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Wednesday, January 7, 2015

Why fighting corruption is key to improving healthcare

In a sector that is scarce and expensive to begin with, corruption can mean the difference between life and death.
I recently attended the World Bank Group’s second annual Youth Summit, developed in partnership with the Office of the United Nations Secretary-General’s Envoy on Youth. The event, hosted thanks to the leadership and initiative of young World Bank Group employees, focused on increasing youth engagement to end corruption and promote open and responsive governments. In the wake of the Ebola crisis, and amidst some very eager, idealist, and passionate conversations, I couldn’t help but think about the price of corruption in health.
Many have argued that decades of corruption and distrust of government left African nations prey to Ebola. Whether in Africa or any other continent, it should come as no surprise that complex, variable, and dangerously fragmented health systems can breed dishonest practices. The mysterious dance between regulators, insurers, health care providers, suppliers, and consumers obscures transparency and accountability-based imperatives. As the recent allegations about Ebola-stricken families paying bribes for falsified death certificates illustrate, when it comes to health, local corruption can have serious consequences internationally.
This is an eye-opening reality for anyone working in the health sector, where the stakes are high and the resources precious. Corruption starves valuable resources available to the health system, quietly reduces the effectiveness of health services and activities, and cripples civic trust in health institutions. In effect, corruption corrodes efforts to combat disease and improve population health status. On a very basic level, corruption in the health sector is about patient or “consumer” vulnerability: Most people can’t find a place where the appropriate care is offered at a reasonable price, let alone understand what is being done to them or evaluate whether the care they received was warranted and of quality. In the midst of such “information asymmetry,” both the “supply” and “demand” sides offer lucrative opportunities for abuse and illicit gain.
​Corruption is a worldwide problem, rife in high and low-income countries alike. The nature and impact of corrupt practices in the healthcare sector are equally widespread. According to Transparency International, a global civil society organisation leading the fight against corruption, common corrupt practices in health include worker absenteeism; theft of medical supplies; bribery in medical service delivery; fraud and embezzlement of medicines, medical devices, and health care funds; improper marketing relations; weak regulatory procedures; opaque and improperly designed procurement procedures; and diversion of supplies in the distribution system for private gains. Relationships, responsibilities, and payment mechanisms vary from system to system, country to country, and there is no “one-size-fits-all” solution.
So, what are the impacts anti-corruption strategies can have on health outcomes? Which actors need to be involved in the process? Which conditions are most likely to achieve successes, and how can we encourage and sustain positive results?
A prominent theme at the Youth Summit was the role of data and technology in promoting transparency, accountability, and citizen collaboration. Although by no means a panacea or replacement for structural change, data-crunching technologies and online social networks can play a large part in combating corruption – the same way user-generated communities are personalising platforms for disease management and surveillance – by offering real-time user-generated feedback. Indeed, as I learned at the Youth Summit, a great deal can be done to reduce corruption – but it cannot be done alone. The health field would benefit from best practices and existing platforms for fighting corruption in other critical sectors, such as aid and development, infrastructure, elections monitoring, and finance. Doing so would not only ensure that civil society and citizens have access to critical information but also empower them to hold governments and health service providers accountable. Tackling corruption is essential for achieving better health outcomes globally.
Silence kills. And, corruption, like Ebola, is a deadly virus feeding on global inaction.
Published in collaboration with The World Bank
Author: Viva Dadwal is a Visiting Scholar at Johns Hopkins University Bloomberg School of Public Health, where she is investigating the transfer of health innovations from low to high-income countries.
Image: A nurse poses for a photo in a trauma center of the University of Mississippi Medical Center in Jackson, Mississippi October 4, 2013. REUTERS/Jonathan Bachman