Corruption in health care “kills en masse”BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7536.257 (Published 02 February 2006) Cite this as: BMJ 2006;332:257
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The prevailing corruption both in public and private health sectors
is a crime against humanity. The public health systems and programmes in
most of developing countries depend on foreign contribution or soft loans
as the national budgetary allocations are far from adequate. The
misappropriation of these meagre resources by politicians, bureaucrats,
doctors and paramedical workers is a disheartening sign of moral
Corruption is not merely siphoning off funds meant for construction
of health facilities, purchase of equipment, drugs or vaccines or
embezzlement of money allocated for health education, information and
communication. It also means geographically lopsided spending, misplaced
priorities and wasteful expenses. A lack of participative planning
processes and political hegemony of influential groups or regions results
in diversion of scarce funds away from needy areas and programmes. At the
cutting edge corruption means absenteeism, lack of punctuality, pilferage
of medicines or equipment by doctors, pharmacists or para-medical workers.
A near absence of planning institutions and over dependence on ‘foreign
experts’ supplied by multilateral agencies also results in shifting of
foci in the matter of implementation of health programmes.
An impression is being created that international donors, are now
going to adopt a no-non-sense approach and would play a more proactive
role in allocation of resources to developing or poor countries. The
earlier it is done, the better it is. I am witness to lackadaisical
approach adopted by international inspectors who visit developing
countries to monitor or evaluate the work done using the funds supplied by
their countries or organisations. It is surprising how pliable such
inspectors turn out to be and close their eyes to blatant misuse of funds.
They fall willing preys to tailor-made reports, jargon of data or
distortion of facts. I would love to learn about those reports where such
international inspectors have put their foot down and stopped flow of
funds. Such examples if any, would be far and few.
The international community would need to adopt a more purposeful
policy. Instead of being satisfied with ‘securing of process benchmarks’
in the input-process-outcome scheme, they should insist more on out come
indicators. The flow of funds should be tuned and based on actual outcomes
determined by independent studies. The national governments should not be
allowed to get away under the garb of sovereignty clause.
With in the countries the growth of watchdog organisation from
national to community levels needs to be facilitated. This may involve
setting up of Partnerships, Patient support groups, Cured Patients Groups,
Opinion Leader Groups. Even the political leaders, especially those in
opposition need to act as vigilantes. However, this will happen only if
“Health” becomes a priority on their agenda.
Once the patients and their communities are empowered, they will
ensure that any type of corruption with in health systems is checked.
Competing interests: No competing interests