The Influence of Corruption on UHC & Health Financing

By Sarah Harris, Transparency International

Across the world, corruption is so pervasive within national health care 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. The report shows that “health sector corruption negatively affects the (financial) resources available for health care” and out-of-pocket payments including bribes have “a particularly negative effect on the poor in society, as they are often unable to pay the bribes necessary for a certain service”.

Furthermore, corruption in the healthcare sector undermines efforts to achieve UHC by eroding financial protection efforts whilst simultaneously increasing barriers to healthcare.

Out-of-pocket payments (OOPS) for healthcare are a huge driver of poverty having 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. According to Transparency International’s 2013 Global Corruption Barometer, 17% of people worldwide stated they had paid a bribe when dealing with the medical sector. Taking bribes for services can deter patients from seeking care, force people to only seek care when conditions have become acute and inevitably can lead to poorer health outcomes.

Enabling patients to blow the whistle on situations where they have been required to pay an informal payment or bribe for services can help to shed light on how widespread this practice is, highlight those areas that are most affected and most importantly, empower communities to force corruption out. Transparency International’s Pharmaceuticals and Healthcare Programme, together with Transparency International Cameroon (TI-C), developed the whistleblowing platform, Corruption No Sissia, for use by patients at public hospitals.

The service is designed to accommodate literate and illiterate populations allowing patients to log complaints online, by SMS or by calling a local number. The complaints are received by TI-C, and hospital administrators of the target hospitals are given a means to view complaints concerning their hospitals. The administrators then undertake measures to address the situation at the facility level. Complaints received are assessed by TI-C and shared directly to the Ministry of Health and other pertinent stakeholders to be dealt with. In the pilot phase, results show that bribes most often occur in maternal care, emergency services, physician consultations and at the hospital cashier.

This blog is part of a series by the UHC Financing Advocacy Collaborative, a network of 50+ members which brings together multi-stakeholder representatives from civil society and development partners who support country and global level health financing priorities relating to universal health coverage. #Finance4UHC