How Does Corruption Affect Health Systems Around the World?

When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems.

“Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.”

García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program.

“According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.”

Fighting corruption, all the guests agreed, is essential to achieve universal health coverage.

Corruption as a matter of life and death

According to Kirya, it is important to consider the phenomenon as a matter of life and death.

“You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.”

While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues.

In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is.

“We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere.

“It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.”

García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be.

“I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled.

“We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.”

However, as soon as she left office about 14 months after she was appointed, the investigation was called off.

“The problems are still ongoing,” she concluded.

The need for leaders with integrity

Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission.

“We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.”

“I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.”

Listen to previous episodes on the Health Policy Website >>

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Image Credits: Global Health Matters Podcast, Courtesy of TDR.

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