A recent headline designating Kenya’s health sector as the most corrupt, reminded me this is a global cancer — after all, corruption has been described as a disease.
When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, estimated in billions of dollars.
Similar to cancer, health-related corruption comes in several types: From ‘petty’ corruption such as absenteeism of healthcare workers to ‘systematic’ corruption involving multinational companies engaged in widespread healthcare fraud and abuse, and ‘grand’ corruption occurring at high levels of government. Once it invades, it is often difficult to detect or diagnose and, most importantly, is hard to treat.
Critically, health-related corruption is distinctly dangerous compared to other forms in that it presents a ‘dual-burden’ of limiting both economic and human development while at the same time endangering patients and population-level health. Its cost can also extend beyond the people and communities it directly impacts.
The motivation of different actors to engage in health-related corruption should come as no surprise. The healthcare sector is one of the fastest and largest segments of the global economy, accounting for nearly 10 per cent of the worldwide gross domestic product according to the World Bank.
In addition, the health sector is characterised by unique risk factors and inherent complexities particularly susceptible to corruption, including information asymmetry, the large number of actors and mix of public and private sectors in healthcare systems, market uncertainty, and large amounts of public spending.
These vulnerabilities allow the presence of various types of corruption: Bribery, kickbacks and informal payments to health personnel and administrators, fraud and abuse involving payments for healthcare goods and services that are not rendered, collusion and bid rigging in healthcare procurement and contract awards.
Others include: Biased or unfavourable decisions due to conflicts of interest in healthcare transactions and relationships, corruption in medical practice, education and research, embezzlement and theft of various healthcare resources.
Further, the diversity and scope of health-related corruption makes it equally difficult to design programmes effective in preventing, detecting and controlling corrupt practices.