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Since 2012, Corruption Watch has received over 500 reports detailing some of the hardships people endure when they visit government health facilities throughout South Africa. Corruption plays a big role in the deterioration of the country’s health system, which is now as sick as those whom it is supposed to treat and heal. The accused are administrators, nurses and doctors.

But South Africa is not alone in fighting this battle. A new Transparency International (TI) report, titled The Ignored Pandemic, reveals that corruption in healthcare service delivery is significantly undermining global efforts to achieve universal health coverage. Bribe-taking, theft of medical supplies, and absenteeism are just some of the malpractice activities that prevent patients from getting the care they need, fuel antimicrobial resistance, and contribute to the spread of HIV/AIDS and other diseases.

Download The Ignored Pandemic.

The effect is devastating – corruption holds back the fight against deadly diseases and is responsible for the deaths of around 140 000 children per year – this was determined in a 2011 study titled Corruption Kills: Estimating the Global Impact of Corruption on Children Deaths. This particular study concluded that the figure of 140 000 largely exceeds the conspicuous pooled total of cholera, rabies, Ebola and combat-related deaths. “But still, because the equation corruption = deaths is seldom explicit, corruption only seems like a nuisance”, the authors stated.

While the World Health Organisation estimates that an extra US$370-billion per year would be enough to give everyone on the planet access to healthcare, this estimate is wiped out by the more than $500-billion in health resources that experts warn are lost annually to corruption.

Unless the most harmful forms of corruption are curbed, universal health coverage is unlikely to be achieved.

“Access to healthcare is a basic human right and it’s frustrating that whilst there is a real consensus around achieving it, not enough is being done to stamp out the corruption that is preventing millions from receiving vital treatment and care,” commented Rachel Cooper, director of TI’s Health Initiative.

“Yet again we see how corruption is a life and death issue. All over the world people are dying from a lack of access to medical care. Mothers are unable to give birth in safety and children are not making it to adulthood. We owe it to them to treat the one pandemic currently being ignored – corruption.” 

The TI study finds that not enough is being done by policy makers to tackle corruption, and that the limited efforts made to date have been too piecemeal to be effective. Stronger oversight mechanisms and greater accountability for health systems are required. Recommendations include:

  • Fund research into corruption in healthcare to address the large gaps in evidence
  • Redesign health systems to minimise incentives and opportunities for corruption
  • Prioritise curbing the most damaging forms of corruption

Efforts to curb corruption can be successful if they focus on the most harmful forms of corruption, are based on a thorough understanding of high-level political constraints and ground-level health system operations, and follow a coherent agenda that is firmly embedded within wider health system strengthening efforts, the report states.

South Africa no different

The TI report named absenteeism, informal payments from patients, theft and embezzlement, service provision, favouritism, and manipulation of data as the specific types of corruption affecting the health sector. Corruption Watch’s reporters have experienced these very crimes – although our Constitution makes it clear that everyone has the right to healthcare services and that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights.

However, in 2018 we received 108 reports of employment irregularities (29%), procurement irregularities (23%), abuse of power by government officials (16%) and abuse of state resources (13%) in the healthcare system. Since our launch in 2012, 586 whistle-blowers have come forward.

In 2018 most reports (40%) originated in from Gauteng, followed by Limpopo and the Eastern Cape in joint second place (11%), and KwaZulu-Natal close behind at 10%. Most of these allegations (70%) are located within the provincial health departments, with 28% of reports directed at the national Department of Health.

One person recounted the sight of “a patient with a ruptured ectopic pregnancy (who) lost three litres of blood”, explaining that “from admission till time of surgery… the patient waited more than two hours” for a doctor notorious for absenteeism. This incident is one of the corruption cases reported to us that highlight irregularities in employment in the sector.

Moonlighting doctors bill the state for many hours of work not done, while other officials issue salaries to non-existing persons, known as ghost workers. These same officials solicit bribes from job seekers, creating an opportunity for the appointment of unqualified persons – these incidences contribute to the more than 17% of health-related bribery cases reported to us.

As if this is not enough, almost 10% of graft accusations show how doctors, nurses, and other officials steal equipment, medication and funds, and politically connected companies repeatedly secure lucrative deals without due process being followed.

South Africa spends 13.5% on health programmes as a share of total government expenditure, with over 80% of the population relying on the public healthcare system. But media reports, government investigations and audit outcomes reveal that the health sector is on the verge of collapse owing to high levels of corruption, irregular expenditure and financial misconduct.

Holding the corrupt to account

In June 2018, we joined forces with fellow activist organisations SECTION27 and the Treatment Action Campaign (TAC) to expose high levels of corruption in the Gauteng Department of Health (GDH). On 21 June we released a report to the public via a media briefing. The report, compiled by the Special Investigating Unit (SIU), highlights serious maladministration, irregularities, unlawful expenditure of public money and improper conduct by GDH officials.

Brian Hlongwa, former MEC for health in Gauteng and former ANC chief whip in the Gauteng Provincial Legislature, was implicated in facilitating and abetting corrupt activity at the GDH, which ultimately led to the capture of the department by private firm 3P Consulting. Corruption Watch, SECTION27 and TAC wrote letters to the National Prosecuting Authority (NPA), the Gauteng Provincial Legislature, and the ANC Ethics Board, and held a public march to the Gauteng Provincial Legislature demanding that Hlongwa be removed and face justice for his actions.

In November 2018, Hlongwa formally resigned from the provincial legislature, but we still believe that this is an easy way out and that stiff penalties should be imposed on him for his actions.

In June 2018, the SIU convened various stakeholders working in both the public and private health system to launch the National Health Anti-Corruption Forum (NHACF). This body is comprised of public sector bodies (Department of Health, SIU, the Hawks, police service, Anti-Corruption Task Team, Financial Intelligence Centre and the NPA), private sector bodies (Board of Healthcare Funders of Southern Africa, Health Funders Association, Council for Medical Schemes, Health Professions Council of South Africa) and civil society organisations (Corruption Watch and SECTION27).

The purpose of the forum is to build relationships of collaboration, consultation, mutual support and cooperation between the listed parties in order to address corruption within the health sector. Corruption Watch currently serves on the steering committee of the NHACF and has referred health corruption reports to the body for investigation that could lead to criminal prosecution and civil litigation.