Exploring Corruption in the South African Health Sector

Exploring Corruption in the South African Health Sector

ZAR 24,082 billion irregular expenditure by provincial health departments combined in the 4-year period 2009/10 to 2012/13. 

In this recent publication in Health Policy and Planning (2015), Rispel et al conclude that corruption is a problem in the South African healthcare sector and influenced by “adverse agent selection, lack of mechanisms to detect corruption, and a failure to sanction those involved in corrupt activities”. An analysis of the financial audit outcomes for the nine provincial departments’ audit outcomes over a 9-year review period found a worsening trend in outcomes. “There has been a steady reduction in the number of unqualified audits with only the Western Cape and North West provincial health departments receiving an unqualified audit in 2012/13. The Eastern Cape never received an unqualified audit (…).” Over a 4-year period (2009/10-2012/13) ZAR 8.005 billion of combined provincial departments of health expenditure was classified as unauthorised and ZAR 24,082 billion as irregular.

Irregular: Expenditure incurred without complying with applicable laws and legislation.

Unauthorised: Expenditure that was in excess of the amount budgeted or allocated by government to the entity (overspending) or that was not spent in accordance with the purpose for which it was intended.

Political will, amongst others, is essential to “run corruption-free health services”, the authors conclude.

Abstract:

http://heapol.oxfordjournals.org/content/early/2015/06/22/heapol.czv047.abstractRecent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose interests are aligned with health system goals are critical interventions in the fight against corruption.