Prevention is Better than Cure

November 14, 2022

Anti-corruption in the health sector workshop for public servants in Guinea-Bissau

UNDP Guinea-Bissau/Elena Touriño Lorenzo

Corruption not only costs money, but it also costs lives. It undermines our progress towards shared goals, including the 2030 Agenda for Sustainable Development and the promise of Universal Health Coverage. The health sector is especially vulnerable to corruption due to its complexity, the large number of stakeholders, and the large quantities of resources and financial transactions at all levels of the system. Corruption diverts resources, reduces the quality of health services and products, limits access to them, increases their costs and therefore threatens people's lives. Empowering public institutions is crucial to strengthening health systems and improving citizens' access to healthcare, because it is ultimately the most vulnerable who are the most impacted. 

The World Economic Forum estimates that corruption costs the world economy 5% of GDP a year, equivalent to $3.6 trillion. According to Transparency International data, of the $7.5 trillion spent annually on healthcare worldwide, $0.5 trillion is lost to corruption. For these reasons, the United Nations Development Programme (UNDP) has been supporting countries to address corruption and reinforce integrity in the health sector for more than a decade, as part of its sector-wide and integrated approach to fighting corruption. UNDP's sectoral corruption risk management methodology was developed in 2016 through the Global Network on Anti-Corruption, Transparency and Accountability in Health Systems (GNACTA), which is led by UNDP, the World Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and funded by the Norwegian Agency for Development Cooperation (NORAD). It is based on the idea that, in practice, corruption results from individuals’ conscious decisions and intentional actions to abuse the powers entrusted to them. 

This is precisely the starting point for the methodology workshops that UNDP has already conducted in Tunisia, Morocco, Libya, Egypt, Lebanon, Palestine, Iraq, Zimbabwe, and now Guinea-Bissau, to build capacity by helping national stakeholders assess risks in their health sectors. "This is very important for ownership and sustainability. National stakeholders from multiple sectors know the country best and their participation brings different perspectives and views. We try to establish common platforms and languages between the variety of stakeholders who participate in the workshops," says Dr Mostafa Hunter, UNDP’s Senior Advisor for Corruption Risk Management, and workshop facilitator. The methodology enables key stakeholders to identify decision points where corruption is likely to occur and to assess the likelihood and impact through practical scenarios. “It is about understanding corruption better, making it concrete, tangible, and relevant, and help them to take actions to mitigate the risk. It gives the responsibility in prevention and managing the risk to the sector itself,” Dr Hunter notes.  

Dr Ndumba attending the anti-corruption in health workshop in Guinea-Bissau

UNDP Guinea-Bissau/Elena Touriño Lorenzo

In Guinea-Bissau multi-stakeholders representing various government departments, including the Ministries of Health and Justice and the Audit Office, and civil society organizations, attended the two workshops organised (one for the government, one for the civil society), which emphasized the need to prevent corruption. “When we focus on the punishment approach, that means that the damage has already been done. Therefore, this new methodology is mainly about prevention,” explains Hunter. The second important point is the sectoral approach. “Each sector has its own stakeholders and its own dynamics, and the health sector is very sensitive. It is not always about awareness raising, but also about institutional prevention, which makes systems less vulnerable to corruption. It is all done through risk management,” he says.  

Prevention is indeed one of the two pillars of the National Anti-Corruption Strategy in Guinea-Bissau, the other being mitigation and combatting corruption. The prevention component of the Strategy will focus on avoiding corruption in all sectors in the country and on developing a fund for interventions that can create positive changes by promoting transparency and prosecuting illegal acts. For Dr Agostinho Ndumba, Director General of Prevention and Health Promotion, "corruption is the axis of evil; we talk about corruption, but we don't fight it. There is no administrative control of the laws and there is an abuse of power.” Political and institutional instability in the country contributes to creating a breeding ground for the proliferation of corruption. “Ministers are always changing and are placed according to political affiliation. It takes at least six months to understand how a service works and ministers leave before they can start implementing any plan. This is detrimental to the Ministry of Public Health,” he laments. Poor working conditions for health professionals can also incentivize corruption in a fragile country like Guinea-Bissau. “Working conditions need to be created in the sector, salaries must be paid. The government must be aware of the importance of providing health workers with good conditions so that they can provide a good service to the population,” reflects Nina Bucencure, Financial Analyst at ENDA Santé Guinea-Bissau.  

Bucencure during the anti-corruption in health workshop for CSO

UNDP Guinea-Bissau/Elena Touriño Lorenzo

According to Transparency International's latest Corruption Perceptions Index, Guinea-Bissau ranked 162 out of 180 countries surveyed; up from 165 in 2020. Enabling reporting channels and activating appropriate mechanisms for witness protection, as well as improving the regime of separation of proceedings, are actions envisaged in the National Anti-Corruption Strategy that can contribute to a gradual improvement. “There are laws, but they are not enforced. So far, the government has not been engaged in reducing corruption,” Cuma Mendes, Head of Major Endemic Diseases at the Bolama Regional Directorate of Health, states. “What the government should do is strengthen the regulatory framework.”  

Support from international development partners is also crucial to mitigating and combatting corruption, which is the second pillar of the National Strategy. “The UN System, as an observer, can influence. Even if the Government doesn't want to, it is necessary to cut the cord where there is weakness,” Dr Ndumba says. This support from international development partners should go hand in hand with a commitment from public employees at all levels. “The partner can perform the audit, find an irregularity, write a report, and submit it to the Minister. But what is the consequence? They do nothing. UNDP can sustain annual financial audits, but with the engagement of the Government. In case of any irregularity, the law should be applied to hold the person accountable, from the top to the lowest level,” Mendes reflects.  

Ndumba, Mendes, Bucencure and the rest of workshop participants are clear about the next steps. "We have to start with ourselves, we have to be reference points for the reduction of corruption risks in the institutions where we work," says Dr Ndumba. “The most important thing is that the participants are able to use what we learnt on a day-to-day basis to bring gains for the last beneficiary of the system, which is the user,” concludes Aburamane Baldé, Health Specialist and Head of Monitoring and Evaluation in PLAN International.

Participants in the anti-corruption in health workshop

UNDP Guinea-Bissau/Elena Touriño Lorenzo

The face-to-face sessions have already produced proposals for systematising and establishing specific procedures for administrative control and for the creation of official documentation with decision and action points to reduce the risk of corruption. The groups will continue with online training and have already embraced a commitment to work together to move forward. On the horizon is the creation of an anti-corruption network in Guinea-Bissau that will engage in awareness-raising, capacity building and advocacy to generate a positive impact in the country.  

UNDP, through its sectoral corruption risk management methodology, will continue to accompany them on that path, helping stakeholders and risk managers themselves to identify vulnerabilities in the system and equipping them with the necessary know-how to address corruption in the health sector before it happens.