Corruption Abounds In Global Health Services
Global Health at a Crossroads: Equity, Climate Change & Microbial Threats
Washington DC April 14-16, 2023
Plenary – April 16, 2023 - How to Tackle Corruption, Conflict and Build Capacity for Development- strengthening public institutions, good governance and accountability.
Session Chairman - Hon. Dr. Keith Martin, MD, PC.
Executive Director Consortium of Universities for Global Health
Frank Vogl - Opening Remarks
Thank you Dr. Martin for inviting me today to discuss corruption and meet with so many leaders from the world of healthcare. I have been involved for more than 30 years on a voluntary basis in working across the globe with civil society organizations dedicated to curbing corruption – dedicated to countering the abuse of public office, primarily by public officials and politicians, for their personal gain.
In many instances, we have worked on projects that involve healthcare. Last December I had the privilege of being invited to speak at the annual meeting of the International Federation of the Red Cross – the topic was broadly gender-based violence, and particularly Sextortion – the hardest of all anti-corruption issues - where women are asked to provide sexual favors when they cannot pay cash bribes.
Corruption in health rears its ugly head when counterfeit and or out-of-date medicines are bought by corrupt ministries of health; when hospitals and clinics have staff that extort patients – taking cash for services that should be free. We have seen hospitals in cities where their charges for prescription medicines have varied enormously and where too often the inflated prices reflect kickbacks.
And almost always in this context women suffer the most.
But the picture is not a totally bleak one. Civil society has made a difference and is making a difference.
For example, one of the organizations that I am associated with is the Partnership for Transparency Fund that deploys veteran World Bank and other development experts to assist civil society organizations in many countries.
When COVID-19 exploded there were great fears that funds for relief, PPE and later vaccines would be stolen, or made available only to elites in developing countries. One project we pursued, led by my PTF volunteer colleague, a World Bank veteran global health expert, Dr. Pietronella van den Oever, was to support a civil society organization called SAVE-Ghana. Based in Northern Ghana they launched radio programs and established a free call-in information number around a show called “The People Must Know.”
They explained how to get COVID relief and medical care; they encouraged citizens to become informed and educated; to report any malfeasance; and in subtle ways, they left pubic officials in no doubt that any acts of corruption and fraud in service delivery would be exposed and they would be held accountable. I am told this limited project was a real success.
Now permit me to place what I have said so far in a global context. Conservative estimates by the Economist Intelligence Unit suggest that one-half of the world’s population – maybe 4 billion people – live in countries run by all-powerful authoritarian leaders, such as President Putin in Russia and President Xi Jinping in China, and in countries that are well advanced in establishing such authoritarian regimes, such as Hungary and Turkey.
All of today’s authoritarian regimes across the world are kleptocracies – the leaders and their cronies steal from the public to finance their positions in power and to accumulate great wealth. These are the kleptocrats. Many of them have been in power for many years – and they have perverted national laws to cast aside term limits and, as we can see from Belarus to Equatorial Guinea, secure themselves in power for life.
\These regimes steal so much that almost everywhere there are shortages of funds to pay public servants, to support free education and free healthcare and other public services. And this is as true for the countries that have no natural resources, as for those endowed with huge oil, gas, and mineral resources. In oil-rich Nigeria, for example, the rate of infant deaths is higher than in Nepal, one of the world’s very poorest nations.
The plundering of social service budgets by top public officials, encourages extortion by low-level officials. To increase their very meager wages, we find that the police, school administrators, health workers and others extort bribes on a regular basis from the poor. These are the victims of corruption and there are hundreds of millions of them.
How do the national leaders get away with this plunder?
The defining feature of all authoritarian states is the lack of an independent judiciary. Dictators secure their power by capturing the institutions of justice and ensuring that they have impunity. They place themselves above the law.
As they do so, so they distort their economies, depleting social services, encouraging fraud, catering to business elites – sometimes called oligarchs – who help to steal from the poor.
Now, you may ask what does President Putin and other kleptocrats do with their stolen wealth?
They launder it. They do not want to invest it in their home countries where it might be confiscated if they lose power. So they find ways to invest their cash safely and secretly in the world’s biggest and freest capital markets – notably the US. I believe at least $600 billion of such dirty cash enters the US every year – more than the global sales of the world’s biggest retailer, Walmart – double Amazon’s sales.
The dirty money buys real estate, factories, bonds and shares on our stock markets – the kleptocrats can do this because they hire outstanding money managers. They hire lawyers and bankers, art dealers, accountants and financial consultants on Wall Street and in other global financial centers – these are the enablers – the title of my most recent book (The Enablers: How the West Supports Kleptocrats and Corruption — Endangering Our Democracy)
The enablers are aiding and abetting Russia’s oligarchs. Some of them today are violating sanctions to assist Russian tycoons and the Russian economy at a time when the freedom of Ukraine and the West is at stake. Let there be no doubt that when we talk corruption today, when we discuss enablers here, then at issue is our security and our democracy.
Corruption and money laundering are universal and they impact so much of daily life, including so much of the world that all of you are leading and that is so essential for our civilization. The curse of corruption in the realm of health is nothing less than a crime against humanity.
Making A Difference - Child Vaccinations
This comes into such powerful perspectives when you consider the scale of humanitarian distress in Ukraine today, and the efforts by so many corrupt regimes, corporations and individuals around the world that seek to aid the Kremlin by undermining Western sanctions. PTF, through it its European affiliate, PTF Europe, is right now working with a civil society group, CVU-Odesa to strengthen voluntary humanitarian assistance organizations that are on the front lines.
In conclusion, let me recount briefly another uplifting story to underscore that working with civil society in healthcare we can counter corruption. In another project by the Partnership for Transparency Fund led by my colleague Pietronella, we are working with OAFRESS (Organisation de l'Afrique Francophone pour le Renforcement des Systèmes de Santé et de la Vaccination). My colleagues are providing mentoring in a program intended to increase childhood vaccination in 17 francophone Sub-Saharan African countries. Our focus over three years is to mentor 22 "Champions" representing health-related platforms in their respective countries.
The Champions' specific mandate is to strengthen the performance in childhood vaccination by identifying "zero-dose" children - those children who have never been vaccinated - and identifying partially vaccinated children and facilitating the completion of the required vaccination process.
There is a hidden agenda here. We all know that these Champions are working in countries where corruption in many health clinics is present – the mentoring and training will assist these Champions to understand better the challenges and the ways to secure the vital vaccination goals that have been set.
Across the world there are champions – be they activists in civil society or investigative journalists – who are monitoring, exposing and fighting corruption. They are facing increasing risks from autocratic regimes, yet they soldier on. They are patriotic, caring about their fellow citizens, and convinced that freedom for all is the essential requirement for countries where transparency, accountability and integrity prevail. Thank you.