: protection request rate and protection acceptance rate. The request rate can be calculated using the number of protection requests and the number of corruption reports. First, we multiply the number of protection requests by 100. Second, we divide it by the number of corruption reports. Finally, we multiply the value by 10. We multiply the number of requests by 100 for several reasons. First, it is natural that all corruption cases need protection. Thus, some reporters do not want to request protection. Second, it is plausible that some corruption cases are false reports. Accordingly, it is not a good idea to protect all corruption reporters by default. Finally, we want to balance the impacts of the request rate and acceptance rate. Multiplying the number of requests by 100 helps us mitigate the large impact of the request rate.

The maximum point value is ten. If the request rate is high, then the number of whistleblowers requesting protection is relatively larger, and the number of corruption reports is relatively smaller. If the request rate is high, we can assume that many reporters have requested protection. This might mean that the reporters highly evaluate the effectiveness of measures for protecting whistleblowers.

The request rate as an indicator, however, has a pitfall. If the number of corruption reports is relatively small because of a lack of trust in the government, then the request rate can be high. In other words, the number of corruption reports might be relatively small when people do not trust their government. In this case, although corruption is rampant in the government, people do not report corruption. Thus, the request rate might fail to reflect the effectiveness of measures for protecting whistleblowers.

For this reason, the index includes the acceptance rate. The acceptance rate can be calculated based on the number of accepted protection requests and the number of issued protection requests. First, we divide the number of accepted requests by the number of overall requests. Second, we multiply the value by ten. The maximum point value is ten. If all the protection requests are accepted, then the number will be one. In this case, the acceptance rate will be ten because the figure will be multiplied by ten. If the acceptance rate is high, then the number of accepted requests is relatively larger, and the number of requests is relatively smaller. If the acceptance rate is high, we can assume that a large number of requests were accepted. This might mean that measures for protecting whistleblowers are widely used.

The acceptance rate as an indicator, however, also has a pitfall. If the number of protection requests is relatively small because of a lack of government trust, then the acceptance rate can be high. In other words, the number of requests might be relatively small when whistleblowers do not trust their government. In this case, whistleblowers will not request protection. Thus, the acceptance rate might fail to reflect the effectiveness of measures for protecting whistleblowers. For this reason, the index adopts both the request rate and acceptance rate.

Quantitative sub-indices are not enough to evaluate the effectiveness of measures for protecting whistleblowers. For example, enacting a whistleblower protection law, including various protection measures, does not guarantee the effectiveness of the measures because the law might not properly work. The request rate and acceptance rates might fail to capture the level of effectiveness of the measures when the level of trust in the government is low. Although request and acceptance rates may be high, whistleblowers might not be properly protected due to the government’s inability to protect them. To overcome these pitfalls, this study suggests qualitative subindices that include the perceptions and experiences of respondents.

To measure perceptions, this index asks questions to four types of respondents: public officials, experts, citizens who have no experience in whistleblowing, and whistleblowers. It is plausible that different types of respondents might have different perceptions of the effectiveness of their present whistleblowing protection institutions. For example, while public officials may think that the present system is good enough to protect whistleblowers, whistleblowers may feel that the system fails to protect them. While experts, such as scholars and lawyers, may deeply understand the advantages and disadvantages of the present system, non-whistleblower citizens may not be interested in the system. Thus, it is important to survey different types of respondents. Ten points are allocated to each respondent cohort. Likert-type scales could be used with questions like “How effective do you think the whistleblower protection law is?” The survey should include various questions that measure respondents’ perceptions related to whistleblower protection measures. In each cohort, the summation of the results can be rescaled from zero to ten.

Since perception might be different from experience, this index also measures experience. Since perception might be different from experience, this index also measures experience. In this case, only whistleblowers are surveyed, again with ten points allocated to the cohort. A sample question might be, “Have you been properly protected when you request protection for whistleblowing?” Other questions should measure the experience of respondents related to specific whistleblower protection measures. The summation of the results can be rescaled from zero to ten.

Assumptions:

1. Establishing the IEWP as a universal measure relies on the availability of data. This paper calls for the development of new data sources based on standard methodologies across countries.

2. Some countries lack publicly available data on protection request and acceptance rates for courts and other relevant authorities.

3. Some countries lack data on public officials’ perceptions.

4. The survey components will generate new findings on trends in perceptions, as well as on the functioning of a given system.

4.1 Toward operationalization: Methods, data sources, and tools

As a cross-national benchmarking platform, the IEWP provides a measurement framework to support and inform anticorruption objectives at national level in different countries. As a composite measure, the IEWP embraces a methodology consisting of two pillars of research: combining existing administrative data from the public sector with survey data. As such, it requires producing and locating data that are not extant, standardized, or accessible.

The IEWP is designed as a long-term digital research tool serving a wide range of policymakers and stakeholders. Administrative data and surveys at the national level should capture the state of indicators on an annual basis.

4.2 Data collection strategies

Sub-indices and indicators draw on internationally agreed definitions of principles and legislation for whistleblower protection. The IEWP draws on some of the Transparency International ( 2013 ) principles like confidentiality, reward systems and protection, among others, to combine with survey data tracking relevant respondents’ perceptions.

Data collection strategies for the compilation of the index will entail extracting existing administrative data from public sector institutions in the country of interest, as well as the creation of new data sources for surveys. Surveys will measure perceptions of actors like actual and potential whistleblowers, public officials, citizens, civil society, and experts.

Besides ensuring representative sampling, the survey should account for multilingual populations in a given country. Research for compiling the IEWP’s annual report, including drafting the questionnaire and data analyses/interpretation, should be conducted by field professionals and scholars.

Outsourcing data collection, storage, and visualization may be an option. Data management should follow existing best practices of research, such as the FAIR principles—findable, accessible, interoperable, and reusable—and take into consideration the highest respect for human rights, equity, and gender criteria. Data collection processes must adhere to data privacy and protection legal framework in the host country.

4.3 Hosting platform

The IEWP may be hosted on an open-format internet platform, enabling data visualization on a cluster, national, and regional basis, by embracing big data and data-driven approaches. Data-driven approaches have been evaluated as relevant to support the prediction of policy outcomes for improved decision-making (The United Nations Development Programme, 2021 ). As the IEWP implementation may commence gradually from country to country, findings from monitoring and evaluation shall inform later insights for change, adaptation, and experimentation.

4.4 From country to global coverage

A standardized methodology should follow the compilation of the IEWP indexes in each country. Extending the IEWP from single-country to global coverage will require a three-step approach: 1) starting small-scale in one country, 2) extending gradually to two or three other countries in the region, and 3) extending further based on supra-national political systems. For instance, the implementation may commence in the Republic of Kosovo, with further expansion via horizontal scalability into the Republic of Albania, the Republic of North Macedonia, the Republic of Montenegro, and the Republic of Serbia, thus ensuring complete coverage of the region of the Western Balkans. The index can also be implemented at the level of the European Union member states, and so on in other regions, eventually getting as close to global coverage as possible.

4.5 Partnerships and outputs

IEWP implementation will require stakeholder engagement, public engagement to track perceived value, monitoring and evaluation, resource mobilization, communication/dissemination of findings, follow-up, and workshops, among other tasks. Consequently, research and data collection may produce and locate big data analytics, standardized scientific data pools, container technology, etc.

4.6 Justification of the index

The IEWP adds value to prior research on whistleblowing by providing a body of knowledge based on a standardized methodology and outputs for measuring protection effectiveness offered by legislation. Given the proposed mixed methods research methodology and the subjects it encompasses, the IEWP will ensure a dialogue with public officials, civil society, citizens, academia, business, etc., to generate insights and data that may be otherwise limited or even unavailable to the public. The benefits of findings generated by the IEWP are multi-faceted: knowledge obtained from countries with long experience in implementing whistleblowing laws, for example, may serve to help countries less experienced in implementing whistleblower protection laws.

The IEWP lays the ground for further development of the line of research on whistleblower protection in three main directions:

1. Exploring and advancing the legalities of whistleblower protections concerning the development and expansion of digital rights.

2. Nurturing information around the regulation of privacy approaches, depending on the country and legislation.

3. Examining gendered perspectives of whistleblowing and providing directions for inclusive frameworks.

4.7 Ownership and funding

Certain requirements for an organization eligible to implement the IEWP may include the following: 1) operating in a specific country (or transnationally) or region, 2) possessing know-how and expertise for implementing such projects, 3) possessing resources for outsourcing data collection or fundraising capacities and 4) possessing the capacity for public engagement.

( Figure 4 ).

Figure 4. From inception to increased scalability.

4.8 Avenues for future research

The IEWP lays the groundwork for further development of research on whistleblower protection in three main directions:

1) Exploring and advancing the legalities of whistleblower protections concerning the development and expansion of digital rights.

2) Nurturing information around the regulation of privacy approaches, depending on the country and legislation.

3) Examining gendered perspectives on whistleblowing and providing direction for inclusive frameworks.

4) Bringing to light variations in whistleblowing experience from different perspectives: public vs. private sectors, big tech vs. users, etc.

5. Conclusions

This paper clarified the relevance of a whistleblower protection system for the public sector. It first summarized recent milestones related to the development of policies for whistleblower protection in the public sector in the EU and some other countries. Next, drawing on two case studies, South Korea and the Republic of Kosovo, this paper sought to examine whistleblowing policies in the public sector. We highlighted some of the differences in whistleblower protection systems in these two countries. South Korea established anti-corruption institutions and policies a long time before the Republic of Kosovo, which only recently enacted a law protecting whistleblowers in the public sector standing in satisfactory compliance with the best principles of whistleblower protection. Next, we used findings from these two case studies to construct a new index for measuring the effectiveness of whistleblower protection systems in the public sector. The index is composed of quantitative and qualitative sub-indices that assess the existence of institutions, rates for protecting whistleblowers, perceptions of public officials and citizens, as well as experiences and perceptions of whistleblowers on several whistleblowing indicators.

Considering the research questions guiding this study, the findings demonstrate that besides the importance of enacting high-quality legislation on whistleblower protection, effective additional measures include timely implementation of legislation, impartiality when appointing institutional mechanisms and officials for protecting whistleblowers, and greater transparency in the form of providing data from different institutions. These factors, among others, determine the quality of public trust in a whistleblower protection system in the public sector.In closing, we propose that the IEWP, as a composite measure, effectively embraces a methodology consisting of two pillars of research, combining existing administrative data (or creating that data) from the public sector with survey data on perceptions of whistleblowing. To implement the IEWP, we suggest improving data that are not existent, standardized, or accessible to identify potential improvements in whistleblower protection systems in different countries. Although we have constructed the IEWP building based on public sector research, with minor adjustments, the IEWP may also track and evaluate whistleblowing in private and not-for-profit sectors, effectively covering all forms of corruption and institutional wrongdoing.

The authors declare not having acquired any source of funding for this article.

S.K.B. declares none. K-s.M. was a senior deputy director at the Anti-Corruption & Civil Rights Commission of South Korea that generated datasets that deal with whistleblower protection in South Korea.

The authors have provided equal contributions in conceptualization, data curation, formal analyses, methodology, and writing of this manuscript.

For the South Korea case study, the authors have used a dataset produced by the Anti-Corruption & Civil Rights Commission of South Korea. This dataset is not publicly accessible. For the Republic of Kosovo, the authors use a survey dataset, accessible in the following article https://doi.org/10.2478/nispa-2021-0018 . Additional demographics of this dataset are accessible at the repository https://figshare.com/articles/dataset/Survey__demographic_details_of_respondents/13139054 .

1 The authors do not assume any responsibility or liability concerning accuracy, completeness, or timeliness for any errors or omissions represented in this article (accessed 26 March 2023). The article is provided as a reference for pioneering research only. In no event will the authors, journal, its affiliates, partners, employees, or agents be liable for any loss or damage related to the use of information from this article.

Figure 2. External whistleblowing cases in the public sector. Source : Kosovo Anti-Corruption Agency (2020, 2021, 2022).

Figure 3. Internal whistleblowing cases in the public sector. Source : Kosovo Anti-Corruption Agency (2020, 2021, 2022).

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The Evolution of Whistleblowing Studies: A Critical Review and Research Agenda

• Published: 20 June 2016
• Volume 146 , pages 787–803, ( 2017 )

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• Barbara Culiberg 1 &
• Katarina Katja Mihelič 1  

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Whistleblowing is a controversial yet socially significant topic of interest due to its impact on employees, organizations, and society at large. The purpose of this paper is to integrate knowledge of whistleblowing with theoretical advancements in the broader domain of business ethics to propose a novel approach to research and practice engaged in this complex phenomenon. The paper offers a conceptual framework, i.e., the wheel of whistleblowing, that is developed to portray the different features of whistleblowing by applying the whistleblower’s perspective. The framework is based on five “W” questions: Who, What, hoW, Why , and to Whom? The answers to the proposed questions clarify the main aspects of whistleblowing, provide insights into existing studies of the subject, and identify relevant gaps in the literature which, in turn, offer opportunities for future research.

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Culiberg, B., Mihelič, K.K. The Evolution of Whistleblowing Studies: A Critical Review and Research Agenda. J Bus Ethics 146 , 787–803 (2017). https://doi.org/10.1007/s10551-016-3237-0

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Whistle-Blowing in the Public Service: an Overview of the Issues

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Whistleblowing as an anti-corruption strategy in health and pharmaceutical organizations in low- and middle-income countries: a scoping review

a Department of Health Professions, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA

b WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

Brianna Agnew

Keith mcinnes.

c Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA

d Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA

Associated Data

Whistleblowing can bring suspected wrongdoing to the attention of someone who is in the position to rectify the problem. Whistleblowing research can help improve effectiveness of anti-corruption efforts in the health sector.

The objective of this scoping review is to understand the extent and type of evidence on whistleblowing as an anti-corruption strategy in health and pharmaceutical organisations in low- and middle-income countries (LMICs).

This scoping review searched the PubMed, Scopus, and EMBASE databases from 2005 to 2020, limited to English language. We also searched websites of multilateral agencies or international non-governmental organisations for policy documents, guidance and reports. Titles and abstracts were screened to remove those where the focus was not on health, pharmaceuticals, whistleblowing, or LMIC context. Articles focused on research misconduct were excluded. Full-text articles were assessed for eligibility on these same criteria. Included sources were analysed thematically, based on five categories including definitions and models; evidence of reporting frequency; factors influencing whistleblowing; cultural context; and outcomes.

The review found 22 sources including reports, policies, and guidance documents (12, 55%), news articles (4, 18%), policy analyses/reviews (3, 14%), commentaries (2, 9%), and empirical studies (1, 5%). Most sources described whistleblowing policy and system components such as how whistleblowing is defined, who can report, and how confidentiality is assured. Few articles documented types and frequencies of corruption identified through whistleblowing or factors associated with whistleblowing. Several studies mentioned cultural norms as a potential limitation to whistleblowing effectiveness. About one-third of the sources described fear of retaliation and noted the need to strengthen protection for whistleblowers.

Research on whistleblowing is scarce in health and pharmaceutical organisations in LMICs. Documentation of policies, factors associated with whistleblowing, and whistleblowing outcomes is needed and could help countries to mainstream whistleblowing as a sectoral anti-corruption strategy.

Corrupt practices in health organisations include bribery, misappropriation of medicines, trading in influence, abuse of functions, false billing, and other illicit enrichment schemes [ 1 ]. Corruption and fraud in health and pharmaceutical organisations have enormous financial and social costs [ 2 , 3 ]. Fraud and abuse are estimated to cost $58.5 billion to $83.9 billion annually in the U.S. alone [ 4 ], and an estimated 7.3% of total health expenditures is lost to health care fraud and abuse worldwide each year, according to figures from the Centre for Counter Fraud Studies at the University of Portsmouth and the accounting firm PKF in the UK [ 2 ]. Abuse of power can corrupt the selection, procurement, distribution, and prescribing of medicines [ 5 ]. Researchers have documented the indirect health impact of corruption including increased infant, child, and maternal mortality, cancer deaths, motor vehicle crash deaths, earthquake-related fatalities, anxiety, poor general health, and antibiotic resistance [ 3 , 6 ]. Corruption in food and nutrition organisations can also adversely affect health [ 7 ]. While corruption is a problem in all countries, the impact of corruption on health is often more severe in low-income countries due to lower economic performance and quality of governance [ 8 , 9 ].

Whistleblowing, the act of raising concerns about suspected or observed wrongdoing to others in a position to effect action, is part of a national integrity system to prevent corruption [ 10 , 11 ]. Reporting by employees in the private sector accounts for 40% of fraud cases detected and is the single most important strategy for detecting occupational fraud committed by employees or managers [ 12 , 13 ]. Whistleblowing mechanisms are especially important during health crises such as the COVID-19 pandemic, when embezzlement of healthcare resources can lead to unsafe working conditions and poor clinical care [ 14–16 ]. In addition to deterring corruption, whistleblowing can reveal systemic weaknesses that allow wrongdoing. Organisations can use this information to strengthen health systems.

Often organisations understand the term whistleblowing to apply only to current or former employees [ 17 , 18 ]. Yet, patients and suppliers may have sufficient knowledge about wrongdoing to blow the whistle [ 19 , 20 ]. These external whistleblowers are sometimes called ‘reporters’ to distinguish them from whistleblowers on the inside [ 21 ]. Whistleblowing channels may be seen as a continuum – first reporting within the management structure, followed by external reporting if internal reporting is not effective [ 22 ].

A scoping review is an approach to rapidly map concepts related to a research topic [ 23 ]. The use of a scoping review is appropriate for this study, given that the types of evidence to address and inform the practice of whistleblowing in this context are not precisely known [ 24 ].

A preliminary search of PubMed, the Cochrane Library, and JBI Evidence Synthesis was conducted in September 2021 to find current systematic or scoping reviews related to whistleblowing, health, and corruption. This search found four reviews.

Kang conducted a systematic review of whistleblowing in the public sector to examine methods and theoretical models [ 25 ]. The review included 71 peer-reviewed publications and dissertations in public administration, political science, and business. Several studies included low- and middle-income countries (LMICs) such as China, Hungary, Serbia and Peru, and 8% of studies examined whistleblowing and corruption. None of the studies considered the health sector. Most empirical studies applied human resources, ethics, and psychology theories to assess individual, organisational, and situational factors associated with whistleblowing. Kang concluded that more research is needed on the frequency of whistleblowing, impact of leadership and training, effectiveness of legal protection systems, and consequences of whistleblowing [ 25 ].

Mugellini, Bella, Colagrossi, Isenring and Killas conducted a systematic review on public sector reforms and corruption [ 26 ]. The review included randomised controlled trials of interventions to curb corruption in any sector. The studies were conducted in high-, middle-, and low-income countries and examined control and deterrence interventions (e.g. reporting, audit, and transparency), and cultural and organisation interventions (e.g. codes of ethics, and training). Only two studies considered the health sector, and neither of these looked at whistleblowing. Five studies examined whistleblowing interventions outside the health sector, including guaranteeing immunity to whistleblowers. Researchers thought this intervention would increase whistleblowing and discourage bribes; however, evidence did not support their hypotheses. The authors recommend that anti-corruption interventions be grounded in economic theory (control and deterrence interventions) but also consider moral and cultural factors such as the political climate and individuals’ self-control or desire for power [ 26 ].

Blenkinsopp, Snowden, Mannion, Powell, Davies and Millar examined empirical studies of whistleblowing related to patient safety and quality of care [ 20 ]. The researchers found that most studies were carried out in Australia, U.K. and the U.S. (66% of studies reviewed), and few studies were conducted in LMICs. The researchers summarised evidence of factors influencing whistleblowing, including individual and role characteristics of whistleblowers, organisational culture and climate, and organisational leadership and management. They also described evidence on the consequences of whistleblowing. The authors observed that studies of healthcare whistleblowing are published in a wide variety of journals, suggesting that studies may not be building on prior theory and knowledge. They observed a dearth of research on the organisational response to whistleblowing and the impact of whistleblowing (e.g. what portion of healthcare whistleblowing results in retaliation versus positive responses).

Kelly & Jones conducted a narrative review focused on whistleblowing literature relevant to care of older people in Wales (domiciliary care organisations, hospitals, nurses, and doctors) [ 27 ]. They included opinion pieces, theoretical articles, and empirical literature from business, management, and healthcare journals. Kelly & Jones observed that there is no universally accepted definition of whistleblowing or theoretical framework guiding the practice in healthcare. Their review found no clear pattern on characteristics of whistleblowers in terms of sex or age, but they noted whistleblowers had better job performance, were more highly educated, scored higher on tests of moral reasoning, and held higher level positions than non-whistleblowers. Nurses tended to blow the whistle more than doctors. Their review found that organisational climate and clinical leadership influenced whether people chose to raise concerns or not. Climate and leadership also affected whether concerns were handled well or whistleblowers experienced retaliation [ 27 ].

None of the reviews included empirical evidence of whistleblowing involving people external to the organisation such as patients, nor did they consider how the ecosystem for whistleblowing may differ in LMICs. Neither of the two reviews that focused on health [ 20 , 27 ] reported findings related to whistleblowing on fraud or corruption. This suggests a need for a review of literature specifically focused on whistleblowing in healthcare, pharmaceutical, and other health-related organisations a) reporting concerns about corruption and fraud; b) including whistleblowing by patients or other knowledgeable reporters in addition to employees; c) in LMIC context; and d) considering many types of sources, not just empirical research.

The objective of this scoping review is to understand the extent and focus of the literature on whistleblowing as an anti-corruption strategy in health and pharmaceutical organisations in LMICs. The findings could help further our knowledge of how whistleblowing systems might be adapted for LMICs, and relevant factors influencing effectiveness in controlling corruption. This can help to inform the direction of future research, policy, and practice.

Review question

The scoping review question is ‘In the context of LMIC health and pharmaceutical organizations, how is whistleblowing understood and what evidence do we have about whistleblowing as an anti-corruption strategy?’

Sub-questions include:

• What definitions, models, and systems for whistleblowing have been used?
• What evidence exists about the types and frequency of corruption reported through whistleblowing?
• What do we know about the factors that influence whistleblowing?
• How does country or cultural context affect whistleblowing?
• What is known about the outcomes of whistleblowing, positive and negative?

The scoping review was designed in accordance with the JBI methodology for scoping reviews [ 28 , 29 ]. Because this review did not involve human subjects research, ethical approval was not required. The protocol for the study was registered in the Open Science Framework database ( https://osf.io/2w3g8 ) [ 30 ].

Eligibility Criteria

Eligibility criteria for scoping reviews generally specify participants, concept, and context [ 31 ]. We focused on organisations, conceptualised as a body of people with a particular purpose. This included national government agencies (such as the ministry of health or medicines regulatory authority), multilateral organisations (including United Nations agencies), private companies, and non-governmental organisations. For studies including participants, we included articles mentioning internal whistleblowers, such as current or former employees, and external reporters such as patients and others who may have knowledge of or suspect wrongdoing, but are not employed by the organisation.

Concepts important to the search included whistleblowing and corruption. As mentioned earlier, our definition of whistleblowing is the act of raising concerns about suspected or observed wrongdoing to others in a position to effect action. We included articles that considered both corruption and safety or quality issues, but excluded articles that focused exclusively on whistleblowing for safety or quality concerns and did not mention corruption or fraud. Finally, we excluded articles related to whistleblowing and research-related fraud. While concerns such as plagiarism, data falsification, and data fabrication in health and pharmaceutical-related research are important, we are interested in corruption more directly affecting health system service delivery, health workforce, health information systems, medicines, financing, and leadership [ 32 ].

Concerning context, we included articles with a focus on LMICs, or both LMICs and high-income countries. We excluded articles focused on high-income countries exclusively. We suspect that the antecedents to whistleblowing and the policies and processes for handling complaints may have to be adapted in the context of LMICs due to cultural, economic, political and other considerations. We wanted to know what studies have already been done to consider these intertwining issues.

We were mainly interested in health- and pharmaceutical-related organisations, though we also included keywords for food, nutrition, water and sanitation (related areas). We excluded sources where the purpose was not related to health goals.

Types of sources

The scoping review considered any type of study design. We included non-research sources such as commentaries, agency reports, and guidance documents. We included news articles related to whistleblowing systems but excluded news articles following corruption cases where whistleblowing was not the main focus.

Search strategy

We searched PubMed, Scopus and EMBASE databases. An initial search of PubMed was undertaken to identify articles on the topic. The text words contained in the titles and abstracts were used to develop a full search strategy. The search strategy was then adapted for each included database and/or information source. The reference lists of included sources were searched for additional articles. We have searched the archives of the journals Health Policy and Planning , International Journal of Health Policy and Management , Public Administration and Development , and the Third World Quarterly .

Studies published in English language from 2005 forward were included. We chose 2005 because this is when the U.N. Convention Against Corruption (UNCAC) entered into force. This global treaty legally binds the 140 signatory countries to consider laws to protect people who report corruption-related offences from retaliation (Article 33). The ratification of UNCAC created impetus for work by member states and international organisations to support whistleblowing [ 33 ].

Sources of unpublished studies included the websites of the European Anti-Fraud Office; European Healthcare Fraud and Corruption Network; Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, TB, and Malaria; Group of States Against Corruption; the National Whistleblower Center (a U.S. non-governmental organisation); the Organisation for Economic Co-operation and Development; Transparency International; United Nations Development Programme; United Nations Office on Drugs and Crime; and the World Health Organization (WHO). Supplementary File 1 shows our initial keyword search in PubMed.

Source selection

Identified citations were uploaded into EndNote 20 (Clarivate Analytics, PA, USA) and duplicates removed. We then conducted a pilot review of the screening process, with two reviewers (TV and BA) looking at 20 sources to see if the reviewers were interpreting the criteria in similar ways. Following the pilot test and discussion to reach a common understanding, the two reviewers independently screened all titles and abstracts against the inclusion criteria (Supplementary File 2a).

Sources were retrieved in full and their citation details saved. TV and BA independently assessed the full text of selected citations against the inclusion criteria. Reasons for exclusion of sources not meeting inclusion criteria were recorded. Disagreements between the reviewers were resolved through discussion. Following best practice, the results of the search and the study inclusion process are reported in the findings [ 29 ].

Data extraction and analysis

Data were extracted from sources by the two reviewers using a worksheet (Supplementary File 2b). The data extracted included details about the citation, participants, concept, context, study type, and key findings relevant to the five review sub-questions, i.e. 1) definitions, models, and systems for whistleblowing; 2) types and frequency of corruption revealed through whistleblowing; 3) factors associated with whistleblowing; 4) country/cultural context and whistleblowing; and 5) impact or consequences of whistleblowing. Disagreements were resolved through discussion.

All three authors independently reviewed the extracted data and created notes about key findings. For example, the notes for an article with findings relevant to sub-question #1, would include the source’s definition of whistleblowing, describe the contextual setting and legislative or regulatory basis for the definition, and explain other components of the policy or system, such as the stated purpose, types of whistleblowers covered, and reporting methods. Notes for an article with findings related to sub-question #3 might describe in more detail the specific factors considered to influence the decision to blow the whistle, and the strength of evidence for the association with whistleblowing. The research team then discussed the notes together, and the results were organised into a synthesis outline with narrative summary under main conceptual categories. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was completed to guide reporting (Supplementary File 3).

Our search resulted in 216 records. After removing 83 duplicates, we reviewed the title and abstract of the remaining 133 records and excluded 75 sources that did not meet inclusion criteria (see Figure 1 ). Full texts were obtained for the remaining 58 sources and were assessed for eligibility. Thirty-six articles were excluded at this stage, including 28 (78%) that did not contain information on whistleblowing in the organisations of interest; 4 (11%) that were not concerned with corruption; and 4 (11%) that were not focused on the LMIC context (see Supplementary File 4). Ultimately, 22 sources were retained for this review, including organisational reports, policies & procedures, and guidance documents (12, 55%), news articles related to whistleblowing systems (4, 18%), policy analyses and reviews (3, 14%), commentaries (2, 9%), and empirical studies (1, 5%). Most sources (13, 59%) included information relevant to the health organisations; three sources (14%) considered pharmaceutical whistleblowing; two (9%) examined whistleblowing related to food supply; and four (16%) considered a mix of these areas.

Article selection process .

Sources from the non-peer-reviewed literature included policies and procedures for whistleblowing promulgated by the European Union, WHO, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and Gavi, the Vaccine Alliance. While the policy of the European Union is not specific to the health sector, the goal of the policy mentions protection of health.

No significant changes to the protocol were made when implementing the scoping review. Below we describe the importance of context to understanding evidence on whistleblowing policies and systems, and present our results organised by review sub-question.

Context for whistleblowing

High profile corruption cases can be impetus to adopting whistleblowing systems. The Global Fund mentions publicised fraud cases, monetary and reputational losses as rationale for a whistleblowing policy [ 34 ]. Policy in the European Union was set in context of global scandals affecting all countries such as the Panama papers and Cambridge Analytica [ 35 ]. Some articles mentioned how whistleblowing may be the only way of gaining knowledge about high level corruption involving powerful interests [ 36 , 37 ]. Whistleblowing systems were also seen as a source for identifying systems-level malfeasance and areas needing improvement [ 36 , 38 ]. Some agencies mentioned the urgency of whistleblowing because of risks with COVID vaccine distribution and other supplies related to infectious disease control [ 39 , 40 ], along with the need to protect human health, animal health, and public health [ 35 , 41 ].

Sub-question 1: definitions, models, and systems for whistleblowing

The first study sub-question asked what definitions, models, and systems for whistleblowing were described in the sources identified for the scoping review. Twenty out of 22 articles (91%) were coded as having relevant information.

Definitions of whistleblowing mentioned reporting to expose wrongdoing, serious misconduct, or serious breaches of rules, guidance, or policy (see Table 1 ). The purpose of whistleblowing policy was often described as increasing accountability and transparency, minimising or managing risks, fulfiling duties, and minimising financial, health, and reputational effects of the wrongdoing.

Definition and purpose of whistleblowing.

Who can report

Most often, the policies and guidance specified who can be considered a whistleblower, including staff, former staff, and others who would know about suspected or actual wrongdoing in the work context [ 42 , 46 ]. ‘Other reporters’ might be people interviewing for a job, suppliers or vendors, and volunteers [ 35 , 42 ]. A few sources mentioned ‘consumers’ as potential whistleblowers. For example, a website created by a citizen group in India was advertised as a place where consumers and employees could raise issues [ 38 ]. Only one source directly mentioned patients as whistleblowers [ 47 ].

Rewards and incentives

Our review found few references to whistleblowing policies structured to reward whistleblowers monetarily. Multilaterals and global funding mechanisms did not have reward policies [ 42 , 44 , 45 ], possibly because they see whistleblowing as a staff obligation grounded in duty [ 42 , 45 ]. However, financial incentive programmes were mentioned as operating in the U.S., India, China, and the Republic of Korea [ 22 , 46 , 48 ].

A whistleblowing system was implemented in India in 2010 by the Ministry of Health and Social Welfare and the Central Drugs Standard Control Organisation to combat substandard and falsified medical products. It included a reward scheme equivalent to 20% of the value of the seized consignment of fake medicines, to a maximum value of Rs 25 Lakh ($54,750 USD). Rewards for individual government officials were capped at Rs 5 Lakh ($10,950) per consignment and Rs 30 Lakh ($65,700) maximum during the officer’s career [ 46 , 48 ].

Anonymity and confidentiality

Policies varied in whether they allow anonymous complaints. All policies we reviewed had provisions for protecting confidentiality of reporting individuals, but where a channel does allow anonymous reporting, it is not possible to protect the reporter from retaliation (if someone later suspects or discovers the reporter). In India, the whistleblowing portal created for medical professionals and the public was only for anonymous complaints. Those managing the portal didn’t want to know who reported on whom, because the purpose of the portal was systems improvement, not detection for prosecution [ 38 ]. A pharmaceutical sector whistleblowing reward programme in India protected confidentiality, but they needed the name of the reporter to provide the reward so reporting was not anonymous [ 46 ].

Global Fund whistleblowing can be anonymous or confidential [ 42 ]. Gavi and WHO policies say they will protect the confidentiality of the reporter and shield them from retaliation; however, anonymous reporters cannot be protected from retaliation [ 44 , 45 ]. Moy [ 22 ] describes how a whistleblowing programme in Russia requires the witness to go public with the report. Policy in Bulgaria also does not allow anonymous reporting [ 41 ].

Whistleblower protections

Whistleblowers often face retaliation [ 36 , 47 , 49 ]. Whistleblowing policies include a definition and examples of retaliation [ 15 , 44 , 45 ]. For example, the UN defines retaliation as ‘any direct or indirect detrimental action that adversely affects the employment or working conditions of an individual, where such action has been recommended, threatened or taken for the purpose of punishing, intimidating or injuring an individual’ as a result of the individual having reported misconduct [ 15 ].

The United Nations Office on Drugs and Crime whistleblowing guidance acknowledges ‘personnel will not come forward if they are unsure that protective measures will be put in place to minimize the risk they are taking.’ Protections from retaliation should extend to witnesses of the wrongdoing, colleagues and family of the whistleblower, and those who helped facilitate reporting [ 15 ]. Possible measures include [ 15 , 41 ]:

• Guaranteeing confidentiality; punishing officials who reveal the identity;
• Reassigning or reinstating the whistleblower when appropriate;
• Putting in place mechanisms to report, investigate and sanction retaliation;
• Providing support to whistleblowers (counselling, advice, financial support).

WHO provides access to an ‘ethics advice’ line and a process for reporting retaliation and reviewing retaliation claims [ 45 ]. The European Union Directive on Whistleblowing states that whistleblowers should be protected if they have reasonable grounds to believe allegations are true [ 43 ]. Because whistleblowers may have violated loyalty or confidentiality to share this information, they could lose their jobs. Regular citizens do not face that imbalance [ 43 ]. Low socioeconomic status of workers may make them especially susceptible to retaliation for reporting fraud [ 22 ]. India passed a Whistleblower Protection Act that became law in 2014. The law has provisions to punish public officials who break the confidentiality of the whistleblower with up to three years in prison and a fine of Rs 50,000 ($805 USD). However, the law does not provide protection for private workplace retaliation and provides no implementation details [ 50 ].

Internal versus external whistleblowing

Systems can encourage whistleblowers to disclose internally to someone in direct chain of command, or externally to regulatory officers, inspectors, auditors, police, Members of Parliament, citizen groups, or media. One example of an external whistleblowing system is Transparency International’s worldwide network of Advocacy and Legal Aid Centres currently operating in more than 60 countries ( https://www.transparency.org/en/alacs ). The centres collectively received more than 1,800 reports from victims of wrongdoing or witnesses to corruption related to COVID-19 in countries such as the Democratic Republic of Congo, Ireland, Kenya, Nigeria, Russia, the United Kingdom, Venezuela, and Zimbabwe [ 51 , 52 ].

Yet, the definition of internal versus external is not always clear. For example, Gavi’s Audit and Investigation unit operates several whistleblowing channels, accepting reports via a web-based portal, by mail and email, and through voice-messaging. It then has a three-stage process to assess reports to determine if it requires further investigation. Some might consider this external reporting, since the group receiving the reports is not in the direct line of command; however, it is still within the Gavi organisation. We found no evidence of empirical studies involving health or pharmaceutical organisations to document attitudes and perceptions about internal versus external whistleblowing.

Sub-question 2: types and frequency of corruption reported through whistleblowing

The second sub-question of our review was to determine what evidence exists about the types and frequency of corruption reported through whistleblowing. Five out of 22 articles (23%) were coded as having relevant information.

The analysis shows that whistleblowing at multilateral organisations is increasing over time. We also found concerns about retaliation may be suppressing whistleblowing in other types of organisations, such as government agencies.

In 2015, the Global Fund OIG’s office launched a campaign with resources for anti-corruption, transparency, and accountability [ 53 ]. Researchers believe the campaign may have helped increase reporting over time [ 34 ]. From 2013 to 2020, Gavi received about three whistleblower reports per year [ 39 ]. Reports substantially increased to 67 in 2021, but a large number were categorised as ‘non-substantive, misdirected … or reflect anti-vaxxer sentiment.’ In other words, the issue raised did not have a significant impact on the organisation’s activities or was not about wrongdoing. After investigation, 16 were found to have merit. These included 14 related to vaccine equity (i.e. complaints about deviations from agreed upon vaccine priorities) and two related to core Gavi activities. The equity complaints were mostly at the start of the COVID vaccine delivery process, and such complaints are now slowing, possibly because supply became less limited [ 39 ].

Between Jan and Nov 2020, WHO received 276 reports from staff and the general public through its Integrity Hotline ( Figure 2 ). Fifty (18.1%) were on breaches of code of ethics and professional conduct, conflict of interest, discrimination and favoritism; 25 (9.0%) were related to human resource issues and breaches of staff regulations/rules; 22 (8.0%) were about suspected fraud, corruption or bribery; 11 (4.0%) were about abuse of authority and harassment; and 159 (57.6%) sounded alarm about substantial danger to public health and personal safety, mainly related to the COVID-19 pandemic. No information was available on whether investigations were completed or the outcomes of such investigations. WHO also reported a significant increase in people seeking ethics advice, continuing a pattern from 2019. In 2020, they received 400 individual requests, possibly due to awareness-raising activities and COVID-19 [ 40 ].

WHO integrity hotline complaints, Jan-Nov, 2020.

Fourteen percent of the anti-fraud experts surveyed by Milata [ 49 ] reported the emergence of whistleblowers related to COVID-19 fraud and corruption, including reports related to procurement fraud and medical bribes to access COVID testing and treatment.

Though the previous examples show an increase in whistleblowing reports to multilateral organisations, reporting at the national level could be suppressed where people fear retaliation. Moy reported that only three in 10 individuals in South Africa felt safe blowing the whistle, despite the official Protected Disclosures Act of 2000, which protects public and private employees who disclose information of unlawful or corrupt conduct by their employers or fellow employees [ 22 ]. A newspaper report in 2021 described how a whistleblower in the Gauteng Province Department of Health in South Africa was killed in a shooting, possibly because she was a witness in the investigation of COVID-related fraud [ 54 ].

Sub-question 3: factors influencing whistleblowing

The third review sub-question was to assess what is known about factors that influence whistleblowing. Seven of the 22 sources (32%) described facilitators and impediments to reporting wrongdoing.

Facilitators

We did not identify empirical studies of factors affecting whistleblowing in the health sector in LMICs. However, four factors were mentioned as being possible facilitators: financial rewards for whistleblowing or financial support after experiencing retaliation, appeal to duty, assurance of confidentiality, and having multiple channels for reporting. In addition, patients who cannot afford to pay informally may blow the whistle on health staff who obstruct their access to care.

The prospect of a financial reward was seen as an important motivating factor in India [ 46 ]. In contrast, the Global Fund relies on employees’ perception of professional responsibility. The Global Fund describes this duty in their whistleblowing policy [ 42 ]:

This whistle-blowing policy springs from the duty of the Global Fund to act as a responsible custodian or trustee of funds entrusted to it, by protecting the interests and assets of all its stakeholders – donor countries, recipient countries, or diverse beneficiaries alike.

European Partners Against Corruption and European Contact-point Network Against Corruption mentioned that offering financial and psychological assistance to whistleblowers through an independent fund might reduce fear of retaliation [ 41 ]. The promise of confidentiality was seen as important to encourage reporting in India [ 46 ]. Policies often include many provisions to protect confidentiality throughout the investigation process.

Having multiple channels for reporting can also be a facilitating factor. Some people are more comfortable reporting in person, others prefer to report in writing (submit by post, physical complaint box or an online platform), or would like to report orally by telephone or voice message [ 43 ]. General research on whistleblowing suggests that whistleblowing practices may differ for men versus women; women may lack means and resources to report, may be particularly influenced by social norms, and have greater fear of retaliation [ 55 ]. This suggests that gender sensitivity is needed in designing reporting channels.

Finally, patients and their families may be more inclined to blow the whistle if they believe there is no other way to access care. In Morocco, a father who blew the whistle had been asked for a speed bribe to get needed care for his child [ 47 ]. He could not pay, and saw blowing the whistle to the police as the only way to get care.

Impediments

The most frequently mentioned impediments to whistleblowing were fear of retaliation and perceived lack of protection (discussed further under sub-question 5). A second, related factor is lack of trust. Some people may fear reporting because they suspect that the higher-level officials, to whom they are reporting, may also be corrupt [ 47 ]. The European Union Directive on Whistleblowing states that ‘Lack of confidence in the effectiveness of reporting is one of the main factors discouraging potential whistleblowers’ [ 43 ].

Other factors include lack of knowledge that people are legally entitled to assistance from authorities if they are asked for a bribe [ 47 ], and fear on the part of outside companies that they will lose revenue if they report knowledge of corruption [ 48 ].

Sub-question 4: how does country or cultural context affect whistleblowing?

The fourth review sub-question was to consider evidence on how country or cultural context affects whistleblowing. Only three sources (14%) included relevant information.

Chatterjee claimed that India’s endemic corruption makes people less willing to blow the whistle [ 50 ]. The author noted a number of violent attacks on Indian whistleblowers, and extreme cases of retaliation such as two medical officers from Uttar Pradesh who were murdered after having reported healthcare corruption. Additionally, medical professionals have been harassed by officials and fired from jobs [ 50 ]. This situation may be similar in the Middle East and North Africa region, where Transparency International has noted that whistleblowing is ‘almost completely unheard of’ and no countries have adequate protections [ 56 ].

Moy observes that cultural context can be an impediment to whistleblowing. In some cultures, the whistleblower is perceived negatively and stereotyped as a disgruntled employee or disloyal worker [ 22 ]. Although Moy does not mention specific cultures, Soon & Manning note that in China, personal relationships, fear of retaliation, and media coverage may discourage whistleblowing [ 37 ]. Guanxi refers to existing or potential informal relationships based on reciprocal obligation in the workplace and socially [ 57 ]. If a person has a good personal relationship, or guanxi , with a work colleague, they may be reluctant to blow the whistle and risk damaging that relationship or not fulfiling the obligation for loyalty and trust that it assumes. Drawing media coverage may also be feared because it could impact guanxi [ 37 , 58 ].

Sub-question 5: what are the impacts and consequences of whistleblowing?

The final sub-question for the scoping review was to understand what is known about the outcomes of whistleblowing for whistleblowers and for the organisation itself. Eight out of 22 sources (36%) included information relevant to this review question.

Negative consequences

Articles described how organisations or individuals retaliate against whistleblowers. Whistleblowers risk career and livelihood, and may suffer financial, health, reputational and personal consequences [ 22 , 35 ]. Retaliation includes workplace harassment, job loss, workplace restrictions, and reduction of responsibilities [ 15 , 36 , 47 , 50 ]. Health workers who reported misconduct were subjected to severe official reprisals including demotion, reprimand, and psychiatric referral [ 37 ]. They were threatened, treated as a ‘traitor’, pressured to resign, or stalled in career progression [ 37 , 48 ]. Some faced false criminal conduct charges [ 36 ]. In extreme cases, whistleblowers have suffered physical harm or death [ 50 ].

Actions to suppress whistleblowers were documented through a survey of anti-fraud professionals from 58 countries [ 49 ]. Researchers reported that in 46% of countries represented, whistleblowers had been suppressed.

Positive impacts

We found little documentation of how whistleblowing led to prosecution or system changes. The European Union’s 2019 directive on the protection of persons who report breaches of Union law describes how whistleblowing could enhance food safety and prevention of disease transmission through the detection of fraud and corruption and subsequent enforcement and prosecution [ 43 ]; yet, we could not find reports to document actual outcomes.

Introduction of a whistleblowing mechanism and I Speak Out Now! campaign in Malawi led to increased arrests, fines, and prosecutions [ 34 ], though no further information was available. In Morocco, a whistleblower complaint about under-the-table payments resulted in police launching a sting operation. An undercover agent offered an informal payment to the nurse who had been identified by the whistleblower. After accepting the informal payment, the nurse was arrested, prosecuted, and received a sentence of two months in prison [ 47 ]. The patient was given the care they needed. Yet, while this may be a good deterrence strategy in the short term, the reporting was not used to identify the drivers of this type of corruption or identify sustainable solutions. Longer-term, sustainable anti-corruption strategies should use whistleblower information to address root causes of the informal payment practice, such as low wages and drug shortages [ 59 ]. None of the sources reviewed provided evidence of how organisations may have used information gained from whistleblowers to determine the drivers of corruption, or to strengthen health systems.

This scoping review was designed to explore the extent and type of evidence in the literature on whistleblowing as an anti-corruption strategy in health and pharmaceutical organisations in LMICs. We found that most of the literature is descriptive or normative, including policies, guidance, reports and commentary. We found no theoretical articles or scholarly critiques of whistleblowing for anti-corruption in the areas of interest. Our study revealed little evidence of data such as surveys, court cases, case studies, or administrative data being collected and used to study whistleblowing or develop policy and procedures. There is little research on how whistleblowing complaints in the health sector are being used to strengthen health systems. This suggests a broken feedback loop and disconnect between the national integrity system and organisational change.

International agencies working in the health arena have promulgated whistleblowing policies and guidance that can help inform country-level health and pharmaceutical sector policy. These policies and guidance documents include definitions and justifications, details on who is covered by the policy, channels for whistleblowing and procedures for investigating claims, provisions for confidentiality, and protection from retaliation. Yet, we did not find empirical evidence to justify policy effectiveness. An important area of future research should be to evaluate whistleblowing policies and programmes, to determine if this is a worthwhile investment at the sectoral level.

Our findings support the ideas raised in previous systematic reviews, i.e. that current research provides little insight on the way whistleblowing is approached in different healthcare systems, and the importance of studying how to provide support for whistleblowers within specific organisational contexts [ 20 ]. Similar to findings by Kelly and Jones [ 27 ], we found that few sources focused on the complex environment and interactions affecting whistleblowing at the personal and organisational level. It is important to understand how these factors intertwine to influence in the decision to blow the whistle, and how they may affect organisational responsiveness [ 27 ]. Theories may be useful in guiding this work of understanding motivational factors [ 13 , 60–62 ].

Case study research may also show how factors in the environment (such as leadership style, organisational culture and values, design features of the whistleblowing system such as modalities of reporting) interact with personal characteristics (gender, tenure, organisational role, personality) to affect whistleblowing frequency, and how the organisation uses the information to address corruption risks and strengthen health systems. For example, researchers in Brazil found that women reported wrongdoing less often than men, and experienced more retaliation [ 63 ]. Although public service motivation increased intent to blow the whistle (and was stronger in women), the experience of past retaliation suppressed intent to blow the whistle in the future. The researchers hypothesise that the relationship between gender and whistleblowing may be related to the low power-status position of women in organisations. Thus, in cultures where gender inequalities are less important, and legal foundations for whistleblowing are stronger, gender effects may be minimised [ 63 ].

Our scoping review has several implications for research. First, empirical work is needed to collect data from whistleblowing reports, court cases, or surveys to analyse types and frequencies of whistleblowing, and the personal, situational, and organisational factors facilitating whistleblowing for anti-corruption in the health and pharmaceutical organisations. Surveys and qualitative work to explore attitudes and perceptions of those involved (potential whistleblowers, managers, etc.) may provide data that can help guide and adapt policies. Empirical work can help us to evaluate factors that contribute to the decision to blow the whistle, and moderating factors that influence the strength or direction of the relationship. Programme evaluations can help us to determine if policies are effective, and what impacts result for the person blowing the whistle, and the organisation as a whole.

Secondly, building on empirical findings, more conceptual work is needed to develop theory on whistleblowing for anti-corruption in the health and pharmaceutical sector in LMICs. Researchers should document and critique whistleblowing models and strategies in health and pharmaceutical organisations. Strategies may vary across countries due to differing social norms, political environment, and structure of the health and pharmaceutical sectors. This information can be correlated with empirical data on whistleblowing perceptions, impact and consequences to develop theory and guide effective policies and protection mechanisms. Researchers should involve civil society actors to gain their perspectives.

Third, a critically important area for research is effective interventions to protect whistleblowers. The lowest income countries have most risk of corruption, yet they are most challenged by lack of resources to protect whistleblowers. Possibilities of protection for whistleblowers managed through third parties could be considered, building on examples of contracting out of government procurement services as an anti-corruption strategy [ 64 ].

Finally, whistleblowing systems may require culture change to overcome negative stereotypes of whistleblowers as traitors who cannot be trusted, and to build a culture of improvement. Further study is needed to understand the impact of cultural beliefs and norms on willingness to report, and how to combat negative perceptions of whistleblowing. This can draw on research designs from other sectors [ 65 , 66 ].

There are several limitations to our study. First, given timing and resource constraints, we chose to include three academic databases for this review along with grey literature. Yet, as others have noted, whistleblowing literature is not well developed in the health sector and may appear in other disciplines not captured. Searching more databases could identify additional sources. Secondly, the exclusion of articles in the review that considered research-related fraud could mean that important experiences of applying whistleblowing in the pharmaceutical sector (where there are likely many examples due to the inclusion of whistleblowing hotlines as part of corporate compliance schemes) were not captured, limiting the findings. Investigation into whistleblowing and research-related fraud in LMICs could be a topic for further research. Third, scoping reviews are designed to consider the extent, range, and nature of literature in the topic area and not to assess the quality of research. Thus, it is possible that some findings from these sources lack adequate evidence due to problems with the quality of methods used. Fourth, we limited the search to English language only. This may have excluded relevant articles published in other languages. Finally, we did not examine whistleblowing policies in health systems at the national or sub-national level in LMICs, or do specific outreach to find policies of international organisations that might not be available online. This might be a useful exercise for future work in this field.

Corruption in the health sector is a serious and growing problem, especially affecting those who are most disadvantaged [ 8 ]. Whistleblowing can reduce the frequency and cost of corruption by allowing organisations to identify potential wrongdoing and address problems at an early stage. Yet, in order to work, whistleblowing systems must be carefully designed and adapted to context, with protections in place for whistleblowers. This review found that limited research has been conducted on whistleblowing in health, pharmaceutical, and related organisations focusing on anti-corruption and fraud in LMICs. Many avenues for further research could be productive and help inform policy and practice. This includes surveys, case studies, and other types of empirical research to examine the factors associated with the decision to report and the impact of whistleblowing on the organisation and the person blowing the whistle. Documentation of existing policies and sharing of experiences in policy implementation at all stages could help countries seeking to mainstream whistleblowing as a sector-specific anti-corruption strategy.

Supplementary Material

Acknowledgments.

The authors would like to thank Claire Sharifi, Reference Librarian and Nursing and Health Sciences Liaison, for her assistance in developing the protocol and methods for the scoping review. We would also like to acknowledge support received from the WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector at the University of Toronto through the Connaught Global Challenge Award.

Funding Statement

This research was supported by a Faculty Development Fund Award from the University of San Francisco School of Nursing and Health Professions. The online publication fee was supported by the Connaught Global Challenge Award, administered through the WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector at the Leslie Dan Faculty of Pharmacy, University of Toronto

Responsible Editor

Jennifer Stewart Williams

Author contributions

TV created the study design, developed the protocol and search criteria, conducted the literature search and screening, charted data, synthesised results, wrote the initial draft, and reviewed the final manuscript. BA participated in the development of the protocol and search criteria, conducted the literature search and screening, charted data, synthesised results, and reviewed drafts of the manuscript including the final draft. KM participated in the development of the protocol, charted data, synthesised results, and reviewed drafts of the manuscript, including the final draft.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Because this review extracted data from secondary sources and did not involve human subjects research, ethical approval was not required.

Paper context

Little is known about how whistleblowing is understood and used to detect corruption in health and pharmaceutical organisations in LMICs. This scoping review documented components of whistleblowing policies implemented by international organisations, and factors that may affect motivation for whistleblowing. We need further research to understand how whistleblowing systems operate in LMIC contexts, factors that enhance the effectiveness of such systems, and outcomes experienced by organisations and individuals involved.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2022.2140494

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Analysing near-miss incidents in construction: a systematic literature review.

1. Introduction

• Q 1 —Are near-miss events in construction industry the subject of scientific research?
• Q 2 —What methods have been employed thus far to obtain information on near misses and systems for recording incidents in construction companies?
• Q 3 —What methods have been used to analyse the information and figures obtained?
• Q 4 —What are the key aspects of near misses in the construction industry that have been of interest to the researchers?

2. Definition of Near-Miss Events

3. research methodology, 4.1. a statistical analysis of publications, 4.2. methods used to obtain information about near misses, 4.2.1. traditional methods.

• Traditional registration forms
• Computerized systems for the recording of events
• Surveys and interviews

4.2.2. Real-Time Monitoring Systems

• Employee-tracking systems
• Video surveillance systems
• Wearable technology
• Motion sensors

4.3. Methods Used to Analyse the Information and Figures That Have Been Obtained

4.3.1. quantitative and qualitative statistical methods, 4.3.2. analysis using artificial intelligence (ai), 4.3.3. building information modelling, 4.4. key aspects of near-miss investigations in the construction industry, 4.4.1. occupational risk assessment, 4.4.2. causes of hazards in construction, 4.4.3. time series of near misses, 4.4.4. material factors of construction processes, 4.5. a comprehensive overview of the research questions and references on near misses in the construction industry, 5. discussion, 5.1. interest of researchers in near misses in construction (question 1), 5.2. methods used to obtain near-miss information (question 2), 5.3. methods used to analyse the information and data sets (question 3), 5.4. key aspects of near-miss investigations in the construction industry (question 4), 6. conclusions.

• A quantitative analysis of the Q 1 question has revealed a positive trend, namely that there is a growing interest among researchers in studying near misses in construction. The greatest interest in NM topics is observed in the United States of America, China, the United Kingdom, Australia, Hong Kong, and Germany. Additionally, there has been a recent emergence of interest in Poland. The majority of articles are mainly published in journals such as Safety Science (10), Journal of Construction Engineering and Management (8), and Automation in Construction (5);
• The analysis of question Q 2 illustrates that traditional paper-based event registration systems are currently being superseded by advanced IT systems. However, both traditional and advanced systems are subject to the disadvantage of relying on employee-reported data, which introduces a significant degree of uncertainty regarding in the quality of the information provided. A substantial proportion of the data and findings presented in the studies was obtained through surveys and interviews. The implementation of real-time monitoring systems is becoming increasingly prevalent in construction sites. The objective of such systems is to provide immediate alerts in the event of potential hazards, thereby preventing a significant number of near misses. Real-time monitoring systems employ a range of technologies, including ultrasonic technology, radio frequency identification (RFID), inertial measurement units (IMUs), real-time location systems (RTLSs), industrial cameras, wearable technology, motion sensors, and advanced IT technologies, among others;
• The analysis of acquired near-miss data is primarily conducted through the utilisation of quantitative and qualitative statistical methods, as evidenced by the examination of the Q 3 question. In recent years, research utilising artificial intelligence (AI) has made significant advances. The most commonly employed artificial intelligence techniques include text mining, machine learning, and artificial neural networks. The growing deployment of Building Information Modelling (BIM) technology has precipitated a profound transformation in the safety management of construction sites, with the advent of sophisticated tools for the identification and management of hazardous occurrences;
• In response to question Q 4 , the study of near misses in the construction industry has identified several key aspects that have attracted the attention of researchers. These include the utilisation of both quantitative and qualitative methodologies for risk assessment, the analysis of the causes of hazards, the identification of accident precursors through the creation of time series, and the examination of material factors pertaining to construction processes. Researchers are focusing on the utilisation of both databases and advanced technologies, such as real-time location tracking, for the assessment and analysis of occupational risks. Techniques such as Analytic Hierarchy Process (AHP) and clustering facilitate a comprehensive assessment and categorisation of incidents, thereby enabling the identification of patterns and susceptibility to specific types of accidents. Moreover, the impact of a company’s safety climate and organisational culture on the frequency and characteristics of near misses represents a pivotal area of investigation. The findings of this research indicate that effective safety management requires a holistic approach that integrates technology, risk management and safety culture, with the objective of reducing accidents and enhancing overall working conditions on construction sites.

7. Gaps and Future Research Directions, Limitations

• Given the diversity and variability of construction sites and the changing conditions and circumstances of work, it is essential to create homogeneous clusters of near misses and to analyse the phenomena within these clusters. The formation of such clusters may be contingent upon the direct causes of the events in question;
• Given the inherently dynamic nature of construction, it is essential to analyse time series of events that indicate trends in development and safety levels. The numerical characteristics of these trends may be used to construct predictive models for future accidents and near misses;
• The authors have identified potential avenues for future research, which could involve the development of mathematical models using techniques such as linear regression, artificial intelligence, and machine learning. The objective of these models is to predict the probable timing of occupational accidents within defined incident categories, utilising data from near misses. Moreover, efforts are being made to gain access to the hazardous incident recording systems of different construction companies, with a view to facilitating comparison of the resulting data;
• One significant limitation of near-miss research is the lack of an integrated database that encompasses a diverse range of construction sites and construction work. A data resource of this nature would be of immense value for the purpose of conducting comprehensive analyses and formulating effective risk management strategies. This issue can be attributed to two factors: firstly, the reluctance of company managers to share their databases with researchers specialising in risk assessment, and secondly, the reluctance of employees to report near-miss incidents. Such actions may result in adverse consequences for employees, including disciplinary action or negative perceptions from managers. This consequently results in the recording of only a subset of incidents, thereby distorting the true picture of safety on the site.

Author Contributions

Institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Woźniak, Z.; Hoła, B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Appl. Sci. 2024 , 14 , 7260. https://doi.org/10.3390/app14167260

Woźniak Z, Hoła B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Applied Sciences . 2024; 14(16):7260. https://doi.org/10.3390/app14167260

Woźniak, Zuzanna, and Bożena Hoła. 2024. "Analysing Near-Miss Incidents in Construction: A Systematic Literature Review" Applied Sciences 14, no. 16: 7260. https://doi.org/10.3390/app14167260

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