How corruption impedes universal health coverage

Half of the planet cannot access essential health services. For manypeople, paying to see a doctor, obtaining medications, seekingfamily-planning advice, or even getting immunised against commonillnesses is a choice between staying healthy and slipping into poverty.And, more than ever, the healthcare options that poor people do haveare being degraded by a familiar foe.In many low- and middle-income countries, corruption, inadequatespending, and wasted resources pose enduring challenges for healthcaresystems. Growing up in Pakistan, I saw people forced to go to extremesto secure healthcare. For example, families might be forced to sell offcattle and other valuables to pay exorbitant medical bills.What is shocking is that the scourge of health-related poverty continuesto claim victims today. Indeed, in some countries, people falling intopoverty due to the high cost of healthcare is an everyday reality.On a recent trip to Africa, I heard a harrowing story of a hospitalwhere women and their newborns are routinely held hostage – often formonths – until families can find the money to settle their bills.According to researchers at the University of California, San Diego,corruption, waste, and unethical billing cost patients and healthsystems billions of dollars annually. In the United States, as much as10% of public-sector spending on healthcare is lost to fraudulentbilling, and tens of millions face significant economic barriers tohealthcare.Clearly, improving health outcomes requires both increased governmentspending and an end to shady practices that siphon crucial resourcesfrom the health system. But how?Around the world, corruption and collusion are institutionalised in manyhealthcare systems. Of the $6.5tn spent annually on healthcare, anestimated $455bn is lost, misused, or stolen. Simply put, health costsare bankrupting some of the poorest people in the world, because many ofthe richest are lining their pockets.There is growing consensus that affordable, quality healthcare is abasic human right. The United Nations Sustainable Development Goalsinclude universal health coverage as a target. And it is not only richcountries that have embraced this goal: from Thailand to Costa Rica toRwanda, countries with mixed health systems and limited resources havededicated funds and political capital to making universal healthcare areality.Steps are being taken to help these countries succeed. Last year, Japanpledged $2.9bn to help developing countries achieve universal healthcoverage. And the World Bank has indicated that a country’s ability toborrow from it could eventually be tied to investments in human capital,including health spending.But such gestures, however laudable – and overdue – will not be enoughto remove the barriers to quality health services. Until corruption,theft, and wasteful and inefficient spending are addressed morevigorously, universal health coverage will remain aspirational.Fortunately, governments are increasingly committed to solving thecorruption crisis. Tax evasion and fraud – both common crimes – aredrawing closer scrutiny from law enforcement agencies. Tax evasiondoesn’t just enable money laundering; it also robs the public sector ofimportant resources. This is one reason why the UN has made reducingillicit financial flows a key component of achieving the SustainableDevelopment Goals.With broad agreement on the need to combat corruption in the healthsector, the harder challenge will be developing workable remedies.National treasuries, finance ministries, and anti-corruption agenciesneed to strengthen their efforts to co-operate on prevention, detection,and enforcement. Improving transparency in financial systems could alsohelp curb corruption, while civil-society groups, journalists, andpatients should push for greater accountability from governments andmedical providers.In the future, new technologies like data mining, artificialintelligence, and blockchain could offer new ways to detect wrongdoingin the health sector; these and other tools should be investigatedfully.Expanding healthcare access and protecting the sector’s finances aredual challenges that the international community must address together.There is an urgent need to act without delay. Rates of noncommunicablediseases like cancer, diabetes, and cardiovascular disease areincreasing almost exponentially, and lack of access to quality care willadd to many countries’ governance challenges.Development strategists understand that poor health is a harbinger ofpoverty and a barrier to eliminating it. Today, some 800mn people spendat least 10% of their household budgets on health, often going into debtto fund the treatment they need. The fact that so many people cannotafford to visit a doctor is truly shameful. The world needs universalhealth coverage; but to achieve it, the world’s health sector mustundergo treatment of its own. – Project Syndicate* Sania Nishtar is a co-chair of the World Health Organisation’sIndependent High-level Commission on Noncommunicable Diseases, a formerfederal minister of Pakistan, and the founder and president ofHeartfile. Find her on Twitter at @SaniaNishtar.