Corruption in healthcare: a view from the pandemic

Abstract

Corruption in healthcare has become transnational and intersectoral in nature; leading countries around the world have become vulnerable and insufficiently prepared to address health crises. The article deals with topical issues of corruption in healthcare during the Covid-19 pandemic in public and private sectors. By comparing different ratings, we concluded that there is a correlation between the level of corruption and the average annual income of the respective state, the observance of human rights and democratic standards in the context of their response to the Covid-19 pandemic.

Corruption in medicine occurs in both developed and developing countries, but the scale and scope of it differs. The Covid-19 pandemic has shown up the holes in healthcare provision and corruption reduced the ability of states to respond to this extraordinary situation.

Corruption and emergency are powered by each other. ¹ Corruption thrives on emergencies, that are characterized by rapid response, a weak system of checks and balances as well as constant funding.

In the first year of the Covid-19 pandemic, we observed how corruption undermines a state's ability to respond effectively to this extraordinary situation. Developed countries and developing countries channelled substantial budget resources to fight the virus, funding the need to provide urgent assistance or economic stimulus packages. Unfortunately, this created an ideal basis for corrupt practices and led to large-scale corruption schemes. These can include falsification of public contracts and kickbacks, embezzlement of healthcare funds, opacity in governance, misuse of power, nepotism and favouritism in management. There may also be petty corruption in the level of service, fraud and theft or embezzlement of medicines and medical devices. ²

Corruption is not spread only in areas where there is no accountability and the rule of law. Corruption is indeed systemic in various countries with deep roots in institutions and daily life. People worldwide during the Covid-19 pandemic times suffered from the impact of corruption when trying to access healthcare, protective and medical equipment, medicines and vaccines.

With the spread of the Covid-19 pandemic, corruption in healthcare became yet more widespread. Starting in March 2020, the wave of corruption investigations resulting from the pandemic has escalated worldwide. According to the Berlin-based anti-fraud company Nemexis, corruption in medical services weakened the provision of medical care, contributing to the deaths from Covid-19 in every third country in 58 countries surveyed. ³ Corruption has caused countries worldwide to be vulnerable and insufficiently prepared to deal with public health crises because their healthcare systems were inadequately equipped to address the challenges posed by the Covid-19 pandemic. At this time many governments failed to implement effective anti-corruption measures or accurately assess the risk and impact of corruption. Large-scale criminal activity connected with face masks revealed several cases of corruption linked to the public contract to purchase 800 million masks; four million forged FFP2 and KN95 masks have been opened in Spain and Italy. ⁴

Corruption differs from country to country according to circumstances and local priorities. For example, the Kingdom of Saudi Arabia has identified bribery as one of the most widespread forms of corruption during the Covid-19 pandemic. During the acute phase of the pandemic, Italy's healthcare system was vulnerable to fraud and corruption and is why Italy suffered such high population mortality. Corruption also affects services in the private sector. In particular, through fraudulent schemes, the population of countries (for example, in the United Kingdom, Italy, Turkey) offered counterfeit or non-existent health products, and collected donations for non-existent charitable organizations that sought donations for various activities related to the pandemic, and used digital technologies for these goals (platform-phishing, emails, online interfaces). ⁵

We need also to focus attention on the structural and organizational readiness of the healthcare systems of different countries. As hospitals tried to cope with Сovid-19 and faced an increasing shortage of personnel, beds and various types of equipment, bribery became the main problem. ⁶ Medical professionals hold the key to the management of health emergencies. To effectively address the challenges and threats that arose from Covid-19, medical professionals at the forefront need to be protected, stimulated and serviced. ⁷ Low wages and poor working conditions make them susceptible to bribes for access or primary access to medical care, testing and equipment along with the disposal of dead bodies. The avoidance of quarantine or passing quarantine rules became grounds for minor corruption during the provision of medical services. Petty corruption during the pandemic reduced the trust in healthcare providers and discouraged people from appealing to the healthcare facilities.

Corruption during the Covid-19 pandemic is transnational and cross-sectoral in scope. Although there are no figures on how much has been lost as a result, the world's death statistics suggest there were as we know insufficient resources to respond adequately.

It increased inequality and highlighted infrastructure deficiencies; limited reporting, distribution and access to screening tests; and led to inconsistencies in the distribution of factual real-time information, and the insufficient provision of personal protective equipment for hospitals and medical workers. For example, in the USA, the pandemic highlighted the wide range of inequalities in the country's healthcare approach with the most severe burden of disease falling upon predominantly black, Latin American, Indian, and immigrant communities. ^{8 – 10}

Good health is a major factor in achieving peace and security; it depends on close cooperation between people and states. ¹¹ The highest attainable level of public health is directly related to economic development and wealth, since the way of life and the conditions in which people live and work impact on their health. The pandemic has damaged progress in this area. ¹²

At the same time, there is a connection between the level of corruption and the average annual income of the respective state, calculated by gross national income and population. We analysed various ratings of the Corruption Perceptions Index 2021, and Health Index 2021, and compared data on the overall quality of the health care system, medical workers, equipment, personnel, doctors, cost and mortality for 2020–2021 during the pandemic. We concluded that the higher the average annual income of the state, the lower the level of corruption, and vice versa, the lower the average annual income of the state, the higher the level of corruption. ^{13 – 15} Thus, we may state that countries with well-protected civil and political freedoms generally control corruption better while countries with higher levels of corruption have created conditions for the violation of human rights and democratic standards as seen by their response to the Covid-19 pandemic.

Coronavirus SARS-CoV-2 continues to evolve. The SARS-CoV-2 variant (Alpha, Beta, Gamma, Delta) underlined the importance of a fair healthcare system, free of corruption and with accountability. The Covid-19 pandemic demonstrated the importance of a comprehensive plan ready for an emergency response but 65% of the world’s countries had no such plan when the pandemic struck in 2019. ¹⁶

A fair healthcare system free from corruption is essential; without combatting corruption, resources can be wasted and trust in the health care system lost. We must make sure that corruption is rooted out to deal quickly and efficiently with the new strains of coronavirus that are still emerging.

In our opinion, today every country in the world should update its anti-corruption policy both generally and in the sphere of healthcare with good governance, transparency and zero tolerance for corrupt practices. Corruption should be tackled at both central and local levels with transparency in the public sector one of the most important means of preventing it. Regular and reliable information from state institutions is crucial in emergencies. Transparency of public health procurements are likely to reduce waste and inefficiency, promote justice and strengthen health systems, and promote fair competition as will monitoring and supervision with reliable reporting mechanisms. We must aim for a more equitable and more inclusive approach in future that leaves the world better prepared for the next global crisis.