Full text PDF - International Policy Network

Corruption in public health 117
The absence of basic information, regular audits and monitoring
evidence define an environment that invites misconduct. As
Colombia implemented Law 100 reforming its health care system
it unearthed extensive corruption and mismanagement in reporting
and record keeping in public programs. In response the
Ministry of Health set up a nationwide database for data matching
and payment controls to identify and correct abuses that were
resulting in paying “ghost” workers, among other problems. That
combined with a multimedia campaign informing citizens of their
rights and obligations under the newly reformed system provided
a segue-way into better oversight and involvement of citizens
(Soto, 2002).
Drug procurement poses multiple challenges and Chile’s experience
is instructive in how to institute reforms that serve multiple
objectives. Chile’s drug and medical supply system run by the government,
CENEBAST, was plagued with poor management, frequent
stock outs and overstocks of other medicines. The reform was built
around a shift from a rules-based system to one grounded in transparency
and good incentive structures. Its main components were:
(1) introducing electronic bidding for pharmaceuticals; (2) reform of
CENEBAST to change its mandate to procurement agent for hospitals
and other providers who define drug priorities; and (3) information
dissemination that let it be known that pharmaceutical
procurement would be under scrutiny. An important element of the
institutional reform was allowing other agencies and the private
sector to purchase, store and transport drugs, removing CENEBAST’s
monopoly position.
The reform reduced information asymmetries between providers
and the procurers of pharmaceuticals. and produced clear and fair
rules resulting in bids from a broader spectrum of companies and
lower prices for government hospitals and clinics. Overall in 1997,
US$ 4 million was saved just in pharmaceutical purchases (Cohen
and Montoya, 2001).
Nigeria has taken an aggressive stance on the issue and has rooted
out considerable illegal manufacturing, identified substandard