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Corruption in public health 91
local oversight, expropriated them (McPake et al., 1999). A later
facility exit survey in Uganda shows much higher drug availability
and distribution, however (Lindelow, Reinikka and Svensson, 2003).
In China various studies indicate that on average about 30 per cent of
public drug supplies are expired or counterfeit (Hsiao, 2005), suggesting
poor logistics management, limited oversight and graft.
More insidious and difficult is drug mishandling from the importation
of substandard medications, to the repackaging of drugs, substituting
lower cost/quality medications, to the pilfering of drug
supplies at points of service (e.g., clinics and hospitals). The health
consequences of tampering can be serious, but rarely traced to the
source of the problem due to ignorance, lack of regulation and
enforcement.
In-kind supplies from patients
Interviews and focus groups from around the world reveal the
common need to either bring or purchase basic supplies (e.g., bed
sheets, bandages) or drugs (Narayan, 2000; Lewis, 2000, 2002) and
in some instances equipment. The concentration of private health
services adjacent to public hospitals and clinics in many countries
attests to the chronic shortages of basic inputs and malfunctioning
equipment. In Kyrgyz Republic in 2001 among hospitalized patients
98 per cent brought food, 73 per cent linens, 80 per cent had family
members purchase drugs and 76 per cent supplied medical supplies
(Falkingham, 2002). Similarly in Tajikistan in 1999 77 per cent spent
on food, 93 per cent on medicines and 51 per cent for medical
supplies (Falkingham, 2004). Thus the health care system supplied
little of the operating inputs in either country. Patients paid for 50
per cent of drugs in the Dominican Republic hospital (Lewis,
LaForgia and Sulvetta, 1996).
In Nigeria 25 per cent of health facilities had about half of the
minimum package of equipment, while 40 per cent had less than a
quarter of what was needed (World Bank, forthcoming). In Ethiopia
two separate surveys revealed that only 21 per cent of public hospitals
had autoclaves (sterilizers) and 46 per cent had functioning