According to an article recently published in the Lancet, some 10% to 25% of the USD $7 trillion spent on healthcare globally every year is lost because of corruption – an amount that exceeds the investments needed to achieve universal healthcare by 2030.

To understand how corruption affects healthcare worldwide, the Global Health Centre at the Geneva Graduate Institute organised a panel to discuss how the phenomenon manifests itself and what can be done to fight it. The event was introduced by Vinh-Kim Nguyen, Co-Director at the Centre, and moderated by Priti Patnaik, Founder of Geneva Health Files.

“Corruption is a disease of the health system, as it is well described in the Lancet,” said David Clarke, acting head of the Health Systems Governance Unit at WHO, Geneva. He explained that agencies focused on criminal activities have traditionally dealt with corruption. However, in recent years the WHO has felt the need to work on fighting it from a healthcare perspective.

“There’s a significant range of activities that could be regarded as corruption,” he noted, mentioning informal payments, absenteeism, data manipulation, lack of transparency, falsified medical products, embezzlement, and bribery. “All of them distort health systems and negatively affect how people receive health services.”

Clarke mentioned how in some countries, up to 80% of non-salary funds in healthcare never reach local facilities and an estimated 140,000 children per year lose their life because of corruption.

The goal of WHO is to fight corruption by creating more transparency and accountability, specifically in the health systems, he pointed out.

According to Dr. Mushtaq Khan, a professor of Economics at the SOAS University of London, fighting corruption is complicated because each of its manifestations might have multiple causes.

“Lack of resources is one of the factors driving corruption,” he pointed out. “If you are in an under-resourced hospital, then there is excess demand, and people have to pay to get seen.”

In addition, he highlighted how political clientelism and patronage represent another driver of corruption.

“The way patronage is used to create jobs is not directly related to resource scarcity,” Khan said, adding that a weak rule of law is critical in allowing corruption to thrive.

Case study: Moldova

During the panel, Dr. Ion Bahnarel, a former Deputy Minister of Health in the Republic of Moldova and the Head of the Department of Hygiene, University of Medicine and Farmacie “Nicolae Testemițanu,” presented the efforts that his country is making to fight corruption.

“Our government has initiated several reforms,” he explained. “They include creating anti-corruption structures in local and state institutions.”

Bahnarel said that all medical institutions now offer a system for employees and patients to report episodes of corruption anonymously. In addition, an Ethics Committee has determined new rules and procedures for health organisations for transparency and accountability.

According to Dr. Monica Kirya, a Senior Adviser at U4 Anti-Corruption Resources Centre in her native Uganda, “it is safe to say that you could die if you do not have money to pay a bribe to move up the queue to see a doctor.”

Kirya resides in Norway where U4 is based.

Kirya emphasized that health workers are victims as much as perpetrators of corruption.

“It’s well known that in many developing countries such as Uganda, health workers are extremely poorly paid,” she said. “This is one of the drivers of absenteeism, informal payments and other corruption that health workers engage in to make ends meet.”

Kirya explained that it is essential to pay attention to the structural factors of the system that enable corruption to thrive, such as bans on public service recruitment.

“These bans on public service recruitment started as structural adjustment programs in the 80s and 90s to reduce government expenditure, and they remain in force from time to time as a way to balance the public budget,” she pointed out.

According to the expert, these bans favour political patronage being used in the recruitment and appointment of health workers.

“Because health is a decentralised service in Uganda, and recruitment is often done at the local government level, district politicians and civil service administration use recruitment to extort money from medical graduates,” she said.

While all experts highlighted how fighting corruption effectively is complicated for various reasons, they also suggested how it should be done.

“It is essential to have evidence-based analysis,” said Khan. “This is what should inform reform, while often, the reform is driven by abstract models of what drives corruption, which might be somewhat relevant to the advanced countries’ experience but not to the developing countries’ experience.”

Everyone agreed that to offer better health services defeating corruption is crucial.

“If you had a problem that affected your financial well-being, that was a threat to your life and was a threat to the way that you live, wouldn’t you do something about it? This is what corruption is all about,” said Clarke. “Unless we address corruption, much of our work on strengthening our health system will be a waste of time.”

Image Credits: Screenshot, Screenshot, Geneva Graduate Institute.