Corruption in Health Sector of Pakistan: An Emerging Issue
Today, Pakistan is counted as the most under-supplied nation among developing countries. The crisis in supplies of basic needs is increasing day by day. We as a resident of Pakistan, often familiar with the word “crises” as this word is widely used now a days. From the crises of sugar to the crises of electricity, the people are disturbed and annoyed by the system handling in Pakistan.
Further, this crisis has landed up to the health care system in Pakistan too. It’s so miserable that the outer infra structure of public health sector are upgraded but the interior has relegated and is no more in use as what it was meant to be. The actual motive to develop this public health sectors was to provide the best quality care to the general people who don’t have easy access to the health care system; but instead of this quality of care, even basic care is not supplied to them then what’s the purpose to have such a big building with no delivery of care? The rationale behind this condition in our hospitals is due to drastic rise of the corruption rate.
Every now and then, we hear news regarding corruption in Pakistan health ministry. A recent news of March 2010 indicated that how the corruption is increasing in our society as evidenced by “Audit finds health dept spent Rs 6.7 billion wrongly; Purchase of medicines and supplies without approval.” (Maken, 2010). Are we tending to accept it as the norm of our health care society? Corruption in our society for the health sectors is just like benign cancer that gradually metastases to all the cells of the body and becomes evident when the last stage of cancer occurs.
The corruption made our health sectors a vacant place. If no steps would be taken against this corruption, the next would be downfall of our entire health projects which are badly affected by this corruption. Corruption is defined as use of public or government property for private gains. Nishtar (2007) defined corruption in the health sectors in Pakistan as: “Actions of stakeholders within the health system mandated with governance and regulatory roles, or those that have a stake in the delivery of services and/or providing inputs to the system, which are not legally provided for and which do or have the potential to do damage to the public or its interests.” (pp.2).
The corruption in Pakistan’s public health sector is of two types; monetary and non-monetary. The practices within our health segment which involves those measures which directly lead to monetary gain and the other one includes the unethical behaviors that are not primarily result in monetary gain in short term but later can develop a great benefit to the individual and result in collapse of health field in Pakistan. The practices of illegal fees from the patients, using the allied resources for private sectors, siphoning of public funds for private gains, stealing of supplies and equipment, selling of public hospital beds and positions in health sectors are some of the ways which result in monetary gains. Whereas, deliberately lack of attention toward the health sectors, inattentiveness toward the financial budgets, unfair hiring of people for positions or offering position to the relatives, use of public leverages for the private benefits and increment of bribes for having position are some of the unethical ways which result in mismanagement of health care system.
These practices can result in highly constrained environment of hospital where clients have to pay illegal fees, increment of absenteeism of health workers, unavailability of resources at the time of need. Pakistan is now on the path to have better health sectors and is on motive to have several health projects. Government of Pakistan has declared some goals and objectives in health planning commission meeting held in Islamabad in 2005 which defined medium term development framework which include eradication of polio, hepatitis prevention program, maternal and child mortality etc. The prevention program of hepatitis is in run since 1997, and still the government of Pakistan is in striving to have a proper prevention program against hepatitis as evidenced by health policy 2009.
What is the reason of this lacking regarding this project? What I experienced in one of my clinical rotations is that the same syringe is used for hepatitis vaccine to each child. The rationale of using the same syringe was that the resources providing to that primary health center are not in enough quantity. If this is the system handling of one of the projects, then rather preventing hepatitis, we are spreading hepatitis and further wasting resources.
Department of health, Government of NWFP (2007) stated that “evidence shows that these priorities cannot be met if institutions do not function and if there is wastage of scarce resource, which leads to poor quality of care, compromised safety and efficiency and demotivation of the staff”. A cross country survey of countries of South Asia done by World economic forum in 2006 which showed that “95% of the population perceives that the health sector is corrupted in Pakistan, the frequency of informal payments to public health care providers amongst the users of services is 96% in Pakistan and other think tanks and institutions consistently rate Pakistan quite low in public sector management, institutions and governance”. (pp. 5) The basis of this chaotic system in health ministry is due to different modes of corruption at different levels of health sector in Pakistan. At a governance level, the field of regulation in the health system lends itself to corruption in many areas; failing to make decisions on basic priorities and allocation of resources and budget management is the top most reason of this corruption in Pakistan health sector.
Further, the use of public fund as a private fund, political leakages of fund as private use, corrupt practices, providing positions to relatives, lack of effective administration and inspection at governance level, is misplaced which directly lead to corruption in health sectors. Department of health: government of NWFP (2007) stated that “within Pakistan’s state health system, transfer of funds from the treasury to the Ministry of Health (MoH) and from the MoH to their own provider units could be possible conduits”. This corruption has also landed up to the drug supply and pharmaceutical sector in Pakistan too. Getting favorable prices of drugs, overpayment for supplies of drugs in hospital, stolen of drugs and different medical supplies from central stores, selling of drugs given by government on black, dispensing drugs to ghost workers (hired person by health care professionals in the mask of fake patient), insufficient management on drugs and other medical supplies stocks, partial delivery of drugs or other medical accessories, selling low quality, expired, hazardous drugs at cheapest level are some of the issues at pharmaceutical sector level.
Nishtar (2007) explained that “It is also reported that varying quantities of drugs and medical supplies are stolen/pilfered from central stores of hospitals and individual facilities and are diverted for resale.” Due to these types of corruption practices, performance of health system can lessen further reduce access to crucial medicines and vaccines to the vulnerable population of Pakistan and hence lead to decline of health projects. The service delivery level is also under the cyclone of corruption. Issues of staff absenteeism and dual job handling by the health workers are the top most reasons of increasing corruption at delivery level.
The frequent absenteeism due to responsibility of a second job, wasting duty hours, late arriving at health center or early departure by staff are all leading to low productivity of care and ultimately lead to increasing in the practices of ill-trained providers or quacks. The informal payments and illegal fees of different medicines and supplies, refusing client to see in government setting and referring them to see in their private clinics, over consumption of resources for private use, and further violation of rights of patients that is right to have autonomy, right to privacy, right to have correct information. In some areas, the clients have to make a decision just on the basis of pressure given by the health workers which is ultimately an unethical practice and lead upon corruption of practice guidelines of health workers. In rural and semi rural areas, there is a great rise of non-qualified health care providers who credit themselves as qualified and are providing services to people, which is unsafe and further utilizing the resources and funds in an incorrect way.
Another example of the corruption is that the physician was taking his salary and further not providing care to the clients and moreover by using his position promoting unsafe practices. Currently Pakistan does not have any regulatory level in the domain of health care, however at this time Pakistan is underway to establish the National Drug Regulatory Authority which will work for the registration and quality control before dispensing medicines. This initiative by Pakistan will help to build up the health care system and further strengthen it. The government should run a mutual reinforcing anti-corruption agencies and agenda which was suggested by national accountability bureau in 1999, as it will help to promote integrity in the health care system and will have investigative and preventive strategic role as evidenced by national accountability ordinance section 33-b (Nishtar. 2007).
For promoting anti-corruption strategy in Pakistan, firstly, the government should ensure that law against corruption should be enforced equally for everyone. This will result in great decline of corruption. There should be some sort of penalty or punishment for violation of law against corruption which should include, supply of dangerous drugs in black, quackery and other issues which led to corruption.
Secondly, there is a need to review financial management and budget planning policies in the health dimension. This will help to build up transparency of leaking of certain drugs. Leaking of public funds and hence eliminate abuse such as paying to ghost workers. Thirdly, use of technology should be promoted in health sector for establishing and promoting transparency in health system records.
Use of electronic national health account, electronic public expenditures tracking record, electronic record of total equipment/drugs and supply of equipment/drugs, electronic records of staff with their profile with picture and their salary. This will help to buildup accountability to their profession and further will decrease the leakages of supplies and resources and hence decrease the use of private gains. Moreover it will ensure the staff to have one job at a time. Moreover, government should promote anti-corruption day which is celebrated worldwide on 9th December.
This purpose of this celebration is to remind political leaders, governments, legal bodies and lobby groups to work together against corruption by promoting the Day and issues that surround this event. In a nutshell, it is a high time for Pakistan to understand the importance of declination of corruption from different areas of health sector. The government needs to pay attention toward the issue of this corruption which is affecting our health performance badly. The above factors at different levels should be reduced to save the entire premises of health care provision which depends on every citizen of Pakistan including people as a part of Pakistan and government strata too. We all have to understand that this cancer of corruption is treatable and we all have to stop it before it’s visible as a cancer and makes our health care system a hollow body.
About the Author: Maryam Lakhdir is currently working as a Bone Marrow Transplant nurse at Aga Khan University Hospital. She deals with adult and peads poulation for selected group of oncology and hematology patients who require isolation, special care and critical care for bone marrow transplant. She can be reached at firstname.lastname@example.org
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