GHF2010 – PS04 – The Challenges of Working with Corruption

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Session Outline

Parallel session PS04, Wednesday, April 21 2010, 11:00-12:30, Room 2
Chair(s): Jean Freymond, President, Network for Governance, Entrepreneurship, and Development (GE&D), Switzerland
Summary: Corruption pervades the health sector, with negative effects on health status and social welfare. Health initiatives, health policy, and international aid are made less effective in achieving their goals as corruption undermines efforts to combat deadly diseases and to increase coverage and quality in health systems. Fighting corruption in health systems is an essential development goal, as it can lead to increased efficiency and maximize outcomes of national health resources. The presentations of this session will be followed by debate and input from actors around the world (on site or via GHF Hubs) who have experienced and fought against corruption.
Fighting Corruption through Transparency and Accountability
Taryn Vian, Assistant Professor, International Health Division, Boston School of Public Health, USA
WHO Good Governance for Medicines Programme
Guitelle Baghdadi-Sabeti, Technical Officer, Good Governance on Medicine, Policy, Medicine Access and Rational Use, Essential Medicines and Pharmaceutical Policies, World Health Organization, Switzerland
Corruption Risks in the Health Sector of Former Soviet Union Countries 
Anne Lugon-Moulin, Deputy Head, CIS Countries Division, Swiss Agency for Development and Cooperation, Switzerland
Keeping a Watch on Corruption: The Example of Community Monitoring in India 
Abhay Shukla, Coordinator of the People's Health Movement, India

Session Documents

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Session Video

This session is available to watch using Dudal. To watch it you will need to have Java installed on your computer.

Session Report

Submitted by: Ann Galea (ICVolunteers); Contributors: Jane Marriott (ICVolunteers)

Photo by John Brownlee, ICVolunteers.org

Sadly, the quotation "It's our turn to Eat", taken from the book by Michela Wrong, still represents a daily fact of life for many people. Corruption in the health sector should be unacceptable as this causes immense additional and unnecessary suffering to the world's most vulnerable and needy people. Fighting against corruption requires strong legislation and transparent accountability. Discussing the causes and challenges of corruption among Health Care Workers is a most important and relevant topic and must be addressed with urgency.

The Chairman, Jean Freymond, from Governance Entrepreneurship & Development (GE&D) here in Switzerland introduced Taryn Vian from the International Health Division at Boston School of Public Health, who was communicating by video link.

Ms. Vian spoke of the reactions of one health worker suddenly faced with evidence of corruption. Along with the initial shock, anger and bewilderment came the feeling of fear as to what she could and should do about this. What would happen as a result? This is not just a personal problem; this is a global health problem that affects us all on many different levels. Ms. Vian has created a course at Boston University on the Prevention of Corruption in Public Health Workers. Leadership and transparency need to be at the centre for reform to be effective in creating a cycle of good practice. Financial control which stops embezzlement and the usage of funds for ‘Pet project’ is essential. An individual may abuse funds or medical supplies when three things coalesce: opportunity, a personal justification and personal pressure. If any of these are not present, corruption is minimised. Therefore the aim has to be to ensure transparency at all levels. Unfortunately the video link with Ms. Vian was broken at this point.

Deputy-head of CIS Countries Division for Development and Cooperation, Switzerland, Ms. Anne Lugon-Moulin spoke about corruption risks relating, in particular, to countries in the former Soviet Union. Her findings are based both on work done in various countries by her organisation and on the findings of the Basel Institute. Corruption, she said, can be identified at all different levels of state administration. State capture or political corruption is the least tangible with the powerful elite taking control of aid and funds for their own private agendas rather than for the common good. Again on all levels there is the issue of conflict of interest.

Generally the problems are the same everywhere' they merely differ in degree. At the level of government there are huge economic resources at stake and powerful individuals can use their power to stop reform processes. The lack of transparency in the public sector makes it very difficult to prove wrong-doing let alone tackle it. Embezzlement of funds is a huge problem and, due to old Soviet systems, money is taken out of funding on an on-going annual basis. Bribery is also a huge problem. Fake tenders, decisions being pre-decided, kick-back payments and public procurement not being undertaken in the public interest are all problems. This results in poor quality investment in public works, high on-going costs and low quality results. Over-spending is common in areas where a payment can be taken, such as with the building of infrastructure or buildings and there is a subsequent lack of investment in ‘soft’ components such as training and personnel, which actually make a difference to people.

The poorer the country the more this is the case. Bribery affects everyone. Bribes to receive diplomas or jobs and an annual premium for retaining a job are common practice. This obviously results in services being hampered and jobs going to those who can afford to pay bribes rather than to those best suited and qualified.

Collusion happens between doctors and pharmacists everywhere, even in Switzerland, it was alleged in the meeting. Public doctors also work in private clinics which often results in patients being referred to places where they have to pay for services that should be provided for free. To complicate matters much of this is intangible and therefore difficult to see or to prove. There is no easy answer but as always, it is rooted in creating more transparent and accountable management and controls, earmarking budget support and applying stringent controls and sanctions. A better economic situation, higher salaries and the reform of the health system would help. Sanctions and other deterrents are also essential, as is the freedom to speak out when corruption is observed. Participants in the supply chain need to understand the correct system of supply in order to notice when it is not being adhered to. Above all, however, transparency is the key.

Dr. Guitelle Baghdadi-Sabeti, from the WHO Good Governance on Medicine, Policy, Medicine Access and Rational Use, Essential Medicines and Pharmaceutical Policies, described the WHO Good Governance for Medicines Program (GGM).

In spite of all the development aid that has been distributed, the WHO estimates that one third of the world’s population still does not have access to the most essential medicines. There are many reasons for this and the usual suspects for this failure remain the lack of human resource capacity and inadequate funding by poor governments. However, WHO also recognises that corruption within the health sector is a major obstacle. WHO is committed not to let this issue be ignored any longer. Indeed, in the words of Dr. Baghdadi-Sabeti, “Corruption can kill”.

The Good Governance on Medicine Project was launched in 2004 and since then has been taken up by 26 countries with the full authorisation of the relevant Ministries of Health. The project model has three phases. Phase 1 entails a National Transparency Assessment and at this point the most difficult challenge is to control the promotion of certain types of drugs to health care workers. Phase2 seeks to develop a GGM Framework based on a nationwide consultation with all stakeholders and demands that both legal and political backing is forthcoming. A mix of approaches based on both discipline and fear of punishment as well as advocating for higher ethical values seems to work best. Phase 3 is implementation of the programme, translating policy into action. The benefits from this programme are already apparent, especially among the early adopters such as Thailand, Mongolia and Malaysia. Although it is difficult to overcome the taboo that is associated with corruption, many lessons have been learnt. By increasing interest and raising awareness the issue can be addressed more openly. A constructive and preventive approach is more appealing than one that is finger pointing. Collaboration with stakeholders is imperative and allowances have to be made for some countries which need more time to get their act together. Many challenges remain, but corruption must stay on the agenda of policy makers if it is to be overcome.

A number of issues were raised during the discussion that followed including ‘collusion’ between big drug companies and doctors in both developed and developing countries; possible positive effects from corruption if the recipient actually invests ill gotten gains in the local economy; the role of whistleblowers in stopping corruption in both public and private sectors and the different laws that can allow or even prohibit whistle blowing; and dealing with corruption in development and aid agencies.

In summary, it was concluded that there should be Zero Tolerance for corruption in the health sector. Corruption is prevalent in both rich and poor countries and this problem can be dealt with most effectively if structures are in place to promote good governance and transparency. All stakeholders must understand that corruption is unacceptable and that indeed “Corruption can kill”.[slideshow id=57]

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