Health sec­tor’s R24bn bill for ‘ir­reg­u­lar’ spend­ing

Finweek English Edition - - IN THE NEWS - BY SHOKS MZOLO

Cor­rup­tion in the lo­cal healthcare sec­tor com­pro­mises pa­tient care and low­ers the morale of em­ploy­ees in the sec­tor. This is ac­cord­ing to a re­cent study, Ex­plor­ing cor­rup­tion in the South African health sec­tor, by Wits Univer­sity’s Prof. Sharon Fonn, Prof. Laeti­tia Rispel and Dr Pi­eter de Jager.

The study noted that in SA, where the to­tal pri­vate and public health bud­get is pegged at R400bn, a to­tal of R8bn com­bined pro­vin­cial health ex­pen­di­tures was “unau­tho­rised” and another R24.1bn “ir­reg­u­lar” in the last four years.

Ac­cord­ing to the study, “fruit­less and waste­ful ex­pen­di­ture” hit R1.3bn for the three-year pe­riod to end 2013.

For Cor­rup­tion Watch di­rec­tor David Lewis, the real cost is the ever-fall­ing stan­dards in the ail­ing public healthcare sec­tor.

Iron­i­cally, “more than enough laws are in place to pre­vent cor­rup­tion” but im­ple­men­ta­tion re­mains a prob­lem, ac­cord­ing to re­searchers and the au­thors of the re­port.

Rea­sons for i ncreased lev­els of cor­rup­tion, ac­cord­ing to the re­port, i nclude t he blurred l i nes bet ween po­lit­i­cal power and busi­ness in­ter­ests; lack of mech­a­nisms to de­tect graft (as whis­tle-blow­ers tend to be muz­zled, de­ter r i ng ot hers f r om r epor t i ng wrong­do­ing); con­flicts of in­ter­est; and fail­ure to sanc­tion trans­gres­sors.

Ear­lier re­search by Econex linked the “demise” of the sec­tor re­gard­ing mis­man­age­ment and cor­rup­tion, with just 20% of state fa­cil­i­ties pre­sent­ing clean or un­qual­i­fied au­dit re­ports.

Gaut­eng, whose health-re­lated ir­reg­u­lar spend­ing over the past four years hit R5.4bn, re­cently axed 18 em­ploy­ees for crimes rang­ing from the theft of R10 000, steal­ing medicines, and the unau­tho­rised use and pos­ses­sion of state ve­hi­cles (in­clud­ing an am­bu­lance).

The study, cov­er­ing a nine-year pe­riod, looked at f in­d­ings from the Au­di­tor- Gen­eral, which s how a “wors­en­ing trend” in au­dit out­comes, and re­ports in print media. Over the pe­riod, the ma­jor­ity (63%) of cor­rup­tion-re­lated re­ports con­cerned the public sec­tor, said the au­thors.

“We would like gov­ern­ment health de­part­ments to en­gage with the is­sues that we raise, de­bate them, and try to im­ple­ment prac­ti­cal so­lu­tions to pre­vent cor­rup­tion, as it tends to hurt com­mu­ni­ties, and the poor,” they said.

On a more pos­i­tive note, the Wits re­searchers noted an im­prove­ment in ir­reg­u­lar ex­pen­di­ture in Gaut­eng f rom 11% of its health ex­pen­di­ture in 2010/11 to 5% a year later. It still hovers around 5%.

In con­trast, KwaZulu-Natal’s has tre­bled to 10%. The North­ern Cape has, for the past three years, ranged be­tween 32% and 42%, com­pared with 5% in 2009/10.

“The [Na­tional De­vel­op­ment Plan] also notes that poor ac­count­abil­ity in the health sec­tor re­duces health sys­tem ef­fec­tive­ness,” said the study, adding that the plan con­ceded “high lev­els of cor­rup­tion” in both pri­vate and public sec­tors.

The prob­lem “is also il­lus­trated by the Na­tional Trea­sury’s 2013 bud­get al­lo­ca­tion of R71.4m [...] to the South African Public Ser­vice Com­mis­sion ‘ to com­bat cor­rup­tion and ad­dress griev­ances’.”



In­stead of in­vest­ing f unds in such ex­er­cises, amid per­sis­tent conf licted in­ter­ests – as in the case of an un­named hos­pi­tal CEO be­ing a di­rec­tor of nine firms – re­searchers ask for “com­mit­ment at all lev­els of the health sys­tem to deal with cor­rup­tion – we need sys­tem­atic in­tol­er­ance of wrong do­ing”. All South Africans need to no­tice and mea­sure graft and be vo­cal about it, they say.

“The louder the noise, the more we can change this so­ci­ety so that it serves its cit­i­zens well,” write De Jager, Fonn and Rispel.

“We would l i ke gov­ern­ment to pay more at ten­tion to i mprov­ing man­age­ment, com­ply with ex­ist­ing laws, en­sure that civil ser­vants with the right skills are em­ployed, and com­mu­ni­cate a mes­sage that cor­rup­tion is not ac­cept­able in our democ­racy.”

Ac­cord­ing to the same study, the US loses an es­ti­mated $60bn (equalling R800bn or 3% of its an­nual health spend­ing) to graft a year.

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