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Corruption in public health 95
The lack of discipline and oversight makes it easy for corrupt officials
to report higher costs for supplies, food and other goods and
to pocket the difference. Even in developed countries, pharmaceuticals
and supplies tend to be locked and closely inventoried to track
supplies and drugs on a continuous basis because theft poses so
much of a threat. Most public health systems in developing and
transition countries lack the ability to limit access to drug supplies
and the infrastructure to control access, although there are some
exceptions. The absence of information systems for supplies and
drugs, and an inability to sanction (or hold accountable) abusing
staff makes control of theft particularly challenging.
Flow of funds
Subsidized health care is meant to rely on public funding and minimally,
if at all, on patients. In many places, bureaucratic problems,
corruption and mismanagement lead to inadequate public funds at
the point of service and the informal charging of patients compensates
for inadequate salaries and gaps in discretionary budgets. At
the same time informal charging may have serious equity implications
undermining the objectives of subsidies.
Leakage of public funds
Whether public resources for staff and other inputs reach the front
line – the clinics and hospitals that deliver the services to the population
– is critical to a functioning health system. The World Bank
has pioneered efforts to measure the extent of leakage, that is, the
amount of the line ministries’ budgets that reaches the intended
communities and the schools, clinics and hospitals funded through
national transfers. These public expenditure tracking studies (PETS)
simply follow the flow of funds through the labyrinth of government
bureaucracy to determine if funds reach each of the designated
levels.
First applied in education, PETS identified key problems of effective
public management. In Uganda, 87 per cent of funds never
reached the schools (Dehn, Reinikka and Svensson, 2003). In Zambia