In every country on the planet, people suffer and die due to corruption in the healthcare sector. Like most corruption, vulnerable populations who do not have the knowledge, money, or power to access services suffer disproportionately. While corruption permeates healthcare at many levels, the result almost always trickles down to effect healthcare services at the local level. Studies of corruption in the healthcare sector have identified eight primary areas where corruption adversely affects public services, it is these areas where UNISHKA concentrates its broad-spectrum anti-corruption in emerging economies:
Corruption in the delivery of medical products and services not only adversely affects the health of millions of people around the world, it has resulted in fatal consequences for many, especially the most vulnerable segments of society (g. women and children). Research indicates that charges at the point of access significantly reduce a person’s likelihood of seeking help. Corruption in the delivery of healthcare is also a primary cause undermining the legitimacy of struggling governments which also adversely impacts security.
Corruption in the administration and management of clinics, hospitals, departments and ministries collectively results in death by a 1,000 cuts to the public health system. For example, during the Ebola outbreak in Sierra Leone, over a third of international donations went missing in the first six months and were never accounted. Not unrelated, according to Sierra Leone’s Anti-Corruption Commission, more than 23% of bribes reported on their anti-corruption hotline were paid to healthcare officials. Additionally, losses in the health sector are usually filled by foregoing services to vulnerable populations (e.g. women, children, AIDS/HIV patients, LGBTQ community, ethnic minorities, religious minorities, etc.).
During distribution and storage, drugs and medical products are at considerable risk from corruption. This includes theft, diversion and re-packaging expired or non-sterile products. This form of corruption is so rampant that ongoing criminal syndicates operate multi-million-dollar businesses by either operating black market sales of stolen drugs or legally purchasing aging drugs from hospitals at significant discounts, relabeling them, and then selling them back to the public sector. This is most prevalent in low and middle-income countries who lack proper supply chain management and oversight.
Corruption in the procurement process is not limited to the health sector but can permeate virtually every government purchase. Procurement has different susceptibilities that can be exploited through corruption during the pre-bid, bid and post-bid process. Unlike most other government procurements, the medical field must also face sophisticated multi-national companies who often interact with the entire supply chain, including consumers, to create demand and reward prescribers or purchasing officers.
Globally, marketing interactions between suppliers and healthcare providers are controlled by both government- and self-regulation. Unfortunately, in much of the world, disclosing gifts and hospitality marketers provide to healthcare workers is not mandatory, therefore there is great potential for corruption. In such cases, marketers may provide explicit gifts and implicit grants to healthcare workers, ultimately influencing them to become a spokesperson of sorts. This is an extremely effective way to promote products and increase prescriptions for their products.
However, impropr gifts are not the only means through which corruption permeates in the healthcare marketing sector. Using post-marketing studies, widening diagnostic boundaries of illness, and setting the curriculum for continuing education programs are tools also used by marketers in the healthcare industry.
The first stage in developing a product is research and development (R&D). During this stage, companies funding the R&D usually contract researchers at universities or contract research organizations to design, run, and report the results of the study. However, because the companies funding the R&D have an interest in getting their products to market, it the researchers may feel pressured to report positive results. Following this, the researchers may under-report negative findings or attempt to display the product in a more positive way.
In developing countries, where healthcare is scarce, declining to participate in a medical trial may mean refusing the only medical care available. This creates an issue with trial participants being unable give full consent to participate. While this is not the only instance where consent may be lacking, it is perhaps one of the most prevalent in the international development community.
In general, the main issues with corruption in healthcare R&D are:
There are numerous ways in which corruption can adversely affect healthcare regulation. From inappropriate approval of products to unwarranted health college certifications, the issues stemming from corruption in the healthcare sector have the potential to be devastating. These types of corruption are not constrained to individual cases. Entire sections of healthcare regulation can be captured by select groups, termed regulatory capture, and as a result serve their personal interests. In these situations powerful individuals and companies will ensure that they benefit most from the regulatory process and can dominate the healthcare sector. To ensure regulation is successful and corruption risks minimized, regulatory agencies must be sufficiently resourced, independent from outside influence and have policies that ensure transparency and accountability for key procedures.
Corruption in the policy and legal framework within the healthcare system has the potential to create the most serious and wide-ranging impacts affecting the services patients may receive. This corruption often starts with lobbying the appropriate governing body to ensure favorable policies are created. When this lobbying is done without integrity and transparency, groups with disproportionate resources compared to others in the healthcare sector are often able to exert an equally disproportionate influence. Alternatively, politicians may have connections or financial interests with suppliers or health facilities, creating a conflict of interest and likely inspiring them to develop favorable policies for specific groups. Overall, undue influence is the most threatening aspect to anti-corruption in healthcare sector's policy and legal frameworks.
USAID – Iraq
Working directly with the Office of the Inspector General at the Ministry of Health, UNISHKA developed a process for managing corruption complaints; mapped the distribution of medicines and medical supplies while providing contextualized recommendations; and increased transparency in the procurement processing.
ISAF/RS – Afghanistan
Working with the High Office of Oversight and Anti-Corruption (HOOAC), UNISHKA documented extensive corruption at the Dawood National Military Hospital in Kabul, primarily in procurement and acquisitions. This documentation formed the basis of a criminal investigation by the Office of the Attorney General and prompted an overhaul of their procurement processes.
OECD – Ukraine
UNISHKA’s Team Lead for Corruption & Healthcare, Drago Kos, currently serves as a member of the Selection Committee for identifying a new Head of the Special Anti-Corruption Prosecution Office (SAPO) in Kiev. He is also a former member of the International Anti-Corruption Advisory Board (IACAB) in Ukraine (2017-2019), and the former Co-Chair of the Ukraine Defence Corruption Monitoring Committee (NAKO) (2016-2019). In each one of these positions, Drago has also been involved in the Ukrainian healthcare sector addressing the nexus between corruption and healthcare. In his position in the IACAB he advised the Parliament of Ukraine (Verkhovna Rada) on drafting of drafting specific healthcare legislation. Additionally, in his position as Co-Chair of the NAKO, Drago forced the adoption of a report on the procurement and distribution of medical equipment and pharmaceuticals, directly initiating stronger internal controls for purchasing and tracking medical equipment and drugs.