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Corruption in public health 93supplies in public hospitals points to corruption. Perceptions ofstaff, their assessment of the probabilities of getting caught andbeing punished, and examination of hospital records and comparingthese with market prices suggest that irregularities are rife. Figure4 shows the ratio of highest to lowest purchase price for fourcommonly stocked medical supplies – saline solution, cotton,dextrose and penicillin – across hospitals in each of the four LatinAmerican countries for which data exist. The poor procurement performanceunderlying the purchases were attributed to gross mismanagementor corruption (Di Tella and Savedoff, 2001).In Colombia, it is estimated that about 11 per cent of costs couldhave been saved if accepted public tendering rules had beenfollowed (Giedion, Morales and Acosta, 2001). Results from surveysof physicians and nurses in Argentina (Schargrodsky, Mera andWeinschelbaum, 2001), Colombia (Giedion, Morales and Acosta,2001) and Venezuela (JaÎn and Paravisini, 2001) show that corruptionwithin facilities leads to overpayment of suppliers, and thatcombined with the lack of punishment and the low probability ofgetting caught make it possible. In short, the lack of enforced rules,procedures and accountability effectively allows irregularities inpurchasing practices.In Argentina a similar finding emerged. When the health systemtransparency policy was introduced the prices of procured suppliesdropped sharply but rose again once the policy was no longerenforced (Schargrodsky, Mera and Weinschelbaum, 2001). InColombia price variations were statistically significant across purchasesof public hospitals, and particularly different where theyignored the price lists negotiated and endorsed by a local NGOunder contract to the government (Giedion, Morales and Acosta,2001).Direct and specific evidence is harder to come by. However, inGhana interviews with officials and the public suggest that 21 percent of procurements in government hospitals are corrupt, and 18per cent of the value of contracts is required in kickbacks to publicofficials (World Bank, 2000d). Petty theft in the aggregate can lead