TI-UK sat down with the new Director of the Pharmaceuticals & Healthcare Programme to see what drew her to the position and where she wants to take the Programme.

What drew you to the position?

I have been working on health issues for many years and this stems from my conviction that health is a human right and that human development and well-being hinge on good health. In the various posts that I have held, I have come up against various types of corruption, which have created a significant hurdle to achieving the health objective set. I have come to understand that corruption in the health sector can be a matter of life and death, especially for the most vulnerable, but it is also experienced daily by millions of people in all countries around the world.

Corruption in the health sector can have severe consequences for access, quality, equity and effectiveness of health care services. Tackling corruption in the health sector is therefore essential for achieving better health outcomes.

The good news is that corruption is now widely accepted as a global public ill and key obstacle to good governance and development. I am therefore delighted to be joining the Transparency International movement at a time when it has launched a programme focusing specifically on pharmaceuticals & healthcare. I believe that its significant track record and geographical scope enable it to make a significant impact in this field.

Do you have any priorities now that you have started in your role as Programme Director?

My long-term priority for the PHP is to make a significant contribution towards fighting corruption in the sector. I hope to do this by following a multi-pronged approach articulated around developing a sound knowledge base, raising awareness/advocacy, as well as holding governments and private actors to account. It will be crucial to identify priority themes that deserve our immediate attention, as well as the best supporting tools and initiatives.

This ambitious goal can best be achieved by working with colleagues in Transparency International chapters across the world and working in partnership with relevant stakeholders in order to develop collective solutions.

What is your experience with corruption to date?

Over the course of my career, I have come across many facets of corruption that range from procurement fraud, to bribery and embezzlement. In all cases, corruption lowers the quality, equity, volume and effectiveness of health care. It increases the price of medical services, and discourages people to use and pay for them. This inevitably has a corrosive impact on a population’s level of health.

Corruption in the health sector also has a direct negative impact on access to high quality patient care. As resources are drained from health budgets as a result of corruption, less funding is available to pay the salaries of healthcare professionals or fund operations – leading to demotivated staff, lower quality of care, and reduced service availability and use.

As many public health advocates, I had no notion of the seriousness of the problem and I was not equipped of how to “deal” with it. I was left to deal with the consequences of e.g. “lost” medical supplies and absent healthcare professionals.

You have a wealth of experience working with NGOs, what are you looking forward to with Transparency International?

My past experience has taught me that corruption is a public health issue that will not disappear on its own. Given its magnitude and the crippling effect it has on people’s health, it cannot be ignored. In this new role, I therefore look forward to developing the appropriate/necessary knowledge base in order that all relevant parties recognise that it is possible to confront corruption by changing the conditions that allow it to develop and thrive.

I very much look forward to drawing on the expertise of Transparency International in order to address this public health threat. Transparency International has shown that corruption is a complex phenomenon that manifests itself in economic, social, political and cultural dimensions. It has also demonstrated that corruption cannot be easily eliminated, an effective policy response cannot be reduced to a ‘one size fits all’ solution. We will therefore need to draw on national level projects and multi-country comparisons to bring about change.

You have significant experience working with EU institutions. Has this helped you develop strategies that can be used when multiple interests are involved?

Given that the EU is a global player, working with the European institutions has given me an international mind-set that requires to take into account the many facets of public policy. For instance, as a public health advocate, I have had to be mindful of developments in many fields such as development, trade and environment etc.

The strategies I have developed towards the EU institutions were based on sound research, evidence based advocacy and tailored communication in order to maximise the impact.

TI as a movement has been exploring a more assertive approach, including a campaign to Unmask the Corrupt, while balancing this with our traditional approach of engaging with governments and companies.  Do you think there might be merit in adopting this approach into our Pharmaceuticals & Healthcare Programme?

Anti-corruption policies have become more visible on the political agenda in most Member States – and most notably in the UK. Arguably, most countries confronted with serious economic difficulties as a result of the economic crisis have acknowledged the seriousness of corruption-related problems and developed or are developing anti-corruption programmes.

Transparency International aims to build a solid understanding of corruption in the pharmaceuticals & healthcare sector upon which well-designed interventions can have a real positive effect.

At this point, I believe it is too early to define/prejudge the tone that PHP will adopt. It will ultimately be driven by the content of the knowledge base and how it is received by interested parties. It will also very much depend on the most effective strategy that will be defined in collaboration with TI chapters – many of which have indeed pursued powerful and successful assertive campaigns.

You have experience in developing health strategies in the context of the Millennium Development Goals (MDGs) and subsequent Sustainable Development Goals (SDGs) – how do you see the role of the Pharmaceuticals & Healthcare Programme evolving within the context of the SDGs?

The Millennium Development Goals (MDG) acknowledge the importance of health for poverty reduction and economic growth. Three out of the eight MDGs refer directly to health, while an additional goal calls for access to affordable drugs in developing countries.

While the MDGs provided the first ever internationally agreed framework around which governments and donors could develop policies and overseas aid programmes, they were seen as too narrow. It was also thought that the 8 MDGs failed to consider the root causes of poverty and overlooked gender inequality as well as the holistic nature of development. The goals made no mention of human rights and did not specifically address economic development. While the MDGs, in theory, applied to all countries, in reality they were considered targets for poor countries to achieve, with finance from wealthy states. Conversely, every country will be expected to work towards achieving the SDGs. In addition to pursuing the fight against extreme poverty the SDGs will add the challenges of ensuring more equitable development, which is intrinsically linked to anti-corruption.

Building on the experience of the MDGs, the SDGs have taken a more holistic and ambitious approach. Fortuitously, PHP will be able to base its work on e.g. SDG 3.8 which namely calls for achieving “universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In addition, SDG 16.3 sets out the goal to “Substantially reduce corruption and bribery in all their forms”.

PHP is therefore well placed to utilise this new framework in order to pursue ambitious and far-reaching policy change to combat corruption.

What kind of impact do you think NGOs can have on such a difficult problem?

NGOs such as Transparency International are certainly well placed to exercise external oversight and to serve in a watchdog capacity on health services. Past experience has shown that external oversight and monitoring are crucial for anti-corruption, transparency and accountability measures to be effective and sustainable.