Petty-corruption in healthcare delivery: The perceptions By Doris Yaa Dartey. The WatchWoman Column

Petty-corruption in healthcare delivery: The perceptions

By Doris Yaa Dartey.          The WatchWoman Column

Often, when we talk about corruption, we tend to label politicians and duty-bearers as the high-level actors who directly benefit from their privileged positions as our elected and appointed service providers. We generally resent public officials for making illicit money from their positions for their private gains.

PAY ATTENTION TO PETTY-CORRUPTION

But we should look beyond the high-level public officials and extend our searchlights into all spheres of our public life to bear witness to petty-corruption. Anytime scandalous corruption-related stories make the news about sectors like education, health, judiciary, we experience a collective national shock and exclaim: How can such a thing happen? 

But it appears that corruption has infected every aspect of our national life. There is therefore the need to cut the head of this monster. How can we pin-point the full characteristics of this complex phenomenon that is nibbling away at our national wealth? When I came across a study report, entitled: “Petty-corruption in public healthcare delivery”,I acknowledged that research offers one of the answers to the quagmire. Although the geographical focus of the study was the northern part of Ghana, the results may as well be a reflection of the reality of Ghana. 

The beauty of a well-done social science research is that through an objective collection and rigorous examination of data, research can lead us closer to facts and move us away from the realms of woozy speculations. Research is therefore a learning tool to gauge public opinion, to consolidate knowledge, and inform action.

Every day, low- and mid-level public officials across our country, whom we have entrusted with state-level responsibilities, abuse the entrusted power in the course of their interactions with ordinary citizens, who often are only trying to access basic goods or services in places like healthcare. Yes, when we are at our lowest, weakest and most vulnerable as sickness strikes, we could easily become targets and victims of exploitation.

KEY RESULTS OF THE STUDY

Maya Angelou, the celebrated African American writer said, “When you know better, you do better.” I have believed in her assertion that when people know what is wrong, they will do the right thing. But the results of this study slaps this assertion in the face. The results suggest that people may know what is good and noble but yet may do the most unprincipled and undignified things.

The study reported that more than 76% of patients and healthcare workers know that receiving informal payments, stealing medical supplies, charging fees that is higher than the official rate, absenteeism, and using public health facilities to see private patients are acts of corruption. In effect, both patients and hospital staff know what is wrong but yet, continue to engage in the wrong acts.  

As if in one accord, patients and hospital staff collectively engage in corrupt acts of informal payment, extortion, embezzlement and favouritism. They do it because they can, knowing that there will be no repercussions and they will get away with it.

As high as 97% of patients and 96% of healthcare workers indicated that bribery and corruption is widespread within the healthcare delivery system. Not surprisingly but sadly, the study further found that 67% of patients and 62% of healthcare workers agree that corruption is accepted as normal in the delivery of healthcare. So sadly, things that are considered normal are typically not being questioned; they are allowed to be, and to fester.

In the study, both patients and healthcare staff acknowledge that the public healthcare delivery system is infested with corruption, yet they accept and actively engage in acts that preserve the corruption culture. They even consider corruption as “normal”. This suggests that you, as a citizen, when you get sick and head to a state-owned healthcare facility, you should ensure that you have extra money to pay for the abnormality that has gained the stature of normality. 

For those who can barely afford the fee for hospital attendance, they might as well stay away from the state-owned facilities and head to prayer camps, where they will be further exploited. With that, exploitation becomes the name of the game in healthcare delivery. Sadly, this segment of the population includes children, pregnant women, people living with disabilities, the poor and other vulnerable individuals.

Informal payments are the fees you pay that you are not supposed to pay. They are the payments that are not approved, or are recorded in any books. Often, they go straight into private pockets instead of to the hospitals’ and state coffers. 

Regarding informal payments, the study found that about 66% of patients have often/very often heard/seen or experienced informal payments in a state-funded healthcare facility within the last one year. About 34% of health workers indicated that “unofficial/informal payments from patients to healthcare providers in return for receiving healthcare services” happens often/very often. 

More than 57% of patients and 70% of the workers studied believe that each of the various categories of health workers are corrupt. 40% of healthcare workers said they have been involved in corruption or taken a bribe. These findings imply that people reported that they have heard of, seen or even personally experienced informal payments.

On the bribery collection front, 31% of health workers indicated that they often/very often receive payments from patients without giving receipts; and 25% admitted often charging a service fee higher than the official rate. The illicit payments are collected along the chain; nowhere is spared. With impudence, illicit payments are collected in the wards and even in operating rooms. Although these acts of petty-corruption are very pervasive, 54% of health workers said they had never reported a corrupt colleague to management of the facility. This suggests the pervasiveness of a culture of silence. 

THE DIRE CONSEQUENCES OF PETTY-CORRUPTION

Ironically, the main motivations for patients getting involved in bribery and corruption in the hospitals are the quest to get good quality health services and avoid long queues However, the study’s respondents listed the following as grave consequences of corruption: long waiting hours and delayed services (94.5%), placing limitations on the poor and vulnerable to afford necessary medical treatments (93.9%), and loss of confidence and mistrust in the healthcare system (87.4%). A major conclusion of the study it that it is very important to reduce the incentives in the healthcare delivery system that nurture and tolerate behavioural acts of petty-corruption. 

The study was conducted by the Community Development Alliance (CDA-Ghana) and its coalition partners. It was supported by a DFID project, STAAC (Strengthening Action Against Corruption) with a goal to help strengthen citizens action against corruption in the northern part of the country. The lead researcher was Dr Samuel Dery of the University of Ghana (School of Public Health); with the support of Salifu Issifu Kanton and other colleagues. 

dorisdartey@gmail.com

For the love of Ghana, ban single use plastic bags! By Doris Yaa Dartey. The WatchWoman Column

From the 2010 Housing and Population Census figures of 24.2 million, Ghana’s population is currently up to an estimated 30.4 million. If each person disposes of five pieces of non-biodegradable plastic waste every week, we would be dumping about seven billion pieces a year into the environment. Multiply that by 10 years of dumping of plastic waste that will not decompose and become one with nature for about 300 to 500 years. It is irresponsible to continue to dump such large quantities of plastic waste into the finite size of earth we know of as Ghana.

The plastic waste get dumped into all sorts of spaces. No space is spared in the 238,535 square kilometres finite size of earth. Not our water bodies, our gutters, our farmlands, our roadsides, our 560 kilometres coastline of the mighty Atlantic Ocean, or tree tops (when the wind lift them upwards!) are spared. 

Plastic bags are used for all sorts of things unholy including as poop-bags, which are tossed. What is upsetting about plastic bags is that we do not actually use them. We only have a touch-and-go relationship with them. They literally pass through our hands as items of convenience, and as holding carrier cells for the odds and ends we buy. Then, mindlessly, we dump them. If we were to pause and think of what happens to each plastic bag after it briefly crosses paths with us, our conscience may slap us.

Increasingly, several countries are introducing measures to reduce, ban and manage plastic waste because it is clear to all that continuing on the current path is unconscionable and more so, is not sustainable. But Ghana’s government is silent on this critical matter. Yet, every well-meaning Ghanaian is convinced that plastic waste is a national crisis matter.  

Recently reported comments by Professor Frimpong-Boateng, the Minister of Environment, Science, Technology and Innovation is disappointing. He made it sound as if Ghanaians are calling for a “wholesale ban” of plastics. That is far from the truth! We all know that plastics cannot be banned on a wholesale basis because after all, some plastics are good. For instance, for now, sachet water provides a key source of drinking water for the majority of our population. So although it is single use plastic, we cannot yet ban sachet water or water bottles!

BAN THE NUISANCE PLASTIC BAGS

It is the nuisance plastics that must be banned. Plastic carrier bags of varied colours and sizes constitute a nuisance, and are destroying our environment. As a people, we have proved that we are incapable of managing plastic waste. We collect just a small fraction of the waste. 

There is a myth about recycling plastics. It is estimated that only about two percent of the plastic waste we generate in Ghana is recycled. So any rhetoric about recycling is nothing less than a big lie, and a grand excuse not to do anything. Typically, whenever people are not eager to do the right thing, they make up elaborate excuses. 

Ghana needs to have a major reckoning over plastic waste. Former President Mahama made some pretentious moves to ban plastic bags but he appeared to have lacked the courage to actually ban it. This is the third year of the Nana Addo Danquah Akufo-Addo presidency. Unfortunately, there is not even the slightest hope that single use plastics of any sort will be banned. Next year is election year, and as important and bold decisions and actions go, it is unlikely that the government will dare to take this responsible action, which although will be good for Ghana, may not be tolerable as a vote-earner.

Why has it taken Professor Frimpong-Boateng three years to develop a draft plastic waste policy? No policy on plastic waste will make sense if it does not include reduction in the quantities of waste we generate.

THE EARTH DESERVES RESPECT

We cannot get away with our destructive attitude toward plastic waste. We may choose to remain in denial for a little while longer. But the foolhardiness of our reckless disregard for the environment by tolerating the piling up of non-biodegradable plastics into our side of the earth will soon catch up with us in a big way. The universe is already punishing us but we are disregarding it. Our plastic-choked gutters, the floods, and the dirty beaches are reminders that nature abhors plastic waste.

The following Kikuyu proverb (a Kenyan ethnic group) is packed with lots of advice for the way we treat our earth. It says: “You must treat the earth well. It was not given to you by your parents. It is loaned to you by your children.”This earth was there long before us. Our parents and numerous generations before us all passed through this earth for whatever number of years they were gifted. The earth was given to us in trust by our ancestors for our descendants; that is why we need to preserve it for the next generation.

We do not know the age of the earth. We are here on a stop-over to wherever we go after death, since none of us can get out of this life alive. The earth is therefore a gift. Gifts can be squandered—irresponsibly. So our mindless acts that result in the destruction of the earth is the most irresponsible act of national destruction. We are bruising the earth with plastic waste!

WASTEFULNESS DOES NOT PAY

A Native American mythology has it that once upon a time, human beings could eat the clouds! Those days, the clouds were not up high in the skies as they are today. The clouds hang really low so people could just raise their arms and reach out to pluck a chunk of cloud like we pluck fruits from a tree. People took the clouds for granted and became very wasteful. 

Over time, they developed the habit of plucking any quantity of the clouds, ate just a little and dumped the remaining as waste. They did not bother to pluck just enough for their immediate needs. The spirit of wastefulness drove them to always pluck more than they needed and mindlessly throw away the bulk of the harvest, which they did not need in the first place. Easy come; easy go! After all, they did not have to struggle to grow the cloud and to pluck it. 

This attitude of plucking more than was needed went on until the gods got fed up with human beings and decided to punish them. As punishment, the gods commanded the clouds to be raised up from the reach of humans and rendered them unfit for consumption. That is how come humans can now only see the clouds up high and above—untouchable and non-consumable. 

dorisdartey@gmail.com