Canadian Journal of Applied Sciences


ISSN: 1925-7430
Short Key Title: Can J App Sci
DOI: http://dx.doi.org/10.21065/19257430
Start Year: 2011

EMERGING CHALLENGE OF CORRUPTION IN HEALTH CARE SYSTEM
Taha Nazir
Ex-President, Pharmacist Federation, Pakistan.
Keywords: Corruption, public health, pharmaceutical care.
Abstract

The corruption is the violence of granted authorities that destroys the basic rights. It has serious consequences on society, system and lives. It also has posed potential threats to the public health care system, complicated the situation and makes extremely difficult to control in rational manner. So, we need the anti-corruption experts to identify key priority areas. They should undertake the corrective measures immediately to defeat the global health corruption. We collected the data from different professional, scientific and academic institution The research article and databases were searched from inception to get more relevant and current knowledge of this topic. The duplications deleted and titles or full texts were screened to obtain the exact professional and scientific information. Finally inferred that the corruption is an emerging global problem and potential threatening the health care system. The hug employment, large financial budget and interactions of multiple business entities provide sufficient opportunities of corruption. So the corruption is metaphorically hurting the quality of life. Therefore, we should perceive its empirical existence to verify theoretical and intuitive significance for public health. Moreover, the recently developed new paradigms may help to determine the severity of corrupt acts to reveal the likelihood of engagement and develop more effective strategy to mitigate all forms of corruption in health care system.

Article Information

Identifiers and Pagination:
Year:2018
Volume:8
First Page:1
Last Page:8
Publisher Id:Can J App Sci (2018 ). 8. 1-8
Article History:
Received:August 23, 2018
Accepted:October 15, 2018
Collection year:2018
First Published:November 5, 2018

INTRODUCTION 

Corruption is the abuse of entrusted power that destroys the basic rights of people. It has devastating consequences on the public institutions and may potentially undermine the prospect for a better life for coming generations. [1] It is also infiltrating into global health like an infectious disease. That has posed potential threats to the public health care system. It is particularly hurting the ethical standards, security and economical growth in developed parts of the world. The corruption has complicated the situation and makes it extremely difficult to control and tackle in rational manner. [2] Moreover, the huge economical size that has been predicted in the billions of dollars makes it harder to handle on legal ground. So, we need the anti-corruption experts to identify key priority areas. They should undertake the corrective measures immediately to defeat the global health corruption. [11, 13]

Thus, we aimed this project to reveal several fundamental challenges. That may potentially allow us to explore best ways and design more successful strategies to eliminate the unique threats posed by health related corruption. That may also help to get more information to design effective scheme to support the global health anti-corruption efforts. We may also then achieve the Millennium Development Goals (MDG’s) given by World Health Organization. [12]

COLLECTION AND INTERPRETATION OF INFORMATION 

The scientific information collected form Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, Cumulative Index to Nursing, Allied Health Literature and Latin American & Caribbean Literature on Health Sciences databases. The research article and databases were searched from inception to get more relevant and current knowledge of this topic. The duplications deleted and titles or full texts were screened to obtain the exact professional and scientific information. The lists reference citations were reviewed for any additional studies. We also contact the authors to collect any possible or missing information and/ or for further clarification.

TYPOLOGY OF CORRUPTION

Corruption is generally described as “the abuse of entrusted power to obtain personal and/ or private benefits”. It is classified into three categories grand, petty and political, on basis of the amounts of money lost and the sector where it occurs. Grand corruption consists of acts committed at a high level of government that distort policies or the central functioning of the state, enabling leaders to obtain benefit at the expense of the public good. Petty corruption refers to everyday abuse of entrusted power by low- and mid-level public officials in their interactions with ordinary citizens, who often are trying to access basic goods or services in places like hospitals, schools, police departments and other agencies. Political corruption is a manipulation of policies, institutions and rules of procedure in the allocation of resources and financing by political decision makers, who abuse their position to sustain their power, status and wealth. [15]

Moreover, the corruption is a complex phenomenon and may have several shapes and forms. Analytically, practically and policy-wise corrupt activities in health care has six typologies on the basis of similarities and common attributes i.e. bribery in medical service delivery; procurement corruption; improper marketing relations; misuse of (high) level positions; undue reimbursement claims; fraud and embezzlement of medicines and medical devices. [4]. The bribery is major and potential challenge of developing parts of the world. That comprised of offering, promising, giving, accepting or soliciting of an advantage as an inducement for an action which is illegal, unethical or a breach of trust. Inducements can take the form of gifts, loans, fees, rewards or other advantages (taxes, services, donations, favors etc.).[19] That is an explicite financial or other advantage offered, given, solicited or accepted in exchange for privileges or behavior [17] Moreover, the procurement corruption is a complete process of acquiring goods, services and works from suppliers. Whereas, the improper marketing relation is another activity for corruption. That cover all interactions between the industry, healthcare providers and/or regulators are also not directly linked to the procurement process. [4] Misuse of high level positions and networks has also been noticed in health care system. These undue high-level interactions include the trading in influence, revolving door corruption, regulatory state capture, conflict of interest, favoritism and nepotism. [17] The undue reimbursement claims covers creative billing and reimbursement of unnecessary and non-delivered services. Whereas, fraud and embezzlement of medicines, medical devices and services is the offence of intentionally deceiving someone in order to gain an unfair or illegal advantage. Embezzlement prevails when a person holding office of dishonestly and illegally appropriates, uses or traffics the funds and goods they have been entrusted with for personal enrichment or other activities.   The United Nations Convention Against Corruption (UNCAC) defines bribery as the promise, offering or giving, directly or indirectly, of an undue advantage to any person, for the person himself or herself or for another person or entity, in order that he or she, in breach of his or her duties, act or refrain from acting, the solicitation or acceptance, directly or indirectly, of an undue advantage by any person, for the person himself or herself or for another person, in order that he or she, in breach of her duties, act or refrain from acting. Thus, the bribery is corruption by definition. Bribes are also called kickbacks, baksheesh, payola, hush money, sweetener, protection money, boodle, gratuity etc. In short, a bribe is a financial or other advantage. This includes money, discount, loan, donation, gifts, entertainment, information, preferential treatment and offers of employment. [10]

PREVALENCE OF CORRUPTION 

The nature and prevalence of corruption typologies is mostly different every time in many ways. European Commission [4] reported corruption in the health sector all over the European Union.  Republic, Latvia, Croatia, Slovakia, Romania, Italy, Bulgaria and Greece are considered having a widespread corruption problem and seem to encounter more bribery in medical service delivery, procurement corruption and misuse of high level positions. More specifically, bribery in medical service delivery occurs most frequently, and is considered systemic, in transition economies of Central and Eastern Europe. Whereas, in Western European countries, bribery in medical service delivery is more rare and restricted to specific areas such as isolated cases in pre- and post-surgery treatment. Procurement corruption and improper marketing relations by providing money or sponsoring of conferences, trips and leisure activities occur throughout the European Union. Healthcare procurement corruption seems to occur less frequently in countries where public procurement is highly regulated. 

SPD Antrag (18) reported the cost of fraud in healthcare system. He estimated the magnitude of corruption and social fraud range between 3% and 8% of national health expenditures. Moreover, a debate on corruption in health care system was opened in German Bundestag. That is the German Federal Parliament equivalent to the lower house of parliament the United States House of Representatives, the Irish Dáil Éireann or the House of Commons of the United Kingdom. The members of Bundestag passed resolution on “combating corruption in health care” and a figure of up to 10% of public health expenditure was quoted. In 2014, losing 3%, 8% or 10% to corruption would mean giving Austria its health expenditures of €36.3 billion or 11.0% of gross domestic product [9] or a loss of €1.1 billion, €2.9 billion or €3.6 billion. 

Moreover, the British Centre of Counter-Fraud Studies examined relevant data from six countries using different methodological calculations. They reported losses as a result of corruption since 2008 have increased by 25% worldwide and even by 37% for the National Health Service in the Great Britian [7]. The European Healthcare Fraud and Corruption Network [3] reported an estimated loss of €56 billion annually in Europe. 

Health Policy Brief [8] reported the information of United State Centers for Medicare and Medicaid Services. They described an approximate amount of US $75 billion paid as unnecessary or incorrect during 2010. Whereas, Berwick & Hackbarth [2] reported another estimate of the loss to the US Centers for Medicare and Medicaid Services owing to fraud and abuse of approximately US $98 billion in 2011.

Additionally, we have a unique model of pharmacy institution that symbolically highlights the potential reasons of poor health care in developing parts of the world - the Department of Pharmacy, Faculty of Sciences, University of Sargodha (UOS), was founded and notified in 2003. Whereas, the UOS was founded in 2002 that was De’Montmorency College before, established in 1929. The administration of pharmacy, UOS is probably corrupting and polluting the health care system constantly. That is evident by the non-compliance of the examination quality with the internationally recognized and defined standards.  The author of this research insight has reported the appointment of an internal examiner notified under official letter No. 10914 dated December 24, 2013 for the subject of pharmacology and therapeutics. This competent examiner has filed his official written disagreement with the compiled result for the class of 3rd professional annual system. The dispute was submitted in the office of the Deputy Controller of Exam (C), on January 24, 2014. That was totally ignored and disrespected by then administration of Pharmacy, UOS.  Moreover, a female post-graduate scholar appear in her annual practical exam under roll number 14MPhil(P.Colo)14508 session 2014-2016. She was targeted and harassed by the examiners. Because, her husband has exposed the corruption of the administration of pharmacy, UOS. He has submitted the written requests to different authorities for appropriate investigation and establishment of the rule of law. So, this is another face of Islamic Republic of Pakistan, where even the academician and high profiled examiners disrespect women scholar to please the corrupt headship of Pharmacy, UOS. They were desired to achieve their evil objective by this unethical and illegal strategy. They were so malicious and biased that they have violated the teaching of Islam, Holy Quran and Holy Prophet Muhammad (peace be upon him). In addition of that the head of pharmacy, UOS has surprising supervised the whole class of M.Phill pharmaceutics of session 2011-13. He has excellently misused his authority, designation and power of his office to obtain the money of approximately Rs. 525,000/- (equivalent to CAN $5500). Because, the government pay approximately Rs. 35000/- (equivalent to CAN $360) to the professor for supervising the scholar. The supervision of whole class at a time by the local Faculty Board (or board of study) and afterward unbelievably approved, endorsed and notified by Advanced Study Board of UOS under notification number UOS/ACAD/464 dated April 19, 2013. There is another incidence confirming the corruption of head of pharmacy, UOS, changing the supervisor for M.Phil scholars twice times without appropriate consent of Faculty Board and Advance Study Board of UOS. Four final version of thesis supervised by head of pharmacy were given to a junior lecturer to become dummy, false or replica supervisor. So, he could cheat the institution, system and authorities of not breaching the policy of supervision of permissible number of scholars at a time. Hence, he fraudulently worked to obtaining monetary benefit or incentive of about Rs. 140’000/- (equivalent to CAN$ 1450). We have successfully confirmed this unbelievable incidence, authenticated the information and validated the allegation by face to face, one to one and direct meeting with both parties. Additional, the administration of pharmacy, UOS has surprisingly misused the official power and did not grant the academic, scientific and/ or professional work load to a staff member, because he reported the corruption to different authorities. This faculty member even filed request in the office of the vice chancellor on November 25, 2015 and afterward submitted two consecutive reminders dated December 01, 2015 and January 19, 2016. But, didn’t receive any written or verbal reply. That indicates the existence of a mafia, unbelievable working in collaboration to protect and support each other like a gang. 

Moreover, the National Curriculum Revision Committee (NCRC) of Higher Education Commission (HEC), Government of Pakistan has unanimously decided in meeting dated June 6-8, 2011 held at HEC, Regional Centre, Karachi to establish five academic/ teaching and/ or administrative departments in all pharmacy teaching institution. The violation in adoption and implementation was stated to be liable to penalty under section 17 & 19 of Pharmacy Act, 1967 and rules framed there-under, which may lead to revoking of accreditation. But, unluckily the headship of pharmacy, UOS has explicitly violated by not implicated the academic and/ or administrative structure. Additionally, an honorable staff member submitted an application in the office of the Vice Chancellor, UOS on March 15, 2016 to obtain the information regarding the appointment of a professor of pharmacy. He request the information under Freedom of Information Act (FOIA), International Covenant for Civil and Political rights (ICCR) and Right to Access Information specified in the 2010 constitutional amendment, declared under Article 19-A. That was unethically disrespected and ignored by competent authority of UOS.   

Furthermore, a model community pharmacy outlet associated with University Medical Complex and Research Centre. That is technical and professional supervised by head pharmacy, UOS. This pharmacy is claimed of providing quality medicines, services and training to the graduating students of pharmacy. But, it is functioning without clinical/ community/ hospital and/ or appropriately skilled pharmacist, round the clock. Thus, the model pharmacy is unbelievably working without pharmaceutical care, patient counseling, prescription reviewing and other basic components of pharmacy practice. Moreover, the graduating trainee pharmacists are not allowed to touch the medicine, talk to patient, receive and/ or dispense the prescriptions. So, the headship of pharmacy, UOS is potentially hurting the scientific comprehension and professional meaning of pharmacy practice. That is probably confirming the violation and incompetency of the management of Pharmacy, UOS.

Moreover, author of this research insight confirm the illegal change of the final result and award list of examination by the administration of pharmacy, UOS. An experienced, highly skilled and competent faculty member filed the result of Microbiology and Immunology of 4th semester Pharm-D in 2014. He was then compelled to change his professional and scientific judgment and modify the result sheet. Two senior faculty members were deputed to harass him. Even head pharmacy threatened him directly on January 29, 2015 and afterward issued “Show Cause Notice” No. 118. Subsequently, the answer sheets, award list and final result was illegally changed by a junior staff member and post-graduating scholar. So, we can easily understand the potential reasons of poor pharmaceutical care in developing parts of the world. 

In addition of that, the Pharmacy Council of Pakistan (PCP) is a statutory federal institution and professional body for accreditation and regulation of pharmacy education. This was established under Pharmacy Act, 1967[3] by exercising the powers conferred by the Pharmacy Act, 1967(XI of 1967), under re-notification No. SRO 1098 (I)/2009 dated December 12, 2009, Ministry of Health, Government of Pakistan.  So, the headship of pharmacy, UOS suggests the initial decision regarding the approval of affiliation with UOS. This is an effective tool to collect the illegal monetary benefits in more sophisticated and scientific manner. So, the bribery was received under the names of class work, examination, research supervision, guidance to design the research studies by headship of pharmacy, UOS. That is unethical, illegal and potential conflict of interest. That is also violation of guidelines described by transparency international. 

There is also an industrial unit started in 2007 and associated with pharmacy UOS. This project was revamped in 2014 and applied for license in 2015. The manufacturing license was granted in 2017 and pharmaceutical dosage forms were registered successfully. The total budget of this project is Rs. 90 million (approximately equivalent to CAN $947’370). The head pharmacy is also appointed as managing director for this industrial unit. But, unluckily, the project is failed because of incompetency and corruption of head pharmacy, UOS. So, the surrender of license may be requested to the Syndicate of UOS in coming days. The institution will also be failed to obtain targeted benefit along unemployment of approximately twenty five staff members and workers. 

Furthermore, these irregularities were reported to the office of then Vice Chancellor on September 9, 2013. A staff member has brought the kind attention of competent authority to probe and investigate the situation and examine the competency and performance of Faculty Board. But, that was disrespected and ignored without any official reply or action. Hence, we can understand the situation of corruption in Pakistan, where the Supreme Court declared the Prime Minister ineligible to hold office on April 26, 2012. A seven member bench announced the verdict and convicted for violating Contempt of Court Ordinance 2003 section 5 and the charges framed against him were for willfully disobeying the court’s orders and ridiculing it. The court cited article 63 (1) (g) of the Constitution and observed that the premier might face consequences under it. Moreover, another prime minister was convicted and sentenced to prison in absentia by a Pakistani anticorruption court on July 6, 2018, in a verdict of Avenfield London UK properties corruption reference filed by the National Accountability Bureau (NAB). They are handing ousted prime minister 10 years in prison and a fine of 8 million pounds, or $10.6 million for owning assets beyond known income and 1 year for not cooperating with NAB. The sentences will run concurrently and will serve 10 years in jail. His daughter was given 7 years for abetment after she was found "instrumental in concealment of the properties of her father" and 1 year for non-cooperation with the bureau. The case stemmed from the so-called Panama Papers leak that disclosed expensive and undeclared property owned by the Sharif family in London. Thus, it is recommended to appoint the heads of institutes and states after appropriate recruitment procedures. There should be rigor scrutiny and strict watched and monitoring system to keep then at right track. The corrupt and dishonest officials should be identified, replaced and/ or detained to recover the damages. 

THE CONSEQUENCES OF CORRUPTION

The corruption impacts the health care system in a multitude ways and costs lives in the worst cases. It also hurt the people by damaging their health, freedom and resources. The major consequences of corruption can be divided into four main categories - political, economic, social and environmental. [14]

In politically perspective, corruption is a major obstacle to the democratic system and the rule of law. In democracy, the offices and institutions may lose their legitimacy when public representatives misused them to obtain personal benefits. This is potentially dangerous in advanced democracies and/ or newly emerging establishments. It may extremely be challenging to make accountable political the leadership in a corrupt climate.

Economical corruption diminishes the resources and depletes wealth of national. The leadership invests inadequate resources in the projects that do not provide opportunities of corruption rather than benefit the nation and country. They may prefer the big projects i.e. power plants, dams, pipelines, refineries etc over less spectacular but more vital infrastructure projects i.e. hospitals, schools, roads etc. Corruption also hurdle the development of competition and fair market structures that in turn discourage the investment.

Social corruption also ruins the societal structure and undermines the trust of public for the institutions, political system and leadership. Thus, the apathetic and distrustful people may become another obstacle to deal the challenges and achieve the defined national objectives.

The environmental corruption is potentially degrading the natural balance and eco-system that is another serious consequence of corruption. The inadequate enforcement of the environmental regulations and legislation may spoil the precious natural resources and ravage entire ecological systems. The business organizations across the world continue to pay bribes in return for unrestricted destruction and offsets carbon. That influences the life quality, environment, ecology, weather, and public health. 

PREVENTION AND CORRECTION 

In recent years, the battle against corruption in the healthcare sector has exaggerated due to the increasing unanimity that corruption in its many forms worryingly alters national healthcare purposes, demoralizes the aims of health policy actions and modifications, and leads to a remarkable waste of resources. [16]

Corruption in healthcare can be aggravated by weaknesses in the healthcare system, fewer salaries, comparatively stumpy levels of healthcare expenditure or research funds, close ties between the industry and healthcare providers or faults and ambiguities in healthcare management, anti-corruption regulation or judicial efficacy. Reliability defilements and exploitation of rights and prospects hinge on individual incentives, norms and values. Thus, an overall approval, or at least tolerance of corruption is measured as main forces behind prevalent corruption in healthcare. This relates to all of the defined corruption typologies. 

A combined effort can be helpful to eliminate corruption, inequality and exemption in health care system. That will support to protect the elementary rights and certify the vanity and make public health better for everyone in world. The Transparency International has announced Declaration Against Corruption in consistent with and reassuring the Universal Declaration of Human Rights and the United Nations Convention against Corruption. 

Exertions have been made in current years by the international community to discriminate ‘active’ (or supply side) and ‘passive’ (demand side) inducement and bribery. Active bribery states the crime committed by the person who assurances or gives the bribe. Passive bribery is the felony done by the authorized who accepts the bribe.

HOW TO DEAL AND FIGHT 

The corruption can be managed more successfully by combined struggle of civil society, government and business. They should make collective effort to improve the adoptable criterions and procedures. A code of conduct or the statement of principles and values can also be established to set of prospects and values. That should intricate the purposes, jurisdiction and procedure for staff, volunteers, institutions, government bodies and associated groups. Transparency International recommended three guiding principles to handle the corruption - build corporations, proceed stepwise and stand non-confrontational. [5] Additionally, the association, coordination and amenability are majorly significant to resist corruption. That states  the measures, systems or sectors within public organizations or companies to confirm the legitimate, operational and monetary activities in conventionality with prevailing laws, guidelines, customs, procedures, morals and public anticipations.[6]

CONCLUSION

Corruption is an emerging global problem and potential threatening the health care system. The hug employment, large financial budget and interactions of multiple business entities provide sufficient opportunities of corruption. So the corruption is metaphorically hurting the quality of life. Therefore, we should perceive its empirical existence to verify theoretical and intuitive significance for public health. Moreover, the recently developed new paradigms may help to determine the severity of corrupt acts to reveal the likelihood of engagement and develop more effective strategy to mitigate all forms of corruption in health care system. 

Acknowledgment 

Author acknowledges the kind support of health professionals all over the world. 

REFERENCES 

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3. EHFCN. EHFCN powerhouse: European Health Care Fraud and Corruption Network. 2016. https://ehfcn-powerhouse.org/welcome. Accessed 25 Jul 2016.

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19. Transparency International. Corruption glossary. Alt-Moabit 96 10559 Berlin Germany. 2016. Tel.: +49 30 3438 200, F.: +49 30 3470 3912, E.: ti@transparency.org, http://www.transparency.org/glossary. Accessed 1 Aug 2017.



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Jiangsu University, Zhenjiang, China

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Dr. Xianghui Qi is working as Professor in the School of Food & Biological Engineering, Jiangsu University, China. His research interests: Biosynthesis of high value-added chemicals by microbes and engineered strains; Discovery of novel genes, enzymes and new strains; Rational & Irrational design of microbial enzymes; Isolation, identification and evolution of microbes; Metabolic engineering & Pathway engineering of functional microbes, and biotransformation; Metabolic regulation based on the research of microbial omics; Application of high value-added products including functional sugar alcohols by biosynthesis and biotransformation based on microbial engineered strains.

Journal Highlights
Abbreviation: Can J Appl Sci
doi: http://dx.doi.org/10.21065/19257430
Frequency: Annual
Current Volume: 7 (2017)
Next scheduled volume: December, 2018  
Back volumes: 1-7
Starting year: 2011
Nature: Online
Submission: Online
Language: English

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