The Cancer of Corruption in Health

Corruption is a word that has become all too familiar in the lexicon of the ordinary South African. Billions rands of government funds have ended up in the hands of corrupt individuals many of whom by virtue of their positions should have been people with integrity and above reproach.

Transparency International reports that the Corruption Perceptions Index places the country at 71 out of the 180 countries. The 2017 Corruption Watch annual report quotes the then Economic Development Minister as estimating that corruption costs the public sector at least R27 billion annually.

During my initial experience heading the Free State health Department in the late 1990’s I uncovered corruption at a Free State Hospital located in one the most poverty-stricken areas of the province to the tune of around R60 million. Funding supposed to deliver essential health services to poor people was siphoned off the hospital budget over time purchasing goods for restaurants, hair salons and other private use. While hospital officials colluded to defraud government, local businesses knowingly accepted goods and services at reduced prices funded by the illicit use of government funds.

This would not be the last occasion when I was to experience the consequences of fraud and corruption in the public health sector. A Uruguayan businessman in 2005, with apparent political backing, offered provincial health departments water purifiers and oxygen generators of dubious quality. He wished to bypass the required procurement processes insisting that the decision that departments should purchase his products has been taken at the highest level. I was fortunately able to resist the pressure but other provinces acquiesced and acquired both water purifiers and oxygen generators. It transpired later that both officials and politicians had received incentives to ensure these transactions. As a member of a ministerial task team to investigate hospitals in 2016, I came across an unused water purifier attending forlornly surrounded by long grass on the grounds of a small rural hospital, a sad monument to fraud, corruption and squandered resources.

More recently in the era of State Capture, the public health sector has not escaped the cancer of corruption. A previous MEC for Health in Gauteng faced allegations of corruption and money laundering in 2007 related to two tenders worth R1,4 billion. In 2016, the Northwest province awarded a R180 million contract to a company to provide primary health services, which the province had the capacity to deliver. This was described by the then Health Minister as “an ATM for the Guptas to withdraw money from the department.” In both the Northwest and the Free State provinces a contract to provide Emergency Medical Services was awarded in 2017 to an outside company after alleged political inference at grossly inflated rates despite concerns about the quality of the service delivered. There are other examples but suffice to say that the cancer of fraud and corruption that has gripped this country has not spared the heath sector.

Leadership and governance are key to an efficient, functioning health care system and there is a clear relationship between weak leadership and governance, and corruption. I will not list the raft of South African legislation and regulations which regulate the conduct of public servants and financial management. In my opinion more legislation is not required, rather greater accountability as well as systems to detect and sanction corrupt behaviour. In addition, and possibly more important is the example set from the highest level in society that honesty and integrity are characteristics that every individual in this country values, which unfortunately has not been the case in the recent past.

Is this an unrealisable Quixotic dream? Even if it is I will continue to tilt at this windmill with my belief that the majority of people are good and with good and honest leadership that this cancer can be excised.