January 10, 2019
How will we solve the health financing problem and bring in the age of universal health coverage?
By Sarah Steingrüber
In October of this year, I attended the World Health Summit in Berlin. During a session on Access to Medicines the conversation landed on a critical barrier to providing universal access, namely, where is the money going to come from? There was subsequently a call made out by the panel to get some answers from the audience to the question, “How can we solve the health financing problem?”
Well what if I told you that the money is already there, or at least it is, until it gets corrupted.
According to the World Health Organization, over 7.2 trillion US dollars are spent a year on healthcare across the globe. It is estimated that about 6% of this is lost annually to due to corruption. This translates into a total of 432 billion US dollars of health funds being wasted every single year. This is money that could be spent saving women’s lives who otherwise die in childbirth, or vaccinating children to prevent avoidable disease, or supporting comprehensive services to handle the ever increasing burden of cancer, cardiovascular disease and other non-communicable diseases.
Corruption in healthcare manifests itself across the entire value chain. It starts at the top with conflicts of interest among government officials leading to countries paying exorbitant prices for health goods and services, to money disappearing through the public procurement process, to substandard and falsified medicines infiltrating markets, to healthcare professionals’ salary allocations being pocketed by higher ups, and finally it trickles down to provider’s demanding bribes from patients for otherwise free or low-cost care. When monies intended to fund health systems are corrupted it increases out-of-pocket payments for services. Transparency International’s Global Corruption Barometer – the largest survey in the world tracking public opinion on corruption – has found that 17% of people across the globe reported paying bribes in order to access healthcare. Having to pay directly for healthcare drives patients and their families into poverty. For those who are unable to pay it reduces the likelihood that they will even seek care and can lead to further illness or in some cases death.
The Sustainable Development Goals enshrined the lofty objective to achieve Universal Health Coverage (UHC) within Goal 3, Health for All. UHC is defined as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship”. Corruption undermines our collective efforts towards achieving UHC. Were you to take the WHO’s minimum recommended spend needed to provide basic, life-saving services of $47, the global annual loss of health system funds due to corruption more than covers this requirement for every single living person on the planet.
So, if we really want to solve the health financing crisis and bring in the age of UHC, corruption has to be more than something we consider intractable or culturally engrained. It can and must be wiped out of our health systems.
This challenge calls out to global health leaders to finally acknowledge and take action against the severe and detrimental impact that corruption in its many forms has on government’s and the international development community’s abilities to provide and people’s abilities to access quality, affordable healthcare. This will require a multistakeholder and multisectoral approach that utilises the extensive knowledge and experience of anti-corruption experts. To begin, I suggest the following three measures:
- Include preventative, detective and mitigating anti-corruption mechanisms in the design of public health programming at the global, regional, national and local levels;
- Embed anti-corruption training in basic and continuing medical education for healthcare professionals at all levels; and
- Demand radical transparency in public health administration, such as public health procurement, conflicts of interest registries for decision makers including healthcare professionals and the regulatory process around medicines, medical devices and other health products.
Universal Health Coverage is achievable, but like it or not we are going to have to deal with the pervasive corruption in order to get there.
 Taken from WHO Global Health Expenditure Atlas (2014) whereby the estimate of minimum spending per person per year needed was $44 USD. This number has been inflated to reflect this amount in 2018 using the US Inflation Calculator.