January 29, 2020
Taboo or not taboo, why don’t we talk about corruption in global health?
By Natalie Rhodes
“Corruption in global health is an open secret. Everybody knows about it, but no-one wants to talk about it”. These are the words of Professor Patricia J. García, the ex-Peruvian Minister of Health who gave the Lancet’s 2019 Academy of Medical Sciences & The Lancet International Health Lecture[i]. When you look at the current global health climate this statement certainly rings true, if you go to a global health event or even look at a university’s global health curriculum you will struggle to even hear the ‘C-word’ mentioned. But why is this?
Over USD $500 billion in health resources is lost to corruption every year[ii], more than enough to cover the current shortfall in healthcare resources needed to reach Universal Health Coverage (UHC)[iii]. However, it isn’t just money that is lost due to corruption, there are major human costs also. It’s estimated that 140,000 child deaths can be pin-pointed to corruption, in reality this number is likely to be higher as corruption undermines other factors such as access to clean water and sanitation which then affects health[iv]. UHC must be the most used term in global health, yet given that UHC could be (over)achieved by preventing corruption in health why aren’t more people speaking about this?
Corruption in Health is Too Complex
Corruption in health can be difficult to conceptualise, it doesn’t just involve patients having to pay bribes (although that does happen), and it can be subtler. For example, a pharmaceutical company adjusting its clinical trial data so their new drug looks better than it is, or a procurement officer giving an old friend a heads-up before they open a tender to build a new hospital. We have identified 37 different corruption types which we’ve categorised into 8 different categories which you can see here.
It’s an Embarrassing Problem
Corruption can be seen as a sensitive subject for governments to discuss, no-one wants to admit it happens. However, we shouldn’t view this as a shameful secret, corruption exists in health systems around the world, and for example in the UK fraud costs the National Health Service £1.27 billion a year[v]. Therefore, all health leaders need to start discussing this together.
Corruption is a Necessary Evil
It has been suggested that corruption is necessary in order to ‘grease the wheels’ of development, however this is not the case. In fact, it would be more accurate to say corruption throws sand into the wheels as it actually impedes development[vi] and poses serious threats to health. Corruption kills 140,000 children a year[vii], is strongly linked to antimicrobial resistance[viii] and undermines efforts to end the AIDs epidemic[ix].
There’s No Solution
It may seem that corruption in health is impossible to tackle given how widespread and diverse it is. However, there are an increasing amount of anti-corruption interventions in health showing promising results (take OC4H for example…).
So how do we change this?
There needs to be a stronger research agenda into corruption and health led by researchers and funders, (hopefully the rumours of a Lancet commission on corruption and health are true…). This research then needs to build the evidence base of health corruption and test anti-corruption interventions. These learnings need to be incorporated into global health curriculums so the health leaders of tomorrow can build a more holistic view of the drivers of poor health. We need ministers of health to openly speak about their struggles with corruption in their health systems. We need multilaterals such as the WHO, Global Fund and UNDP to continue convening global stakeholders in the form of the exciting Global Network on Anti-Corruption, Transparency and Accountability (GNACTA) recently established in 2019[x]. But the first, and simplest, action we can all take is to start saying the c-word…corruption.
[iii] World Health Organization. (2017). Together on the road to universal health coverage: A call to action (No. WHO/HIS/HGF/17.1). World Health Organization.
[iv] Hanf, M., Van-Melle, A., Fraisse, F., Roger, A., Carme, B., & Nacher, M. (2011). Corruption kills: estimating the global impact of corruption on children deaths. PLoS One, 6(11), e26990.
[vi] Nur-tegin, K., & Jakee, K. (2019). Does corruption grease or sand the wheels of development? New results based on disaggregated data. The Quarterly Review of Economics and Finance.
[vii] Hanf, M., Van-Melle, A., Fraisse, F., Roger, A., Carme, B., & Nacher, M. (2011). Corruption kills: estimating the global impact of corruption on children deaths. PLoS One, 6(11).
[viii] Collignon, P., Athukorala, P. C., Senanayake, S., & Khan, F. (2015). Antimicrobial resistance: the major contribution of poor governance and corruption to this growing problem. PloS one, 10(3).
[ix] Friedman, W. (2018). Corruption and averting AIDS deaths. World Development, 110, 13-25.