December 12, 2017
Briefing: Corruption in health: the greatest barrier to Universal Health Coverage
Across the world, corruption is known to be so pervasive within national healthcare systems that it has become normalised. Recently, the UN Special Rapporteur for the right to health stated that healthcare is among the most corrupt sectors, having “significant implications for equality and non-discrimination, since it has a particularly marked impact on the health of populations in situations of vulnerability and social exclusion, in particular children and people living in poverty”.
Health systems are particularly vulnerable to corruption for several reasons: information asymmetry between individuals and groups (e.g. healthcare providers and patients), vulnerability of patients in a state of ill health, the complexity of medical products and their industries, and the large sums of money flowing through the system. Also factors that influence population health outcomes are at the mercy of changes in health policy and legislation.
Corruption in the healthcare sector presents a significant barrier to the achievement of Universal Health Coverage, often undermining financial protection efforts whilst simultaneously increasing barriers to healthcare. Within the health sector, corruption most often manifests as embezzlement of health budgets; informal payments to healthcare providers; nepotism; absenteeism; bribery; procurement corruption; embezzlement of user fees; and the theft, falsification or misuse of property.
The following provides a non-exhausting list of examples of how corruption impacts on the three objectives of UHC – universal access, service quality, and protection from financial risk.
Corruption in healthcare procurement robs health systems of limited resources desperately needed for health system and infrastructure investments, quality service delivery, and a strong workforce to ensure that a country can provide health services to all people, especially those living in hard to reach areas. Corruption disrupts and reduces the flow of finance through health systems, such as healthcare professionals’ salaries who in turn are more likely to be absent from their posts. Healthcare cannot only be theoretically available; it must be practically accessible to the entire population.
UHC demands that healthcare provided must be of sufficient quality to be effective – corruption significantly undermines this. Nepotism within healthcare can lead to poorly trained, or unqualified professionals being appointed to provide care or to the procurement of substandard medical products. Spurious professionals or medical products can at best be innocuous and at worst fatal.
Out-of-pocket spending (OOPS) for healthcare are a huge driver of poverty as this has a knock-on effect on other areas of people’s lives. Monies spent acquiring healthcare can no longer be used to ensure that a family is properly fed or that children can attend school. As many as 100 million people a year are pushed into poverty due to healthcare-related payments. Often OOPS is the result of bribes or informal payments requested by healthcare professionals for services that should be provided at no or low cost. Corrupt procurement practices can lead to resources being wasted on expensive branded as opposed to cheaper generic medicines of equal quality, or simply on equipment that is not needed. Embezzlement of health insurance funds robs people of the coverage they have invested in.
In each case, corruption serves to tear down public trust in the effectiveness and value of a health system. In order to move towards UHC, it is imperative to address the widespread corruption in the health sector. This can be achieved through improved legislation and enforcement, and regulatory capture to hold corrupt individuals to account; the removal of incentives for corrupt behaviour and building of health systems that reward good behaviour; and ensuring protection for those who are brave enough to come forward and report instances of corruption.
Sarah Harris Steingrüber, Programme Manager