There is need for a surgical team to uproot graft from health sector

afya house scandal
Ministry of Health offices in Nairobi. [Photo/Courtesy]

Last week, Germany donated €40 million to support the health sector in the region. Ordinarily, such news would call for celebration; with the recent runaway corruption in the region and especially in the health sector, however, one fails to understand the purpose of donations which end up in a few people’s pockets.

While donors have been generous in supporting the health docket, the national governments have done little to stop the grand looting and misappropriation of funds meant for upgrading the lives of citizens.

Already in Kenya, investigations are ongoing over the alleged loss of Ksh5 billion ($50 million) in the health ministry through diversion of funds, double payments, manipulation of the country’s Integrated Financial Management Systems, and payments to phony suppliers.

The latest donation brings Germany’s contribution to fighting child mortality through immunisation programmes to €90 million since 2013. So far, about 50 million rota virus, pneumococcal and pentavalent vaccines have been financed in the EAC partner states using these donations.

This is by no means little money and its impact must be felt by ordinary people across the region. But unfortunately, child mortality and maternal deaths are on the rise, cancer continues to be a major killer, and malaria and other non-communicable diseases are still a major threat to the attainment of universal healthcare.

It is commendable that the Federal Republic of Germany, KfW Development Bank and the East African Community (EAC) have signed the agreement for the money that is meant to support regional immunization programme and establishment and operations of the Regional Laboratory Network for Communicable Diseases.

It is unfortunate that immunization against common ailments in children continues to be a major challenge. Many children are not reached, particularly those from the most marginalised and excluded communities. In 2012, out of the 14.3 million children under the age of one targeted under routine immunization in all 21 East and Southern African countries, 13 per cent, or 1.8 million, were left unprotected.

It is unfortunate that most of the affected children are from rural and remote areas, urban slums, conflict zones, and those whose families and communities have refused to have them immunized. Nearly 90 per cent of all unimmunized children live in nine countries – Angola, Ethiopia, Kenya, Madagascar, Somalia, South Sudan, Tanzania, Uganda and Zambia.

Fighting corruption is key to ensuring the region attains universal healthcare. Those accused of misappropriation of funds must be arrested and prosecuted.

It is a proven fact that corruption in the health sector affects the poor most adversely, given their limited access to resources. Poor women, for example, may not get critical healthcare services simply because they are unable to pay informal fees.

Corruption is primarily responsible for the deaths of thousands of pregnant women annually (including during childbirth). It has a significant, negative effect on health indicators such as infant and child mortality, even after adjusting for income, female education, health spending, and level of urbanization.

Graft in the health sector has ensured low immunization rates of children and discouraged the use of public health clinics. Across the region, its pervasiveness impedes the improvement of health outcomes and is a serious barrier to the achievement of the United Nations Sustainable Development Goals.

The EAC partner states must develop effective anti-corruption interventions that can help policy makers and practitioners to solve the crisis in the health sector. For example, the public can be encouraged to post medical supply prices to help prevent collusion.  Regular external and internal audits can help ensure that allocated budgets are spent appropriately; and citizen scorecards can help decision makers identify where potential problems lie.

Standalone anti-corruption interventions cannot eliminate all risks. Instead, what is needed is a multipronged approach that includes a variety of supporting interventions mainstreamed across sectors.

Prioritization is essential; based on evidence, governments and others involved in health projects and programming should prioritize areas of the health system that are most susceptible to corruption and design fool-proof methods of stopping criminals in their tracks.

Partners with experience in implementing anti-corruption strategies and tactics should be identified for technical support.

Prevention is the best strategy. Therefore, it is best not to wait for corruption to happen before beginning to deal with it. Good behaviour should be rewarded, and bad behaviour punished.

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