View from Peru: ‘Funders ignore the problem of corruption in our health systems – we need to empower patients’

When Peru was hit by one of the world’s deadliest Covid outbreaks, patients were being charged up to $21,000 for a hospital bed. Dr Patty Garcia, the country’s former Minister of Health now a global health researcher describes how data, education and global partnerships can support her nation in successfully combatting corruption.

Dr Patty Garcia has contributed as much as anyone in the fight to bring transparency to Peru’s services. Five years ago, working with the Interior Minister, Patients were regularly being told that drugs had run out, even though plenty were being ordered by central government.

Patients were unable to access drugs at hospitals that should have been readily available at no cost through national insurance. The black market simultaneously stationed shadowy figures known as jaladores (‘pullers’) outside of hospitals to intercept desperate patients, diverting them to illicit pharmacies where the medicines could be obtained “for a good price”.

Women’s health at risk amid worsening corruption

When Garcia left politics, the investigation was discontinued – frustrating after a lifetime spent watching corruption damage health outcomes. “When I trained as a medical student, I saw corruption related to providers, practices, supplies, drugs and more,” Garcia told delegates at Corruption: A Public Health Emergency, a Transparency International event staged in December 2022. “But because resources were scarce at that time, there was not too much to steal. However, when I became the Minister of Health in 2016, I realised the [modern-day] magnitude of the problem, where there are now more resources [at risk].”

Garcia introduced landmark new policies while Health Minister, such as new guidelines for cervical cancer screening (self-sampling) and the introduction of emergency contraception. However, progress for patients remains stubbornly compromised by corruption, which plays out in various harmful ways.

Scanners and lab equipment are deliberately damaged so that patients are forced to spend money on private services. Garcia recalls one X ray machine being deliberately disabled by a paper clip, so that patients had to use the private X ray services on the next block of the public hospital.

Money allocated for training also goes mis-used. Health workers are paid to attend training as an incentive, where they sometimes don’t need to attend, rather than funding being ring-fenced to ensure a training gap is filled for the staff who really need it.

“Funders ignore the problem,” Garcia says Foreign aid has fuelled corruption. With more money comes more corruption.”

Counting on data to fight fraud and fear

Garcia is on record as lamenting “the fact that we are not used to really counting what the people are doing at the health centres, or what is going on.” Speaking to the World Health Organisation’s Global Health Matters podcast, she continued “absenteeism is a big issue, at least in my country. Productivity too.”

“What is happening is that physicians will mark their attendance to the health centre and they will just go out and start seeing patients in the private sector. Technology can help us with accountability and transparency.”

Behind every statistic is a patient, Garcia reminds us. “In some parts of Peru, we now have whole areas where people simply won’t seek out treatment. They are too fearful of what it might cost them.”

Shaping a healthier future

A new pandemic fund promises to see more billions of dollars set aside for low and middle income nations ahead of future disease outbreaks

Transparency International Global Health has been lobbying for anti-corruption and transparency safeguards to be built into a pandemic preparedness and response accord being shaped by World Health Assembly members. Our recommendations have been reflected in the latest draft ahead of a 2024 sign-off.

“We need to make it simple for patients to complain, when they are seeing things that are not right, Garcia adds. “We also need to make it clear to people what they should expect. Then we should have an investigations system to investigate what has gone wrong, correct it, and sanction those responsible. That should dissuade others from abusing the system and engaging in corrupt practice.”

“In other countries they have these processes and it is what we need to have here in Peru. We need to understand better what works in the fight against corruption: design, evaluate, test and if successful, implement adequate interventions.

“Funding for corruption research is needed in the same way as we research cures and vaccines for diseases because corruption is a disease of our health systems. We also need to empower people to demand more from their taxes. Finally we need to work on education too – people need to be educated that corruption is not the standard and that we can expect more.”