The recent endorsement of the Sustainable Development Goals (SDGs) has prompted greater discussion and debate about the most important aspects of, and the most effective means for achieving, sustainable development. Most of the discussion of corruption in the context of the SDGs has focused on SDG 16 (“Promote just, peaceful, and inclusive societies”), which specifically includes anticorruption and related objectives among its targets (and which has prompted some debate on this blog – see here, here, here, and here.) But the fight against corruption is also closely linked to the achievement of another one of the SDGs: SDG 3 (“Ensure healthy lives and promote well-being for all at all ages”).
On its face, SDG 3 is about health, not corruption. But the fight against corruption is in fact closely connected to SDG 3, and health professionals need to open their eyes to this connection. Corruption worsens health outcomes in many ways: siphoning off resources that are supposed to be devoted to health care (for example, through embezzlement and absenteeism), increasing the cost and decreasing the availability of medicines and medical equipment (or enabling the spread of fake medicines), creating barriers to use of health services (particularly by poor and uneducated people who are especially vulnerable to bribery) and reducing the overall availability and quality of health services. Thus the fight for increased health ought to be—perhaps must be—seen as inextricably connected to the fight against corruption.
Though measuring the impact of corruption on health is challenging, at this point we have a sufficiently large (and growing) body of evidence that corruption threatens health. Consider the following:
- Researchers found a significant association between corruption and child death rates, estimating that 1.6% of world deaths in children, or 140,000 child deaths per year, could be indirectly attributed to corruption. Moreover, public spending on child mortality had a stronger effect in reducing child mortality in countries with lower levels of corruption and higher institutional capacity.
- Other research has found that more corrupt countries have higher rates of infant, child, and maternal mortality; indeed, the prevalence of bribery is positively correlated to death rates for women giving birth, even after adjusting for per capita income and share of total spending on health in the country.
- A study of 72,524 adults from 20 African countries found that higher (perceived) national corruption was consistently associated with poor health; this association was present for in all socio-economic groups, but more prevalent among those with less education.
- One study suggested that fake anti-malarial medicines are responsible for an estimated 450,000 deaths per year
- Other research has identified corruption as the main socioeconomic factor explaining the growing problem of antibiotic resistance.
In light of this and other evidence, anticorruption should be seen as a priority for achieving public health goals, including SDG 3. Efforts to strengthen health systems should place greater emphasis on mechanisms for citizen voice, using techniques such as health boards and complaint mechanisms, which have been used to control corruption in Bolivia and Serbia. Performance indicators related to medicine stockouts should be harmonized and strengthened, with community monitoring to pressure government to halt the theft and private resale of publicly-procured medicines. Development partners need to recognize the deficiencies in capacity for financial management and audit in the health sector, and to support efforts to improve accounting and auditing capacity as health interventions.
When I first began work in public health 30 years ago, we were not yet able to see that corruption is a public health problem: a cost that rarely gets quantified in our cost-effectiveness analyses, a risk that often goes unmentioned in project appraisal reports. Yet corruption is a real barrier preventing us from achieving our goals in public health. Public health professionals need to work harder to understand why corruption happens, and to take actions to prevent it.