Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

Abstract

BackgroundGlobally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown.MethodsA qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts.ResultsAnalysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty.ConclusionsThis study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher wages and benefits for workers could be important and initial steps in improving access orthopaedic care and OMDs, and managing the global injury burden.

Greasing or sanding the wheels? Effect of corruption on economic growth in sub-Saharan Africa

“…This happens when the quality of the resources are degraded as little attention is paid to their maintenance and quality. For example, Bouchard et al (2012) in their study on the effects of corruption on orthopaedic healthcare in Uganda found that, corrupt practices tend to reduce the quality of care and products, increase the prices of equipment and also reduce access to healthcare. They again maintained that about two-thirds of drugs meant for free public distribution were stolen and unaccounted for by public officials which affects access to and the quality of healthcare provided to the general public.…”

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

“…The World Health Assembly, as well as independent organizations such as the Bellagio Essential Surgery Group, recommends that research on the socioeconomic impact of surgically correctable injuries at the district and country level is critical to developing informed policy and appropriate financing strategies in sub-Saharan Africa [3,9]. However, the burden of disability from injuries is poorly available in the region [10].…”

Orthopaedic research activity in South Africa measured by publication rates in the 15 highest impact journals related to population size and gross domestic product

“…23 Bouchard et al demonstrated that one of the largest barriers to access orthopaedic and trauma care is corruption. 7 The ranking of the included African countries on the 2015 corruption ranking index and corruption perception index, clearly demonstrates a high level of corruption in all countries. This is even more significant as the WHO has identified that the development of healthcare infrastructure is partly dependent on locally produced research, demonstrating the complex relationship between healthcare delivery, infrastructure and research.…”

“…6 Similarly, Bouchard et al demonstrated that poor leadership, high cost, poor healthcare structure, inadequate human resources and especially corruption are barriers to orthopaedic care and research. 7 Shipley suggested that the lack of resources in public hospitals, administrative support, funding and motivation in South Africa are possible barriers despite an abundance of subjects addressing local and continental topics. 8 Bibliometric analysis is commonly used as a proxy for research output and several authors have previously performed bibliometric analysis of orthopaedic publications.…”