What is the relationship between health sector corruption and human rights?
Corruption is defined as the “misuse of entrusted power for personal gain” according to Transparency International and is pervasive across the health-care sector. The health sector is particularly vulnerable to corruption owing to the large amount of allocated public expenditure in many countries, several stakeholders including regulators, payers, providers, consumers and suppliers all interacting in a complex way with a great asymmetry of information between them. Often, private providers are also entrusted with roles that serve the public, thus the identification and control of diverging interests is especially difficult.[1]
Examples of corruption include but are not limited to, resale of free public health-care goods for profit, inflated prices during medicines procurement, and the giving or receiving of bribes to access medical care or services. Corruption has a negative impact on global health outcomes and in low-resource settings marginalized and vulnerable groups are disproportionately impacted.[2]
Aside from the wastage of financial resources, health sector corruption can further deter access to health care and prevent individuals from obtaining life-saving interventions. This can occur because prices for health-care products and services become unaffordable for patients due to the demand for bribes. If health professionals are employed on the basis of nepotism this results in potentially incompetent people providing care and services. In the area of drugs and medicines, the sale of counterfeit products can have a severe negative impact on the quality of medication available for patients. Thus, health-sector corruption has the potential to severely compromise the quality and coverage of healthcare services and therefore undermines the fundamental right to health.
What are the relevant issues/problems with regards to this issue?
It is important to note that the sociocultural context of the country in which the health system is situated can have an impact on which practices are considered to be corrupt. For example, in the case of informal payments for clinical services it can be unclear which payments are bribes or gifts for exceptional service.[3]
Types of corruption in the health sector include:[4]
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How can the situation be improved?
Although the concept of corruption has officially been acknowledged internationally, and included in the 2003 UN Convention against Corruption (UNCAC), there is still a need for a legally binding anti-corruption instrument to be implemented globally.[5] Coordinated efforts from all the actors in the health-care system is required to decrease corruption in the sector. It is important to investigate the drivers, pressures and behaviours that give rise to corruption in order to develop effective preventative strategies for corruption. Emphasis should be given to the utilization and dissemination of current research on corruption, creating the right balance of incentives and disincentives for good and bad behavior in the health sector.
Generalised anti-corruption strategies include improved public finance management in the health sector, and stricter enforcement of regulation and policies against corruption. As recommended by the WHO GGM (Good Governance in Medicines) Program, the implementation of legislation and the fear of sanctions or fines can be used as a method for combating corruption, at the governmental or an organizational level.[6] Elements of good governance relevant to the health sector include improving transparency, accountability, flows of information, regulation, policy planning and implementation, leadership, ethical behavior etc.
Health workers are advised to work in accordance with best practice guidelines and ensure the timely delivery of affordable care of sufficient quality to their patients. Furthermore, they are encouraged to participate in trainings on ethics and governance. Health workers are given the autonomous power to make decisions such as prioritizing patients, or deciding which medicines to dispense, which is defined as discretion. Strategies are required that give health workers the freedom to make these decisions, with adequate checks and balances in place, which prevent them from abusing this entrusted power. These could include the development and implementation of standard operating procedures, which outline and clarify decision-making processes. Care should also be taken to control the level of discretion without creating dysfunctional bureaucracy.
Professional organisations are urged to incentivize their employees appropriately to prevent them from indulging in fraudulent practices, and clearly outline job responsibilities and accountability.
Governments are encouraged to build capacity and strengthen their health-care systems to reduce inefficiencies, through methods that could include participation in the WHO GGM programme, or informed policy planning at national and regional levels. Governments should ensure that information asymmetry is reduced through increased transparency approaches, e.g., mandated disclosure agreements that require all actors to publically disclose medicines prices and prevent the monopolization of health-care services. Transparency initiatives help document and disseminate information on the scope and consequences of corruption and can aid policy planning and decision-making. Whistleblower protection should be offered to individuals on behalf of the state so that corrupt practices will be detected and reported. Detection mechanisms such as monitoring and surveillance should be improved to identify and remove ‘bad agents’ in the health sector.
International organisations are called upon to build consensus to develop globally applicable binding legislation and policies against corruption, which can be implemented and adapted according to the national law of a specific country.
This page was written by Gauri Deoras and last updated in February 2015.
Notes
[1] Gaal P, McKee M. 2005. Fee-for-Service or donation? Hungarian perspectives on informal payment for health care. Social Science and Medicine 60: 1445-57
[2] Fighting Corruption in the Health Sector: Methods, Tools and Good Practises 2011 : http://www.undp.org/content/undp/en/home/librarypage/democratic-governance/anti-corruption/fighting_corruptioninthehealthsector/
[3] Gaal P, McKee M. 2005. Fee-for-Service or donation? Hungarian perspectives on informal payment for health care. Social Science and Medicine 60: 1445-57
[4] Vian T, The sectoral dimensions of corruption: health care, Chapter 4 in Spector BI (ed.). Fighting corruption in developing countries. Bloomfield, CT: Kumarian Press Inc., 2005, p. 45-46.
[5] United Nations Convention Against Corruption (2003) http://www.unodc.org/unodc/en/treaties/CAC/index.html
[6] WHO Good Governance for Medicines Program: http://www.who.int/medicines/areas/policy/goodgovernance/en/