As I mentioned before, I spent 3 years living and working in Cambodia. But what I might not have mentioned yet is that I was working on a project to stop corruption in Cambodia, and my specialty was corruption in Cambodia’s health system. So when I woke up this morning and saw Lydia Polgreen’s NYTimes article on the problem of corruption in India’s health care system, my spidey senses got tingling again.
Billions of dollars flow into health systems these days. The money must be raised, allocated and spent; and in that process, so many interests get a chance to weigh in on what can potentially be done with that money. So it is no surprise, in developed and developing countries alike, that hundreds of millions, if not billions, of health spending dollars are leached through corrupt practices on a yearly basis. As a result, money that is supposed to support services of a public need, wind up going into the pockets of private interests.
In developing countries, health care resources are already low and most countries, like Cambodia, depend on international funding because they cannot rely on their own financial resources. Corruption of these resources effectively decreases these already scarce resources, thereby lowering the quantity, quality and cost-effectiveness of health care development interventions. What you wind up with, are people who cannot afford to seek supposedly free medical care because the doctors are demanding under-the-table fees, because they are not getting paid. They are not getting paid because the provincial treasury has no money. The provincial treasury has no money because as much as 25% of it has been leaked into private hands….and the list goes on. Sometimes, clinics may not exist at all, even though money continues to be allocated to them in a national health budget – these are called ghost clinics. The end result is are a population who is not able to access medical care, and it is not unusual to see people suffering or dying as a result of care denied.
And what happens to the whistleblowers who try to reveal this corruption to the public? No one likes their dirty laundry aired and it is no surprise about what happened to the doctors profiled in Polgreen’s articles.
So what can we do about it? Well, there are governments who are sincerely trying to halt the use of public funds for private interests. Unfortunately, those private interests may wield far more power than the government can muster. Nonetheless, the fight against corruption continues with help from civil society and development partners in countries like Cambodia, Mozambique and Pakistan. And hopefully, at some point, the combination of visionary and bold leadership, public engagement and the desire for transparency, integrity and accountability will develop systems of trained professionals and bureaucrats that are truly accountable and responsive to the public.
To learn more about what’s going on in corruption around the world, check out the U4 Anti-Corruption Resource Centre. In Cambodia, you can read about it from the Coalition for Integrity and Social Accountability, and if you want to see how your country fares on corruption, check out Transparency International’s Corruption Barometer.