Health sector’s R24bn bill for ‘irregular’ spending
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’.”
ALL SOUTH AFRICANS NEED TO NOTICE AND MEASURE GRAFT AND BE VOCAL
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.