Decrying a Scourge of Health Care Development

by JHI Staff on February 27, 2014

There is no shortage of challenges when it comes to bringing affordable access to high-quality, safe health care for populations in countries that don’t yet have it. You need a sound and actionable vision, willing investors, government support, a pool of skilled clinicians, nurses and administrators, and an adequate educational infrastructure, among other resources. If any of these components is missing—as is the case in many countries around the world—it can be difficult or even impossible to get an ambitious health care delivery project off the ground.

Despite our progress in expanding health systems collaborations to new regions, one issue in particular has presented one of the biggest challenges: corruption. There is nothing that more surely undercuts efforts to invest in significant improvements in a society than pervasive parties who create friction and barriers in order to line their own pockets.

As an example of how pervasive corruption can be, let me look at one country generally regarded as pretty low in the corruption scale: The United States. I just looked at this website from U.S. Department of Health & Human Service’s Inspector General’s Office, and found a long list of convictions of and settlements with a range of alleged fraudsters, grafters and kickback-takers. The alleged offenses involved medical clinics, dentistry, medical equipment, hospital administration, pharmacies, diagnostic testing, and speech and occupational therapy, among others—and that’s just the previous eight days-worth of offenses. There have even been accusations of kickbacks within a U.S. organization that has played a strong role in setting patient-safety-related practice standards at hospitals across the nation.

From that dubious start, it mostly goes downhill when you look outside of the United States. According to Transparency International, which monitors global attitudes toward corruption, several nations even regard their health care sectors as being among the most corrupt institutions in their countries. Europe does not remain unscathed; far from it. A recent report issued by a European Union commission prominently mentioned health care as a sector in which bribery—specifically, clinicians improperly taking money in exchange for providing patients better care—has become a problem in the E.U., contributing to a total corruption cost of about $160 billion a year. Said one commissioner in introducing the report: “Corruption undermines citizens’ confidence in democratic institutions and the rule of law, it hurts the European economy and deprives states of much-needed tax revenue.” And most E.U. countries aren’t seen as very high up on the corruption scale, either—it gets far worse elsewhere.

Corruption can become part of a nation’s culture, until it serves as a routine way of getting by. Institutions and the population can learn to live with it, in spite of its pathological nature and how it degrades a country’s infrastructure and the fabric of daily life. It can seem like a normal state of affairs, to be expected whatever one does. But it’s insidious, restricting resources, limiting progress, and ultimately scaring off those who would otherwise invest and help improve conditions.

Turning around a culture of corruption can be extremely difficult. At Johns Hopkins Medicine International, we’re used to tough challenges, and we’re willing to work creatively to get through or around obstacles. But we’re fairly helpless in the face of corruption. We spend lots of time in our due diligence process looking for signs of corruption. We also have mandatory training on the U.S. Foreign Corrupt Practices Act and the U.K. Bribery Act for all of our employees. We recently reiterated our firm stand against corruption in all forms in our recently published Principles of Business Integrity, distributed throughout our organization.

We believe in respecting local ways of doing things, but we draw the line at corruption. It’s unethical, it’s illegal, and it’s counterproductive. In the end, our only option is to walk away from it and not get involved in projects that threaten to be tainted by it.

Please don’t take that to mean we’re giving up on countries where corruption is a problem. We don’t like walking away. We want to offer our services to every region that’s interested in improving health and health care delivery. We continue to watch carefully for signs of improvement, and to look for partners who work ethically. Even in places where corruption is widespread, there are plenty of good people and institutions who despair of it and resist it. More and more people around the world are looking for better access to better health care, and if corruption is preventing that access they will find ways to defeat it. We’ll support that effort any way we can.

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Valerie October 21, 2014 at 9:06 am

Great article! Many countries around the world have inadequate healthcare, but there is a lot of red tape involved in setting up healthcare facilities in developing countries. Thanks so much for sharing!

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