Transparency International (TI), in its recently-released Global Corruption 2006 report, says that it is difficult to estimate the overall costs of corruption in the global USD 3 trillion health sector. However, TI reports that the scale of corruption is vast in both rich and poor countries. Doctors from Cambodia, for example, estimate that more than 5% of the health budget is lost to corruption before it even leaves central government. Meanwhile, the two largest US public health care programmes, Medicare and Medicaid, approximate that 5–10 % of their budget is lost to ‘overpayment.’
The health sector is “an attractive target” for abuse, the report reveals, because of the large amounts of money and complexities involved in health care systems. The report from Berlin-based anti-corruption watchdog cite cases of 19 people dying from a faulty heart valve in Italy, where doctors of victims allegedly received payments from the manufacturers of the faulty device, as well as cases of doctors in the US receiving as much as USD 40,000 for eight days’ consultancy work.
However, in poor countries, “the price of corruption in health care is paid for in human suffering,” said TI Chair Huguette Labelle.
In Papua New Guinea, for example, bad management has led to a health delivery system collapse. People suffering from malaria and other serious diseases have to walk four days before reaching health clinics. The report notes that 20 years ago, no one was supposed to be four hours away from primary health care.
The collapse of Papua New Guinea’s heath care is one reason why life expectancy in PNG is much lower than other poorer countries in the Pacific. The country is also threatened by a rising incidence of infant mortality and HIV/AIDS.
Meanwhile, in the Philippines, extortion by medical personnel has reportedly increased, leading to a reduced rate of child immunisation by up to 20 %. The report adds that in poor and middle-income municipalities, patients in public clinics wait 30% longer than those in rich towns. In Cambodia, health practitioners estimate that more than 5 % of the health budget is lost to corruption before it even leaves the central government.
The report also cites doctors prescribing drugs that are not always based on patients’ need but pushed by aggressive marketing techniques. Pharmaceutical companies invest billions in research into new drugs, and even greater sums in advertising. Big Pharma is very profitable: global sales for the industry for 2004 were USD 550 billion, with the largest pharmaceuticals posting profits of at least USD 10 billion.
“Corruption underpins a lucrative counterfeit drugs trade. Payoffs at every step of the chain smooth the flow of counterfeit drugs from their source to the unwitting consumer. With pharmaceuticals often the largest household health expenditure in developing countries, corruption in the pharmaceutical industry has a direct and painful impact on people struggling for survival,” said David Nussbaum, TI chief executive.
The report also revealed that corruption has hampered the success of global efforts to rein in HIV/AIDS. “Theft by ministries and national AIDS councils of funds allocated for treatment leaves sufferers without critical care.” Kenya’s National Aids Council, for example, was “hijacked” by a few high-level civil servants, diverting critical resources through shell organisations that siphon public funds. “Corruption can contribute directly to infection when relatively low-cost measures, such as sterile needles and screening of blood donations, cannot be carried out because a corrupt procurement or distribution process holds up supplies.”
TI recommended that corruption needed to be addressed within the context of a nation’s health system and tackled through greater transparency, such as the publication of health budgets and performance; and improved codes of conduct and training. The report also recommended greater protection for whistleblowers, decent wages for medical staff, stricter conflict of interest rules, and more rigorous prosecution to better tackle corruption.
It has been said that an ounce of prevention is worth a pound of cure. Widespread corruption blocks even the semblance of prevention; doubly so, the possibility of cure.
To download the full report, go to the Global Corruption Report 2006 website: <http://www.transparency.org/publications/gcr/download_gcr#download>.
Sources:
BBC News. February 1, 2006. “Medical Corruption 'Global Issue.'” Downloaded from BBC News website <http://news.bbc.co.uk/1/hi/business/4666328.stm>.
Suri, Sanjay. February 1, 2006. “Corruption-Health: A Killer Combination.” Downloaded from Inter Press Service News Agency website <http://www.ipsnews.org/news.asp?idnews=31997>.
Transparency International. 2006. Global Corruption Report 2006: Corruption in Health. Berlin, Germany: Transparency International.
FYI In the health sphere, corruption includes: - Embezzlement and theft – occurring at any level – from central government down to the patient. Corruption is not limited to abuse by public officials, because society frequently entrusts private actors in health care with important public roles. When hospital administrators, insurers, physicians, or pharmaceutical company executives dishonestly enrich themselves, they are not abusing a public office, but they are abusing entrusted power and stealing precious resources needed for people’s well-being. Source: BBC News. February 1, 2006. “Medical Corruption 'Global Issue.'” Downloaded from BBC News website <http://news.bbc.co.uk/1/hi/business/4666328.stm>. |
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