The global health services industry, worth an estimated US $3 trillion per year, is a maze of complex and opaque systems and a fertile field for corruption. Healthcare is a global human right. But corruption in the health services sector in both rich and poor countries deprives citizens of access to health care and is one reason why, so often, increased spending does not improve health.

A cure for corruption is imperative.

As Mary Robinson writes in the foreword of the Global Corruption Report 2006, “there are populations for whom the consequences of ill health are particularly bleak. If corruption and a lack of transparency are not addressed as integral to health care strategies, HIV/AIDS and other infectious diseases threaten to reverse hard-won development gains, especially in Africa.”

According to the World Health Organisation, AIDS expenditures worldwide nearly doubled to US $8.3 billion between 2003 and 2005. By 2008, it is estimated that at least US $22 billion per year – nearly three times the current funding level – will be required to pay for national HIV prevention, treatment and care programmes.

The sums are huge compared to the existing budgets of many countries, but in many instances the systems to use these funds appropriately are often poorly developed. Indeed, for corrupt officials large budgets offer greater scope to siphon off vast sums without anyone noticing.

Recent headlines point to the scale of corruption

HIV/AIDS is one of the biggest challenges facing in Kenya. In 1999 it was declared a national disaster. In 2004 the National Aids Control Council was allotted US $41 million and was set up under the auspices of the Office of the President. However, it has been the focus of some of Kenya’s most flagrant acts of corruption, with civil servants using the agency as their personal cash cow. Because of graft allegations, the World Bank is delaying US $260 million in loans for education and health projects in Kenya. This has serious implications in a country where, according to UNAIDS figures for 2003, 200,000 adults and children died of AIDS in 2003 alone. By the end of 2003 the total number of children in Kenya who have lost one or both parents to AIDS was 930,000.

In Zimbabwe, the government has imposed an "AIDS levy" since 2000. Employees contribute three percent of their gross salaries towards a fund administered by the National Aids Council. It is estimated that the government collects about US $20 million per year. Yet no information about how the fund is used or who benefits from it has ever been made public.

This week HIV/AIDS organisations in Uganda are threatening a nation wide demonstration if President Museveni does not sack the Minister of Health, Jim Muhwezi, for his alleged involvement in the mismanagement of the Global Funds Global Fund to Fight AIDS, Tuberculosis and Malaria. An inquiry by the Global Fund has revealed massive graft in the use of US $367 million in grants.

Corruption in the delivery of health services

Informal payments – charges for services or supplies that are supposed to be free – are common in many parts of the world, especially in developing and transition countries. Informal payments can lead to a massive distortion of the health system by undermining official payment systems, distorting the priorities of the health system, reducing access to health services and impeding health reforms. They can also provide undesirable incentives and encourage unprofessional behaviour by health workers.

According to Transparency International's Global Corruption Barometer 2005, the medical services sector is seen as being more corrupt than education or the military. The Barometer polled 55,000 people in 69 countries to assess their views on corruption. In Kosovo, medical services are seen as the most corrupt sector, while in Italy, Moldova, Poland, Romania, Serbia and Turkey, medical services are within the top three sectors and institutions most affected by corruption.

Sectors and institutions most affected by corruption
(1 - not at all corrupt... 5 - extremely corrupt)

Source: Transparency International Global Corruption Barometer 2005

To mark World Health Day 2006, Transparency International recommends the following measures to bring greater transparency to the health sector:

• Donor and recipient governments should grant easy access to information on key aspects of health-related projects, budgets and policies. Budget information should be available on the internet and subject to independent audits.
• Provided codes of conduct for health workers and private sector companies should be adopted and enforced and provide ongoing anti-corruption training.
• Governments should incorporate conflict-of-interest rules in drug regulation and physician licensing procedures.
• Public health policies and projects should be independently monitored, both at the national and international level, and their reports open to public scrutiny.
• Procurement processes should be competitive, open and transparent, and comply with Transparency International’s Minimum Standards for Transparency and Public Contracting. No-bribe pledges such as TI’s Integrity Pact should be adopted to level the playing field for all bidders.
• Prosecuting authorities must demonstrate the message that corruption has consequences by rigorously pursuing corrupt acts that are clearly proscribed by law.
• Governments and health authorities should ensure that special anti-corruption and fraud agencies to detect corruption and promote preventative measures in the health sector are equipped with the necessary expertise, resources and independence to carry out their functions, and be backed by functioning independent courts.
• To reduce incentives for corruption doctors, nurses and other health professionals must be paid a decent wage, commensurate with their education, skills and training.
• Pharmaceutical, biotech and medical device companies must adopt the Business Principles for Countering Bribery, through which a company commits to refraining from bribery in its operations and implements a comprehensive anti-corruption programme.

For the full list of recommendations for the health sector, please click here.

Transparency International’s work on health is now available online. This is a compilation of the latest research on health systems, service delivery, the pharmaceutical industry, how corruption effects HIV/AIDS treatment, and tools and best practices to check corruption in health. To read more on how bribery and extortion rob millions of proper healthcare, download the Global Corruption Report 2006, that focuses on corruption and health.

photos © WHO

All figures taken from the GCR 2006.