Confronting corruption in public service: a case study of Public Health Delivery Service

 

By

 

M. M. Yusif

Department of Political Science

Bayero University, Kano

 

Being a paper prepared for anticorruption sensitization conference to be held in AKTH conference Hall in Kano

 

November, 2010

 

 

Introduction

Corruption is a deadly cancer which if it is not removed would continuously deepen until it destroys the functions of a whole system thereby causing its disintegration.

Historians and other social scientists who observe and keep record of world events could recall that many years ago the Cuban communist party used the deep corruption of the society to mobilize and sustain support of the people of Cuba against Batista administration. Again, not quite long, in Kenya the dominant political alliance as KANU lost political control because of corruption which blocked any path of progress in Kenyan society.

In Nigeria, we are witnessing perhaps the only major achievement of democracy. This is that although corruption is fast "eating" and destroying every economic, political, and social light for the development of the country, but now there is a wider space, involving many people to discuss corruption and suggest how it could be eradicated. Once again, I think this is the greatest achievement of democracy in Nigeria.

Conceptualizing Corruption

In order to fight something you must know what it is, and what it involves. So, what is corruption? There is lack of common understanding of corruption which creates obstacles about containing corruption. In developing countries in particular, there is argument which shows that corruption is part of culture and it is used to promote development and also enhance administrative efficiency.

In Nigeria, the concept found expressions even in the local languages "Gaisuwa" in Hausa, "Egunje" in Igbo, all refer to gift to higher public officers to recognize the giver in distribution of public resources. What about distribution of public resources to friends, brothers, etc, even if these follow the procedures laid down to do the distribution? Is that not corruption?

From a more universal language it could be argued that corruption is the misuse of entrusted responsibilities for private benefit.

That is only a broad sense of corruption but there are different characteristics as there are different models and types of corruption. For the purpose of talking about corruption in public service, it would involve behavior on the part of any category of government workers, whether politicians or civil servants, in which they improperly and unlawfully enrich themselves or those close to them, or any behavior that discriminate the recipients of the services, for whatever reason, by the misuse of the power entrusted on those who deliver the services.

Corruption in the public service involves the activities of many individuals officers, clerks, messengers, etc who, in their positions as public workers or policy makers or as administrators control various activities or decisions.

Corruption is not merely and only giving and receiving bribes as is the common conception of the term in Nigeria. A former president of Nigeria, Olusegun Obasanjo on the occasion of the formal signing into law of the corrupt practices and other related offences Act 2000 noted that "corruption covers such acts as;

1. Use of one's office for pecuniary advantage;
   
2. Gratification;
   
3. Influence peddling;
   
4. Insincerity in advice with the aim of gaining advantage;
   
5. Less than a full days work for a full day's pay;
   
6. Tardiness and slovenliness
   

Corruption is damaging to human progress and general development of society, because important decisions are determined by personal interest, with no feeling of the consequences for the wider society. Specifically, corruption;

1. Raises the cost of government contracts as well as of foods and services;
   
2. Subsequently, in order to gain personal benefits project choices are made more in capital than on manpower, which would be more useful for overall development of people;
   
3. Similarly, in a corrupt society, resources are directed to non-productive areas e.g. security to protect the corrupt officials
   
4. Thus, corruption rather than investment, becomes the major sources of financial gain.
   

All the above undermine the economy, bring decay and degeneration as well as lowering of standard in everything, causing decline of values, rise of crimes and ultimately lose of legitimacy of government.

As earlier alluded some writers spread ideas that corruption can have beneficial effects such as non-violent access to government affairs and administration or even as shock-absorber for turmoil of development in newly developing countries.

However, counter-arguments seem more verifiable as corruption brings political instability, kills institutions of democracy in governance, leads to economic inefficiency and waste and negative effect on the allocation of resources, on production and on consumption.

Further, the cost of corruption is always included in the price of the goods produced, hence demand tends to be reduced, and so the structure of production becomes biased and consumption falls below efficiency levels. Thus, corruption lowers the general welfare of the populace, increasing health hazards among the people.

Corruption in Public Health Sector

Initially the care of the sick has been the main task of medicine but today its scope is infinitely broaden, there are four major tasks of public health institutions. These are:

1. The promotion of health
   
2. The prevention of health
   
3. The restoration of the sick and
   
4. Rehabilitation of the patient
   

Accordingly, the conception of health in the constitution of World Health Organization embraces all the above constituent parts of health in its broader scope. Thus, "health is therefore defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

In spite of inadequate health delivery network and services in Nigeria, the training of medical personnel, the provision of medical centers and the relative availability of medical resources, health was originally conceived as in the above definition.

However, as a result of deregulation of the economy in general and the health sector and services in particular, a new concept and new strategy of health and development has evolved. The characteristics of the new strategy in broad sense are:

1. Reduction of the role of government in health delivery services.
   
2. Marketised strategy of health care system.
   
3. Private sector-public health link.
   

 

Consequences for Health Sector and Health Delivery Service

1. Healthcare in most cases become marketised. This means that healthcare system is for sale. It is like saying health delivery services are for sale, just pay and got cured or treated.
   
2. Therefore, in public health sector, there came poorer medical services compared to private health sector, and so worsening health for those who cannot be able to pay as even in public health centers there are all kinds of charges to get medical attention. Then after one got the attention and the prescription, the drugs have to be purchased.
   
3. It is therefore cheaper for those who have money to get out of the country to pay and got medical care.
   
4. Unfortunately, various levels of government are not only paying but depositing millions of dollars in private hospitals in Europe and the middle-east for health care of government officials, their friends, families, etc.
   

There are three perspectives showing direction of corruption in delivery of health services with problems mentioned above.

1. One is private sector control as well as private-public sector nexus in health care delivery services. The national health insurance scheme revealed the fact that government is withdrawing from provision of health services and secondly is creating a link with private sector for the profitability of the private. One of the major angles of the modern economy is for Government or an official of Government to facilitate transfer of funds from any public agency to private. For whatever reason.
   
2. Second, there is increasing collapse of ethics in medical profession. One needs to visit only any public health center, to see how crowded it is to appreciate the pressures on the facilities and even on the medical personnel and the consultants. This would naturally create conditions not for good ethical relationship between medical personnel and the patients, between the medical personnel themselves, also between the personnel and the existing facilities and resources and generally with the society.
   
3. Mismanagement of resources. Corruption in the public services of Nigeria is first witnessed in mismanagement of available resources. The public health sector could hardly be exempted. If we do not have top level record of mismanagement of resources, we know that there is misuse of drugs, collapse of facilities, also lack of required medical instruments for efficient medical services, etc.
   

Confronting Corruption in Public Health Care System

There are many approaches, in containing corruption. In the Public Health Delivery Services in Nigeria, the following could be given a test.

1. Ethical approach
   
2. Regulation of private sector health care
   
3. Efficient management of resources
   
4. From the legal angle
   

The ethical approach begins with recognition that medicine is a profession and that like any profession there are ethics of medical profession. The essence of ethics, in a broad sense is "working properly" according to discipline of the profession. In this context, particularly in medical personnel-patient relationship.

However, misconduct is found not only because of corruption but also and above all, from inadequate facilities, availability of many patients that cannot be attended, lack of enough consultants and drugs, as well as marketisation of the available drugs, etc.

This will result in medical personnel faced with more than required number of patients to deal with. The outcome will be personal frustration and may be personal interest like sexuality, all sorts of bribes, etc got into the work.

In order to contain these ethical problems successfully, there is need of a complex relation between anticorruption agencies, medical council of Nigeria, medical associations and the patients with a legal cover to check these problems.

The second approach is regulation of private sector health care. Yes! Health care is a right. A responsibility of the state. The constitution of the federal republic of Nigeria 1999 provided in section 17 subsection 3 (c and d) that;

1. The health, safety and welfare of all persons in employment are safeguarded and not endangered or abused; and
   
2. There are adequate medical and health facilities for all persons;
   

However, deregulation of economy has also affected the health sector. The outcome is that:

1. The private health care sector is becoming larger and larger substituting the state sector.
   
2. State pays to the private sector for health care of individuals instead of equipping public health centers.
   
3. Medical consultants in public hospitals either have their private health delivery outfits or are also working in private medical centers.
   

These ultimately bring decay, degeneration and erosion of discipline leading to fraud and corruption.

The third approach is to ensure efficient management of resources. In the 'Law Books' and many administrative guidelines of conducting public affairs in Nigeria, there are rules and regulations as well as administrative procedures to do this but are deliberately set aside and nobody want enforce them. So, this should be enforced.

Fourthly, is protecting the public health sector by a special legal instrument and body exclusively for public health delivery services. A code of rules specifically targeted to employees of medical centers and other service providers designed to create practical rules which would ensure the observance of high ethical principles, ensure transparency in procurement and distribution of medical products as well as penalty for violation of the rules.

Development conscious state do not take health problem with reluctance. Because people who are the vital resource and agents of development must be healthy. There are examples of countries who have legal instrument to safeguard health institutions from corruption. In People Republic of China, any one who misappropriate or waste, for whatever reason, equivalence of fifty thousand naira the penalty is death. In Federal Republic of Germany, drawing from EU, has a special code of conduct in respect of procurement and distribution of medical products, with a view to protect health care system from corruption.