Corruption, COVID-19 and Inequality – a deadly cocktail

Delivery of Healthcare Services

Health System Regulation

Health System Governance

Transparency and Equity in the COVID-19 Vaccine Rollout

By Daniela Cepeda Cuadrado

In the first half of 2020, there were almost 19 million cases of COVID-19 globally and more than 700 thousand deaths.[i] Despite the staggering numbers, we now know the virus does not affect us all equally. Not addressing corruption risks in this environment can make that inequality much worse.

Recent studies have shown that social determinants of health—that is, the conditions in which people are born, grow, live, work and age, have a considerable impact on COVID-19 outcomes.[ii] Issues such as poverty, physical environment (e.g. overcrowding, homelessness), and race or ethnicity play a key role in determining whether certain groups of people will die or survive the virus.[iii]

In New York City COVID-related deaths in black and Latino residents are double those amongst white residents[iv]. In the UK, COVID-19 deaths of ethnic minorities are much larger than those of white Britons. A study found that hospital fatalities from Bangladeshi, Pakistani and Black African ethnic groups are respectively 2, 2.9, and 3.7 higher than deaths of their white counterparts.[v] Meanwhile, tens of thousands of migrant workers in Singapore, who are secluded in crowded dormitories, have been getting infected at a much faster rate than Singaporean residents.[vi]^,[vii]COVID-19 highlights the profound inequality that exists in the world, between and within countries.

Now, add in the impact of corruption which we know drains $500 billion from global health care every year. The inequality highlighted by the pandemic is immediately even starker.

Marginalised groups are also the most reliant on health and other public services. If these services are blighted by corruption, it is unlikely that they can cater effectively to the needs of all vulnerable groups. During health emergencies like the current pandemic, when large amounts of funding are allocated rapidly, often without normal scrutiny, there is ample opportunity for corruption to go unchecked.

That’s why we at Transparency International Health Initiative believe it’s essential to include corruption in any public health conversation:

Corruption and the pandemic can further alienate already marginalised groups. People facing the greatest deprivation, such as poor people and people from Black, Asian and Minority Ethnic (BAME) groups, are more likely to be exposed to COVID-19.[viii].[ix] These are the same people who have been disproportionately affected by corruption. Evidence shows that poor people see the greatest share of their incomes lost to bribes and informal payments. In Paraguay, for instance, 12.6% of poor people’s incomes goes to bribes, while the most affluent households only pay 6.4%.[x]
Corruption increases distrust in the government. A lack of trust can be lethal for the most vulnerable during public health emergencies. At the start of the most recent Ebola outbreak, many people in Liberia questioned the existence of this disease and believed that Ebola was an excuse for government employees to enrich themselves from foreign aid. This caused a delay in containing the outbreak.16 The result was catastrophic, with the impact largely being shouldered by women, who accounted for 75% of the deaths.[xi]
Corruption disproportionately impacts core tenets of health policy, including social determinants of health. This creates a more uneven playing field for vulnerable groups during the pandemic. Take poverty. Poverty is one of the strongest determinants of health: on the one hand ill health limits people’s ability to work and is strongly related to poor social and economic development; on the other hand, poorer people live shorter lives and have poorer health than affluent groups.[xii] Poverty also has a reinforcing relationship with corruption. Corruption increases poverty and inequality because it reduces economic growth, limits the effectiveness of social spending, and perpetuates unequal distribution of income and access to education.[xiii] It is also the same deprived communities that are most impacted by corruption and the ones with barely functioning hospitals (if any) and poor access to health services.
Corruption thrives in public emergencies, siphoning off key resources needed to address COVID-19 as well as all other health needs, once again affecting the most vulnerable. We have already seen how most governments have relaxed their procurement and contracting laws in a race to speed up their public health response.[xiv] These measures have unfortunately also provided a space for corruption, further weakening their health systems. A case in point is Brazil, where Rio de Janeiro’s Governor has been accused of misusing of R$1 billion of public money allocated for building hospitals and buying respirators, PPE and COVID-19 tests.[xv]

Another example: In Colombia, the National Planning Department is suspected of transferring economic subsidies to ghost accounts under its programme “Solidarity Income”.[xvi] Without transparency and accountability measures in place, initiatives taken to support marginalised communities during the pandemic will be ineffective.

Key resources lost to corruption during the pandemic also mean lost opportunities for health systems to effectively respond to other health needs.[xvii]^,[xviii]. Take Zambia, where the Minister of Health was arrested in June over allegations of having stolen US$2,5 million from his ministry.[xix] Corruption in Zambia’s health sector is not new.[xx] Its health system is ill-equipped to tackle the pandemic, and this also means that diverting its limited human resources, essential health commodities and supplies to respond to COVID-19 puts at risk other vulnerable population groups such as pregnant and lactating women in a nation which has the highest fertility rate in Africa.[xxi]

What can be done?

Corruption risks in the health sector are numerous and challenging. As a key determinant of health on its own, corruption should not be ignored, especially when COVID-19 is making it clear that we are only as strong as our weakest health system.

At Transparency International Health Initiative, we believe that fighting corruption in the health sector is one of the most effective ways to reach everyone who has been left behind – even at times of global emergencies. Integrating transparency and accountability measures into all health plans, programmes, and all pandemic responses is critical.

How can that be done? Fostering citizen social accountability at the point of health service delivery, monitoring the highest corruption risks in a countries’ health systems, enhancing budget transparency, committing to open health procurement and contracting, tracking all health expenditures, and getting timely access to this information, are some of the approaches we can take. These measures play a vital role in ensuring all resources go to where they are most needed.

Let’s be clear: fighting corruption in the way we respond to the pandemic is a critical step. But we must go even further. We must make accountability and transparency measures fundamental to all health systems. It is the only way we will be able to make up for the disproportionate impact that healthcare corruption has on victims of inequality.

[i] https://coronavirus.jhu.edu/map.html

[ii] https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930234-4

[iii] https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930234-4

[iv] https://hitconsultant.net/2020/04/20/covid-19-social-determinants-of-health-importance/#.Xvn2PihKjIU

[v] https://www.ifs.org.uk/inequality/are-some-ethnic-groups-more-vulnerable-to-covid-19-than-others/

[vi] https://edition.cnn.com/2020/05/14/asia/singapore-migrant-worker-coronavirus-intl-hnk/index.html

[vii] https://soundcloud.com/megontheinternet/right-on-4-who-will-be-left-uncounted-in-data-on-covid-19

[viii] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31380-5.pdf

[ix] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31380-5.pdf

[x] https://www.worldbank.org/en/topic/governance/brief/anti-corruption

[xi] https://www.independent.co.uk/news/world/africa/ebola-virus-outbreak-this-is-why-75-of-victims-are-women-9681442.html

[xii] https://www.euro.who.int/en/health-topics/environment-and-health/urban-health/activities/poverty-and-social-determinants