In the health-care sector, corruption can mean the difference between life and death (Hussmann, 2020). It has serious implications for health care access, quality, equity, efficiency and efficacy. It stands in the way of the long-term aim of universal health coverage. Every year, an estimated US$ 500 billion in public health spending is lost due to corruption around the world (ibid). This is significantly more than what would be needed to provide universal health care. During the COVID-19 pandemic, corruption has continued to be seen in different parts of the world. There is a lack of transparency and accountability on different states spending both in the global north and developing countries. Corruption in the health sectors takes different forms; theft and embezzlement of funds, lack of data sharing and interference with the procurement process (Kohler & Dimancesco, 2020). This article will focus on procurements as the main corruption in the health sector. The Kenyan MoH has been accused of corruption in terms of malpractices during the procurement process.
Transparency in health sector
If there is a lack of transparency and accountability in the procurement system, publicly financed vital drugs are extremely prone to corruption (Kohler & Dimancesco, 2020). According Savedoff and Grépin describe bribes for inspectors, improper bidding procedures for purchasing, diversion of the public drug supply to private practice, kickbacks for referrals, and pharmacies or drug shops selling illegal items as examples of corrupt activities that may occur in the pharmaceutical procurement process (Savedoff & Grépin, 2012). Bribes or kickbacks are also common kinds of corruption in public procurement, according to Ware et al. (2007). Individuals with procurement duties may participate in corrupt activity, while the government as a whole may play a role by awarding promotions to physicians’ eager to make advantageous procurement choices for corporations with ties to the state (Kohler & Wright, 2020).
How can we combat the systemic risks of corruption that endanger people’s health and well-being? For starters, we must ensure that the entire procurement process is transparent. Transparency necessitates the release of publicly available information on procurement decisions (Kohler & Wright, 2020). This can help to prevent price manipulation, and overpayments by allowing prices paid for the same health items to be compared across local, regional and global levels. Data sharing can also reveal trends of normal procurement behavior and detect any outliers that could indicate overpayment, collusion or bribes.
Accountability in Health Sector
During outbreaks and normal time, we must ensure that accountability systems exist to keep governments accountable to the people they serve. This necessitates the use of metrics to track what is being acquired, why it is being procured, where it is being procured, and how much it is costing. Civil society plays an important part in this (Ibid). A strong civil society can ensure that issues, whether they are related to corruption or not, are not overlooked. The efficiency of the limited resources deployed to respond to the epidemic will be harmed if this does not happen (Kohler & Wright, 2020). Corruption hazards will eventually result in more deaths if they are not addressed. Public procurement is a complicated and sometimes overlooked topic, but it has enormous ramifications for the population’s health.
Towards transparent and accountable procurement process
The government of Kenya has put transparency and accountability measures in the health sector. Following charges that government officials stole over $ 400 million in crucial medical supplies, in August 2020, President Uhuru Kenyatta ordered Kenya’s Ministry of Health (MOH) to reveal details of all procurement transactions made during the COVID-19 outbreak (France 24, 2020). Despite allocating significant resources to the COVID-19 response in Kenya, the government failed to provide adequate protective equipment, testing, or other safety precautions to ensure that health personnel could respond to the pandemic safely and efficiently (Human Rights Watch, 2021). Since the first instance of COVID-19 was discovered in Kenya, over 577 health personnel have died as a result of the virus (France 24, 2020) . This shows the need to place more emphasis on eliminating corruption in the health sector in Kenya.
Even in times when there are no health outbreaks, eliminating the risk of corruption in public procurement is difficult. In 2017, the United States (US) halted $21 million aid to Kenya’s health ministry due to allegations of corruption (Houreld, 2017). The US Embassy in Nairobi, mentioned that this action was due to the continued concerns about claims of corruption and inadequate accounting system within the Ministry. Further, the US Embassy claimed to be working with the state to improve accounting and internal controls within the Ministry of Health (ibid).
Applicability of transparency and accountability in Kenyan Health Ministry
In 2020, during the Ministry of Health COVID-19 scandal a directive by the Kenyan President, ordered the health ministry to build a ‘transparent system’ that would allow all ministry’s procurement processes to be made public. He ordered the building and implementation of the system within 30 days. He claimed that ‘this level of transparency, along with the use of technology, will go a long way toward ensuring that our people have faith in those placed in institutions to handle the Kenyan taxpayer’s and development partners’ resources in an open and transparent manner’ (France 24, 2020). However, there are few published reports or data on whether this directive was implemented or not. Though the key players (Chairman and CEO of a health parastatal) during the COVID-19 MoH corruption cases were asked to step down from their position. They both got clearance from the ruling party to vie for respective seats in the upcoming election. It is such action that leaves one wondering if these people were acting on behalf of the state and were rewarded with party nomination in exchange. This questions Uhuru’s directives on fighting corruption in the MoH. Further, it shows lack of transparency.
Data sharing is key to ensuring transparency. The MoH should ensure it shares its data both at local level and regional level. At the local level, the MOH should ensure that the different counties’ health sectors share data on the procurement process from bidding to open tendering and contract awarding. This can reveal trends of routine procurement behavior and detect any outliers that could indicate overpayment, collusion or brides. This will help both the national and county government in ensuring there is transparency and data sharing. In case of price manipulation, this can easily be detected.
On accountability, the civil society plays an important role in providing checks and balances to government spending. The Kenyan civil society has been at the key front in questioning the government in policies and practices. In 2017, it was due to the civil society participation in demonstration over corruption in MOH that the US suspended direct aid to the ministry as shown in figure 1. This resulted in the US embassy putting pressure on the government to establish internal controls and accountability in the ministry.
Image Source: Civil Society demonstration against the corruption in the MoH- Kenya: Houreld, 2017
In this article, we have examined the threats that corruption poses to the population. First, the article has examined the different ways in which corruption takes places in the health sector with a more emphasis on the malpractices in the procurement process. Secondly, the article has explored the different transparency accountability mechanisms in the health sector. Thirdly, Kenya has been used as a case to find out how transparency and accountability has been implemented and if they are applicable.
Though, the Kenyan government has put much effort ‘on paper’ on eliminating corruption in the procurement process by establishing transparency and accountable mechanisms. The implementation of such efforts have not been documented. In addition, the ruling party goes ahead and issues direct party nominations to the people involved in the malpractices. This leaves one to wonder if the government is true to itself on the fight against corruption in the health sector and on building transparency and accountable procurement systems.
Muthoni Kahuho (Kenya) is a member of the 2022 cohort of the Future Africa Fellowship