Corruption in health system: The scale of problem!
HEALTH IS a most significant global industry but, more than that, it is a global human right. The health sector is susceptible to abuse through diverse channels. Health system integrates various different actors in a complex web of relationships, which makes corruption difficult to be identified where it exists. Corruption in the health system is broadly known both in developed and developing countries but widespread corruption in Pakistan is disquieting. According to the Transparency International, corruption may be defined as “the misuse of entrusted power for private gain” or “sale by government officials of government property for private gain”.
Corruption in the health division is not exclusive to any particular kind of health system. It occurs in systems whether they are principally public or private, technically simple or sophisticated, and sound funded or badly funded. The degree of corruption, in part, is an indication of the society in which it operates. Corruption in health system is less expected in societies where there is broad obedience to the rule of law, transparency and trust, and where public sector is ruled by effective civil service codes and strong accountability mechanism.
Corruption in the health system is an anxiety in all countries, but it is particularly a serious problem in developing countries like Pakistan. The number of features of health system corruption can be identified that includes financial leakages, fraud, illegal fees, theft of supplies and equipments, over-invoicing, clever book keeping, selling public positions and bribes, failure to base decisions on evidence, etc. According to the cross-country survey by the Transparency International, the public gauging perceptions of corruption in public service shows that 95 per cent of the study population perceives that the health system is corrupt in Pakistan.
The overall impact of corruption in health system on society and on individuals can be wide-ranging. We can differentiate between direct and indirect impacts, for example, tangible (material, health quality) and intangible (social, psychological), short term (price and quality) and long term (health system) impacts. Corruption not only reduces the resources effectively available for health, lowers the quality, equity, and effectiveness of healthcare services, but also decreases the volume and increases the cost of provided services. The list demonstrates the overall impact of corruption in healthcare on the society and on individuals.
• Impact on health budget: Corruption in health system may lead to a non-optimal allocation of health budgets;
• Impact on price: Corruption in health system may lead to a provision of services or procurement of equipment and drugs at above market prices;
• Impact on access to health: Corruption in health system may threaten the goal of universal health coverage because the price of healthcare increases, the accessibility decreases;
• Impact on health quality: Corruption in health system may lead to low quality in the provision of healthcare services and a low quality in the provision of medical devices and pharmaceuticals;
• Impact on markets: Corruption in health system may lead to various market distortions such as bad doctors driving out good doctors, bed suppliers driving out good suppliers;
• Indirect impact on society: Corruption in health system may cause productivity loss through bad health; distrust in provisions of services by the government; distrust in the health system; and distrust in society as a whole;
• Cross-border impacts: Corruption in health system may lead to brain drain of medical personnel;
According to the study carried out by the International Monetary Fund (IMF) using data from 71 countries, shows that countries with high indices of corruption scientifically have higher rates of infant mortality. Reverting back to local setting, initially, preventing maltreatment and reducing corruption is a key to increase capital available for health, to make more efficient use of existing resources and, ultimately, to improve the general health status of the population. Before I finish, for promoting anti-corruption plan in Pakistan the government should ensure the law against corruption and the law should be enforced equally for everyone. An effective and efficient anti-corruption policy will result in great decline of corruption not only in health system but also all public sectors.
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