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92 Fighting the Diseases of Poverty
operating theaters, both serous shortcomings given the spreading
AIDS epidemic and the high volume of patients (World Bank, 2005b).
A study in Udaipur district in Rajasthan, India found patchy availability
of basic equipment in health facilities with only a quarter
having sterilizers. A third of sub-centers lacked a stethoscope, thermometer
or scale (Banerjee and Duflo, 2005).
Corruption in the supply chain
Graft and padding of billings form a commonly identified form of
corruption in the public sector, and health care is no exception. The
constant need for supplies to complement the skills and infrastructure
investments of government offer an opportunity for petty theft.
Siphoning of public funds for private gain can occur in the
transfer of funds from public treasuries to ministries of health, from
the ministries to their provider units, and within the provider units
themselves. All of these levels provide opportunity for theft. Misuse
of funds often occurs in the process of tendering and payment,
something all countries need to guard against through required procedures
and regular audits. Having clearly articulated policies and
procedures, adherence to policies and regulations, and consistent
enforcement of rules discourage illegal behaviors.
In a 4 province survey across 80 municipalities in the Philippines
corruption perceptions of households was negatively associated
with providers’ knowledge (of required immunizations), which in
turn was strongly related to immunization coverage and disease
incidence in the survey areas. Although significance is not highly
robust in all cases, the analysis illuminates the negative relationship
between corruption and performance at the local level (Azfar,
Kahkonen and Meagher, 2001).
The contracting process for construction and the purchase of
supplies offers a traditionally rich source of returns for corrupt officials
and suppliers through kickbacks, over-invoicing or outright
graft. A recent study of 7 Latin American countries provides insights
on overpayment for supplies (DiTella and Savedoff, 2001).
In Argentina, Bolivia, Colombia and Venezuela overpayment for