Brook Horowitz

 Brook Horowitz*

In Việt Nam, since the start of the year, the government’s efforts to curb corruption and promote integrity in the public healthcare system have continued unabated.

Việt Nam is not the only country to have suffered from corruption in its healthcare system. Indeed, worldwide, the healthcare sector is one of the sectors most vulnerable to corruption. In many countries, there were major scandals around emergency procurement when PPE equipment, testing kits and antiretroviral medicines, all in critically short supply, had to be purchased and distributed urgently.

In the UK, for example, conflicts of interest, unethical lobbying and 'gifts' all revealed themselves during the pandemic and are now under investigation. Post-pandemic, the UK’s public procurement laws are now being reformed and tightened up, as they are in Việt Nam. It has been estimated that approximately 6 per cent of the total $8 trillion spent on global health is lost to corruption each year.

Such losses are a serious matter. Corruption compromises people’s access to universal healthcare, undermines the quality of treatment, and destroys trust in the healthcare system. Often, as we saw during the pandemic, it directly impacts the quality of life – and sometimes is the cause of death.

A recent review of literature conducted for the Global Network for Anti-Corruption, Transparency and Accountability (GNACTA), a group of leading healthcare and anti-corruption experts convened by the World Health Organization and other UN agencies, listed among the root causes of poor oversight and accountability, lack of transparency in policies and procedures, and weak sanctions in enforcement. According to the research, in many countries, corrupt practices were considered culturally ‘normal’.

The biggest challenge, arguably, is the last. In countries where anti-corruption reforms have been tried, even if governments reform their procurement laws, prosecute wrongdoing and clamp down on corrupt actors, the public's perception of corruption as ‘normal’ may still endure, undermining the other efforts to reform the system.

There are examples of interventions which have successfully addressed these challenges in other healthcare systems: policies such as transparency in procurement and open pricing of medical supplies; social accountability mechanisms such as patient feedback, citizen monitoring, public grievance and redress and participatory budgeting; management practices such as careful scrutiny and screening of managers appointed to senior positions – such efforts have had a beneficial impact on reducing corruption and improving efficiency and patient care.

Another approach being trialled worldwide is multistakeholder initiatives involving the private sector as a contributor of good practices and experience.

For example, the International Finance Corporation (IFC) and the World Bank have developed Ethical Principles in Health Care (EPiHC), an initiative helping to achieve Universal Health Coverage and ensuring the access of patients everywhere to high-quality, affordable healthcare.

EPiHC is a set of 10 concise, pragmatic and universally applicable values designed to promote ethical conduct and to help guide decision-making for private healthcare providers, payors and investors, as well as their relative associations. With a network of more than 230 signatories to date, EPiHC promotes the exchange of best practices and tools, helping to build transparent, resilient health systems. This is an invaluable resource for hospital managers worldwide to try out innovative methods of managing healthcare facilities with integrity.

Elsewhere, a recent review of business ethics at a major healthcare provider showed that private hospitals face many of the same integrity challenges as their public counterparts, but, less constrained by the lack of human and financial resources and the excess of red tape, they have been able to do something about it. The private hospitals’ experience here could be invaluable if shared with the public sector’s healthcare providers.

Some efforts along these lines are being tried out in Việt Nam, albeit outside the healthcare system.

A project led by the Việt Nam Chamber of Commerce and Industry (VCCI), and supported by IBLF Global, UNDP and the UK Embassy in Việt Nam, has shown how the private sector and government can work together to reduce corruption. In 2017, VCCI created a space for a unique dialogue between medium-sized companies and the Government Inspectorate, the country’s anti-corruption watchdog. This “Government-Business Integrity Initiative” contributed valuable market inputs to the 2019 revision of the anti-corruption law. Since then, training, toolkits and other useful materials have been made available to companies to help strengthen their compliance under the new legislation.

In Việt Nam, the issue of corruption in healthcare has become, quite rightly, a top priority. The private sector has a lot to offer the public sector in terms of good governance practices, internal control, compliance systems, reporting and whistleblowing, employee training and creating a resilient ethical culture. Such innovative 'collective action' methods, combining public and private sector approaches to common problems and already being experimented within Việt Nam, could complement the traditional regulatory approach. VNS

*Brook Horowitz is CEO of IBLF Global, a UK-based NGO promoting responsible business practices in emerging and developing countries. IBLF Global has been working with local partners in Việt Nam since 2015.