Tag Archives: health

Civil Society Organizations Can Help Fight Corruption in the COVID-19 Response. But Only if Governments Let Them

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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.

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Guest Post: Highlights from the UNGASS Anticorruption Session Side Events

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Last month, the UN General Assembly held its first-ever Special Session focused specifically on the fight against corruption. In addition to the UN General Assembly Special Session (UNGASS) itself, various governments and civil society organizations arranged various side events, held in parallel with the main UNGASS meeting, to allow activists, policymakers, and researchers to share their expertise. Today’s guest post, contributed by Michaella Baker, a JD-MBA student at Northwestern University (working in collaboration with Northwestern Law Professor Juliet Sorensen), summarizes the themes and principal contributions of three of these side events.

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More Commentaries on Corruption and the Coronavirus Pandemic

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Perhaps unsurprisingly, folks in the anticorruption community have started to generate a fair amount of commentary on the links between the coronavirus pandemic and corruption/anticorruption; these pieces approach the connection from various angles, including how corruption might have contributed to the outbreak and deficiencies in the response, the importance of ensuring adequate anticorruption safeguards in the various emergency measures being implemented to address both the public health crisis and the associated economic crisis, and concerns about the longer term impact on institutional integrity and checks and balances. Last week I posted links to four such commentaries. Since then, we’ve had two commentaries on the corruption-coronavirus relationship here on GAB (yesterday’s post from Sarah Steingrüber, and last week’s post from Shruti Shah and Alex Amico). Since then, I’ve come across some more, and I thought it would be useful to provide those additional links, and perhaps to try to start collecting in one place a list of commentaries on corruption and coronavirus. The new sources I’ve come across are as follows:

In case it’s helpful to readers, I may start to compile and regularly update a list of corruption-coronavirus resources. The ones I’ve got so far (including those noted above):

I’m sure there are more useful commentaries, and many more to come over the coming weeks. I’m not sure if I’ll be able to keep a comprehensive list, but I’ll do my best to provide links to the resources I’m aware of, so if you know of useful pieces on the corruption-coronavirus link, please send me a note.

Thanks everyone, and stay safe.

We Need An Extraterritorial Law To Hold Companies Responsible For Clean Global Supply Chains.

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Six years ago, the deadliest garment industry accident in modern history killed more than 1,100 people and injured 2,500 in an apparel manufacturing facility, Rana Plaza, in Bangladesh. Perhaps the worst part is that the tragedy was entirely preventable, and the result of corrupt practices by the politically well-connected owner. The Rana Plaza building violated codes, with the four upper floors having been constructed illegally without permits. The foundation was substandard, and despite safety warnings that led shop owners and a bank branch on lower floors to immediately close, owners of the garment factories on the upper floors instructed employees to work the next day to keep up with customer demand. The customers that the garment factory was trying to satisfy? Mango, Primark, Walmart, the Dutch retailer C & A, Benetton, and Cato Fashions, among other recognizable global brands. And yet none of the US brands accepted responsibility for the problems in their supply chains that enabled this disaster (unlike non-US brands that contributed millions of dollars into a victim support fund).

Years later, not much has changed. Despite some recent encouraging developments, the current legal regime still does not do enough to hold international companies responsible for health and safety violations by their suppliers, and two-thirds of corporations continue to turn a blind eye to supply chain corruption. Such corruption can lower production costs and increase profits by enabling suppliers to engage in a wide range of insidious practices, including cutting critical corners on labor, health and safety. And when an accident does happen, companies can walk away free of any liability for the practices of their subcontractors, as in Rana Plaza. The beneficiaries of these corrupt practices are not only the owners of the supply factories, but also the multinational purchasers and their consumers in rich countries, who get cheaper goods at the expense of the health and safety of disadvantaged workers in low-cost manufacturing hubs.

This is ethically unacceptable.  And because we cannot expect companies to engage in responsible sourcing on their own volition, the right response is more expansive liability on companies that do not take sufficient steps to ensure clean supply chains. While the ideal solution might be some sort of broad international legal regime, that isn’t going to be feasible anytime soon, meaning that countries like the United States should act unilaterally and create a bill focused on bringing about clean supply chains.

The law I advocate here would have the following features:

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Guest Post: Tackling Health Sector Corruption—Five Lessons from Afghanistan

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GAB welcomes back Mark Pyman, Senior Fellow at the London Institute for Statecraft, who previously served as Commissioner of the Afghanistan Joint Independent Anti-Corruption Monitoring and Evaluation Committee (MEC). He contributes this post together with Hussain Rezai, a researcher at MEC.

Despite the horror stories, interesting things are happening on tackling corruption in Afghanistan. Besides the progress (discussed in previous posts) on education and procurement, a major anticorruption initiative has been underway in the Afghanistan health system since June 2016. The initiative, which is another surprising (if qualified) anticorruption success story in a very difficult environment, offers five lessons for anticorruption practitioners and health ministers in other countries. Continue reading →

Incorporating Corruption and Accountability into Public Health Education

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Corruption is a serious threat to achieving global health objectives. As Professor Taryn Vian pointed out, corruption increases the cost and decreases the availability of medicines and medical equipment, creates barriers to health services, enables the spread of fake medicines. As I argued in a previous post, corruption also undermines the trust in government that is essential to dealing with public health emergencies. The importance of training and educating public health professionals on how to identify and understand problems of corruption in health, along with how to incorporate anticorruption strategies into programs and institutions, would therefore seem quite obvious. Yet the core public health curriculum at leading graduate institutions generally does not include a serious discussion of corruption and its impacts on public health. There are exceptions–Professor Vian, for example, teaches on this topic in her courses at Boston University’s School of Public Health—but for the most part corruption appears to be absent from public health course catalogs.

It’s not clear why this is the case. It may be that there is a shortage of professors who are knowledgeable or willing to teach on the topic, or perhaps most graduate students do not see the value in enrolling in such a course, especially if they have not witnessed corruption firsthand. Whatever the reasons, the end result is that students graduate from public health programs with little knowledge about the causes and consequences of corruption in the health sector, the reasons why good governance is so important to health care systems, the best ways to prevent, detect, and report cases of corruption. This is a problem. Public health education can and should place greater emphasis on corruption (and related topics like good governance and accountability), for three main reasons: Continue reading →

The Disease of Corruption: How Distrust in Corrupt Governments Impacts Emergency Health Delivery

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Corruption negatively impacts health outcomes. As noted in a previous post, corruption is associated with higher infant, child, and maternal mortality, overall poor health, the spread of antibiotic resistance, and many other problems. When we consider the reasons why corruption undermines health, the most obvious include things like theft or diversion of healthcare resources, or how demands for extra “informal” payments to healthcare providers can deprive poor communities of adequate care. There is, however, another important mechanism through which corruption undermines public health: corruption undermines trust in government and government-run services, which in turn can hinder effective health delivery and thereby escalate the spread of infectious diseases, especially in emergency situations like the recent Ebola crisis. Continue reading →

Corruption in Health Aid: Escaping the Scandal Cycle

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William Savedoff, Amanda Glassman and Janeen Madan of the Center for Global Development, a Washington-based development policy think tank, originally wrote this post for CGD.  It is reprinted here with permission.

Health aid pays for life-saving medicines, products, and services in the poorest countries in the world. Funding for such uses needs to be smooth and uninterrupted. But when fraud is detected, funds are subject to sudden stops and starts—the result of a sequence of events set off by the scandal cycle in health aid depicted below. We examine this idea and offer ways to escape the cycle in a new CGD policy paper we summarize here.

The Scandal Cycle

 

To understand the scandal cycle, we looked at four cases of fraud and response involving the World Bank in India, USAID in Afghanistan, the Global Fund in Mali, Djibouti and Mauritania, and European donors in Zambia. While corruption is discovered in different ways, scandals tend to erupt when the press publicizes it or a funder reacts strongly. Once allegations are in the public eye, funders typically react by suspending aid. Then, they work with recipients to create action plans for improving financial management systems, and eventually resume funding.

This scandal cycle is, unfortunately, all too common. In May, the Global Fund published an investigation that tracked down $3.8 million in fraudulent expenditures at Nigeria’s Department of Health Planning, Research & Statistics. The Fund’s executive director issued a statement reaffirming the Fund’s “zero tolerance of corruption” policy, underscoring that the Fund had frozen disbursements to several Nigerian agencies, and calling for reforms to government control measures.

As with the cases we analyzed in our paper, the focus on fraud often comes at the expense of considering the scale of corruption and the impact of disruption on health programs. While $3.8 million is no small number, it represents less than one percent of the $889 million in grants to Nigeria that the Global Fund audited in a companion report on the Wamboo.org project. Furthermore, the impact of international support on improving health has been rather large; the Global Fund’s own statement indicates that international support has helped Nigeria reduce deaths from malaria by 62 percent since 2000.

Halting disbursements to health programs can have serious consequences for service delivery, health outcomes, and institutional development. In light of the scale of fraud and the potential health impact, is suspending aid an effective response? And without information on health impact, how would we know?

We argue that funders may be able to escape the scandal cycle—and reduce such disruptions—by paying greater attention to information on program achievements. Currently, funders pay a lot of attention to procedural issues. For example, a 2013 report from the Special Inspector General for Afghanistan Reconstruction (SIGAR) documented weak accounting systems at the Afghan Ministry of Health. Even though the report had no direct evidence of fraud and the health program was successfully delivering services, SIGAR recommended USAID suspend the program.

By contrast, the World Bank’s 2008 Detailed Implementation Review of the Indian health sector not only included evidence of procedural failures, such as bid rigging, but also documented results failures, like continuing high malaria rates and inoperative hospitals. If the World Bank and India had reported these results failures earlier, the cases where corruption was big enough to affect programs would have come to light much sooner.

We think results on service delivery, population health, and institutional development are the key piece of information that could change the dynamics of the scandal cycle. This kind of information can help funders communicate more effectively about why they are deciding to suspend or continue aid, set appropriate standards for when aid should be halted, and establish new funding mechanisms that make it more difficult to divert funds.

We recommend the following three steps to improve funder response:

  1. Communicate using results. When a scandal erupts, communicating the funder’s actions to control or prevent corruption to stakeholders, the media, and the broader public is important. But emphasizing whether health aid programs are achieving intended results is also an essential component of the communications strategy. If a program is achieving results, stakeholders and constituents would better understand a funder’s decision not to suspend aid when a scandal erupts (while investigating abuse and working with the recipient to address the problem).
  2. Differentiate responses by results. In addition to responding to corruption allegations (which typically come from whistleblowers), tracking program results could help funders detect corruption. If a program is falling short of achieving results, corruption might be a contributing factor and an investigation could help determine whether and how much. Moreover, results data would allow funders to determine whether corruption is—or is not—hampering program implementation, and to recalibrate anti-corruption controls accordingly.
  3. Disburse in proportion to results. Where feasible, paying for results in health could help ensure that funds are only paid out when results are achieved. This approach makes it harder to divert funds because payments only occur after the program’s impact is measured. In programs that pay for results, dishonest people can only skim off funds if they have been very efficient at generating impact. In practice, they are likely to simply set their sights elsewhere.

The Scandal Cycle

The Global Fund’s recent statement recognizes the importance of communicating the results of its health grants to Nigeria, but it doesn’t address whether it is helpful to suspend aid over a relatively small amount of fraud or lack of supporting documentation. Our paper encourages funders to incorporate information about program results into their risk management strategies so they can communicate better, detect corruption sooner, and make more considered choices about creating or responding to scandals.

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Yes, Corruption Is Bad for Development. No, Corruption Is Not a Western Obsession

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Recently there has been a spate of commentary in the blogosphere that revives a set of tired old canards about corruption and development — the related claims (1) that the focus on corruption and governance in the development discourse is misplaced, because there isn’t a lot of evidence that corruption matters much for development, poverty reduction, etc.; and (2) that anticorruption is a fixation of wealthy, mostly Western countries, because it enables people in those countries congratulate themselves about their moral virtue and to look down on habits and practices in the poor, benighted South. Recent examples include Chris Blattman’s posts on his blog (here, here, and here), Michael Dowdle’s contributions to the Law & Development blog (here and here), and Jason Hickel’s post on Al Jazeera English, though there are others as well.

Sigh. Do we really need to go through this again? OK, look: Yes, there are still lots of unanswered questions about corruption’s causes and consequences, and its significance for various aspects of economic development. And yes, some anticorruption zealots have sometimes over-hyped the role of corruption relative to other factors. But the overwhelming weight of the evidence supports the claim that corruption is a big problem with significant adverse consequences for a range of development outcomes. And the evidence is also quite clear that the focus on corruption as a significant obstacle to development comes as much or more from poor people in poor countries as it does from wealthy Western/Northern elites.

A blog post is not the best format for delving into a very large academic literature on the adverse impacts of corruption. And so the posts to which I’m responding might be forgiven for generally failing to provide much evidence in support of their claims that corruption is relatively unimportant for development, and largely a Western obsession. But, let me at least take a stab at trying to move the conversation beyond unsubstantiated declarations to some assessment of the actual evidence, starting with the impact of corruption on development.

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