Corruption in the health sector—a longstanding problem that may cost $500 billion per year globally—has become an even more salient concern in light of the COVID-19 pandemic. As the virus swept the globe, many governments responded by sidestepping traditional procurement safeguards in the interest of speeding up emergency responses. While it was important to provide relief as quickly as possible, the relaxed regulations allowed corruption to thrive, leading to numerous scandals. To illustrate with just a few of the many, many possible examples: Bolivia’s Minister of Health was detained for allegedly purchasing 179 unusable ventilators at twice their original price; Indonesia’s Minister for Social Affairs was suspected of having pocketed US$1.1 million in funds relating to COVID-19 aid; and senior leaders and wealthy individuals in numerous countries, including Canada, Peru, Argentina, Spain, and Poland, jumped the queue to get access to vaccines. Much of this health sector corruption arises due to a lack of transparency and accountability in the governing systems. Especially in the midst of what seems like a never-ending pandemic, working towards combatting this type of corruption is especially salient as citizens are relying on the government for more health-related needs.
Anticorruption advocates have long argued that civil society organizations (CSOs) can and should play an important role in monitoring government activities and promoting accountability in the health context and elsewhere. A particularly encouraging example of the constructive role that CSOs can play, in the specific context of the COVID-19 response, comes from Argentina. Last year, the Argentine chapter of Transparency International, known as Poder Ciudadano, launched a COVID-19 Public Procurement Observatory, which uses open-source information to make procurement deals available to the public. Using this monitoring tool, Poder Ciudadano carried out an exhaustive survey of public purchases and contracting that took place within the COVID-19 emergency procurement framework. By December 2020, Poder Ciudadano had tracked more than seven hundred procurement activities valued at US$200 million. In addition to its work in monitoring COVID-related procurement, Poder Ciudadano worked with other CSOs to ensure transparency and equity in vaccine distribution. Using information provided by the Ministry of Health, these CSOs ensured daily publication of information about the numbers of vaccine shipments, their distribution, and who had been vaccinated. These transparency measures help prevent improper favoritism and other departures from the official vaccine distribution plan.
This example is both encouraging and instructive. The Poder Ciudadano case highlights how CSOs can be effective in promoting accountability and transparency in procurement and distribution. But this example also underscores that in order to play this role, CSOs in developing countries need outside funding, partnerships, and resources, as well as the support and cooperation of their governments. CSOs can play a vital role, but only if they have the right kind of help.
For CSOs to play the independent monitoring role that many advocates envision, they need to have adequate resources and technical capacity. And for many CSOs in low or middle income countries, this requires partnerships with other CSOs on both the local and international level—as exemplified by the coalition of CSOs that worked with the Argentine Ministry of Health to ensure daily publication of vaccine distribution information. Effectiveness also requires adequate donor support. One reason Poder Ciudadano’s COVID-19 projects were successful was that the program was sponsored by the Partnership for Transparency (PFT), which provided access to resources, technical expertise, funding, and program tools. Additionally, the project was co-funded by the Canadian Embassy in Argentina. The multi-level support was one reason Poder Ciudadano was more successful in these projects than other CSOs in Latin America have been in implementing similar initiatives.
Additionally, the sort of role that Poder Ciudadano and other CSOs played in Argentina—providing transparency and monitoring procurement and distribution of vaccines and other supplies—generally requires the support and cooperation of the government. Though Argentina has seen its share of COVID-related corruption scandals, in general the government embraced CSOs as constructive partners in promoting accountability. The Ministry of Health, for example, was willing to provide information to Poder Ciudadano and its partner CSOs about vaccine distribution. Other government organizations, such as the General Trustee of the Nation and the Prosecutor of Administrative Investigations, were likewise on board and supported Poder Ciudadano’s efforts. Furthermore, other successful PFT projects (in Uganda, for example) have often involved partnerships between the CSO and the government of the country in which the program is located.
Unfortunately, not all governments are so open to empowering independent CSOs to monitor the government’s activities. Indeed, in numerous other countries, including many of Argentina’s neighbors in Latin America, CSOs have been hampered by a variety of legal mandates and government restrictions. The trend, if anything, is toward imposing greater constraints on CSOs and the work they can do. Partly as a result, the degree of CSO participation in monitoring the government is inconsistent and generally weak across countries. In addition, the political climate in some countries also impedes the ability of CSOs to be effective. In contrast to the climate in Argentina during the pandemic, in many other Latin American countries, such as Brazil, CSOs had to focus on pressing the authorities to take the pandemic (and corruption) seriously—a difficult political struggle that left little possibility for playing a more active role in day-to-day monitoring of procurement and distribution.
Argentina provides a great example of how governments, CSOs, and international donors can join together in the fight against corruption in the health sector and elsewhere. But in too many countries—including many of the countries that would benefit most from using CSOs to create independent monitoring processes for public procurement and distribution—the governments themselves may be standing in the way.