Corruption in health sector

No doubt the persons who steal money by re-directing funds or over-invoicing; or who use hospital budgets for their personal needs; or who pilfer hospital property — no doubt such persons do not think they are injuring other human beings. Indeed, the corrupt usually find all kinds of ways to justify their own actions — that what they steal does not make a difference in this rich country; or that their salaries do not reflect the hard work they do; or that everybody steals so they might as well do it, too. But, when patients’ health is damaged, or when patients die because of a lack of drugs or proper medical equipment, then all those persons involved in corrupt practices — whether they are doctors, nurses, clerks, or contractors — are accessories to effective assault and negligent homicide.

Indeed, it may even be fair to say that many of the problems of the health sector are rooted in corrupt practices. After all, the question is often asked why a country as rich as Trinidad and Tobago does not have an efficient health care system. Indeed, it is telling that the country’s leaders do not trust even private health care here, preferring to go to London and Cuba and Miami for treatment. That in itself is an admission of failure on their part. And, while the problems in the health care system have multiple causes, it is a certainty that reducing corruption would go a long way to solving them.

This is why the Trinidad and Tobago Transparency Institute (TTTI), having received Transparency International’s Global Report, which focused on health sector corruption, has forwarded copies to top officials at the Health Ministry, the Public Services Association, the Medical Practitioners Association, and the Nursing Council. One would hope, not only that these organisations would take some sort of action, but that they would understand that it is their members who practise much of the corruption that plagues the health services. Unfortunately, the habit in our society is to always blame someone else — so the Health Ministry blames doctors, doctors blame the Ministry, the PSA blames both, and so on. But there are splinters in everyone’s eye, and beams in quite a few.

So what can be done? TI in its report highlights several strategies, most of which involve systemic changes. Openness in the tendering and granting of contracts is a crucial measure. So too are conflict-of-interest rules, not only in drug regulation, but in the relationship between doctors’ private practices and their jobs in the public hospitals. And public health policies must be independently monitored.

The creation of the Regional Health Authorities was intended to make the system more efficient by putting private sector expertise into the running of the public health system. But this has not worked for various reasons, one of which is political nepotism. Indeed, the North-West Regional Health Authority is the poster-child for this failure, with the disappearance of a million dollars some years ago highlighting the deficiencies of all the RHAs.

But many of the problems in the health sector, including corruption, can be surmounted if the various interested parties come together to initiate system changes. We suggest that, given its 2020 ambitions, the Government must create a multi-sector committee to start this process in the shortest possible time.