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.
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