Rx for Corruption

Maria Concepción’s son was sick with a fever. Although the nearest clinic wasn’t that far, she had no car. It took two hours to get to El Salvador’s Belén Guijat Health Unit by foot, plus several more hours of waiting. The clinician diagnosed the boy but couldn’t give him any medication. The drugs were out of stock. Concepción had to purchase what she could afford at a private kiosk outside the clinic.

Fortunately, her son survived. But others are not so lucky. In the developing world, going to public health clinics means long waits, repeat visits, and large gaps between diagnosis and treatment. Budgets from government health ministries mysteriously disappear. Medical equipment breaks down, but there is no money to replace it; doctors stay home because they think they’re underpaid. Drugs sit in warehouses because delivery truck drivers can’t afford to fill their gas tanks.

Why is it so hard for needy patients to get access to the drugs they need? It’s not merely poor management; it’s corruption. The line between corruption and poor management is often a fine one. But some practices amount to extortion, plain and simple. In nearly half of 23 developing countries surveyed by the World Bank, a majority of the officials, business leaders, and citizens interviewed considered corruption in the health sector to be a major problem. Many even identified health as the most corrupt sector in the government, topping customs and police. Three quarters of the officials polled in Bosnia and Herzegovina say that getting a public health job or promotion requires a bribe. In Ghana, 25 percent of health-sector jobs are "for sale."

The transfer of funds within government poses another difficulty. Data are so poor that tracking the flow of money is impossible in many countries. Where data exist, only between 20 and 60 percent of budgeted funds actually reach the intended health providers; the rest never leaves the central government’s coffers, or else it disappears along the way. In Uganda, only 30 percent of non-salary budgets ever reached local health clinics.

Part of the solution is to enforce existing rules and hold managers more accountable. But that isn’t enough. In some settings, health ministries should grant communities the authority to oversee healthcare service delivery. Systematic audits, clear contracting rules, adequate oversight, and community organizations can help blunt corruption and foster good management. Creative solutions, such as contracting out service and delivery, have been successful in Cambodia, Guatemala, Haiti, and elsewhere. Clear incentives and public action can stem the tide of healthcare corruption, and patients like Maria Concepción’s son can finally get the care they have been promised.