Exploring corruption in the South African health sector

Abstract

Recent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose interests are aligned with health system goals are critical interventions in the fight against corruption.

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…[115][116][117] For example, research in South Africa illustrates the siphoning off of scarce resources can gravely affect health, with sorely needed health equipment failing to reach remote areas, and thus increasing the chance of adverse events for which frontline health workers will be held responsible. 116 In Chad, a study shows less than 1% of the nonwage funds allocated by the Ministry of Health to the regions reached local health facilities due to high level of leakage at regional level. 118 A review of gaps in health systems research identifies corruption as an area where there has been remarkably little research relative to its impact on subSaharan health systems.…”

Building political will for HIV response: an operational model and strategy options

“…Coovadia et al () enumerate the dysfunctions in the health system that constrain service delivery and trace their historical roots in racial and gender discrimination, highlighting, among other factors, weak stewardship, poor human resources management and inequitable access. The growth in corruption has also had a negative impact on implementing HIV policy and on services more broadly, an issue that Rispel et al () discuss.…”

People-centeredness in health system reform. Public perceptions of private and public hospitals in South Africa

“…Public sector health workers in South Arica are frequently described as 'cruel' or 'uncaring' with little regard for patient confidentiality [25][26][27] . This has fuelled perceptions that the public health system is strained, under-resourced and has 'worsened' over time 28 . The optimal performance of the health system is thus dependent on addressing acceptability of care, alongside integrating the highly fragmented public-private split and overcoming human resource challenges 9,23,29 .…”