Health System Governance

Health system governance determines the primary objectives of a health system and the direction of policy and legislation needed to achieve these. Political institutions are responsible for seeking a compromise between the different groups in the healthcare sector, while ensuring public health needs and goals are met. This governance process of policy and legislation setting is required at all levels of the health system, from the international to the local. Corruption in governance at the higher levels of the health system will have serious and wide-ranging impacts, affecting the services and treatments delivered to patients.

Lobbying itself is an accepted part of policy making, acting as a legitimate avenue for groups to share their opinions and expertise with policy makers. However, when it is conducted without integrity and transparency, powerful groups are able to have a disproportionate influence.

Some individuals, companies and groups have disproportionate resources in comparison to others in the sector. This may allow them to push for their own interests to be met at the expense of public health goals. Those in powerful positions are able to unduly influence politicians and policy makers through intense lobbying, donations or support for political campaigns, or by offering employment after service. In cases where interests align powerful groups may cooperate to influence the policy making process to further their own interests.

Alternatively, politicians may have conflicts of interest such as personal connections or financial interests with specific suppliers or health facilities, which they may help by developing favourable policy.

In some countries, corrupt governance is overt and easy to identify. Where there’s systemic corruption, bribes, favouritism and the revolving door may be viewed as an integral part of politics. In other parts of the world corrupt governance can be obscure and be conducted in sophisticated ways to subvert the system. Rather than outright bribes, powerful groups will use less obvious methods to gain influence such as undue lobbying. In both cases increased transparency and accountability of decision-making processes can make the identification of corruption easier to identify and tackle.

The effect of powerful groups unduly influencing policy has been gaining attention in certain areas of healthcare. On a global level, the Report of the United Nations Secretary-General’s High-Level Panel on Access to Medicine highlighted the difficulty in holding governments and suppliers accountable for the impact of their policies and actions on access to health technologies, due to a lack of transparency in trade and investment agreements.

Unfortunately, pharmaceutical and medical technology companies are not always driven by public health needs, profitability can be much more important, and they can unduly influence public and government agencies’ decisions.

— Judit Rius Sanjuan - US Manager & Legal Policy Adviser at the Access Campaign, Médecins Sans Frontières

Corruption Types

Capture of health policy

Powerful individuals, companies or groups use corruption to influence policies to benefit their own private interests.
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The undue influence on policy in the health sector results in private interests being prioritised at the expense of public health goals. This type of corruption primarily occurs through the privileged access to politicians and policy makers that some groups may have.

When there is a lack of rules and regulations to maintain transparency and accountability in lobbying, powerful individuals and companies can use their ample resources to push for policy in their favour. Influential organisations may pay the salaries of policy makers or arrange secondments where their employees are placed in governmental departments. Without robust management of conflicts of interest this could provide them with direct access to the policy making process.

Case Studies

USA – Lobbying against Medicare price negotiations

UK, May 2013 – Milburn, the NHS, and Britain’s ‘revolving door’

USA, June 2016 – Former state Sen. Ron Calderon’s guilty plea in corruption case marks blow to political dynasty

UK, November 2015 – Andrew Lansley takes post advising drugs firm involved in dispute with NHS

The Pharmaceuticals & Healthcare Programme is an international programme of Transparency International, based in the London office of Transparency International UK.

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