As nations and health systems begin to reopen in the aftermath of COVID-19, we should not forget opportunistic corruption exists because the system allows it. But for the poor, they may not even know they are trapped. Being a victim of corruption does not mean you are aware you are a victim, and this is where the defenseless are most vulnerable. Written by Michael Seo and Khadija Rheto.
In April, official creditors including the IMF and the World Bank discussed mobilizing up to $57 billion for Africa in 2020 to provide front-line health services to the vulnerable and prevent economies from collapsing. But estimates for Africa anticipate that twice the amount, $114 billion, will be needed to combat COVID-19. The funds and assistance should bring both hope and hesitation.
According to the UNECA (United Nations Economic Commission for Africa), African countries are losing at least $50 billion annually to illicit financial flows. Before the pandemic, as economies suffered, international media coverage gravitated towards flagrant displays of exported wealth such as the automobile collection of 25 luxury cars including Aston Martins, Bugattis and Ferraris that was auctioned for $27 million (2019).
But brazen displays of wealth should not divert our attention from the endemic challenges that countries and vulnerable populations constantly face. As Covid-19 aid flows to Africa, a problematic interim “new normal” aid may overwhelm already fragile governance and accountability structures.
In a time of crisis, the ease of side-stepping accountability checkpoints and the opportunities for abuse increase as oversight narrows. What the COVID-19 crisis has done is to compress and funnel where corruption occurs. The urgency of resource mobilization, understandably, weighs process safeguards against expediency but a crisis should not camouflage environments where corruption is pervasive, self-enforcing and punishing to the most defenseless. Research shows that the most vulnerable are disproportionately affected by corruption. The poor are twice as likely to be victims of corrupt behaviour than the rich, and at our clinic we see it every day, prior to and amid the current pandemic.
ReaMedica Health’s (RMH) clinic in Mombasa, Kenya serves the lower middle-income, the working poor and the chronically poor (in the second half of 2020, we will expand services to the middle class). As a for-profit social enterprise, we do not offer free services but for many services such as ultrasound imaging, our pricing is commensurate with public hospitals. When offering services to the poor, we see that their vulnerabilities are an internecine mix of poverty, lack of information and a dearth of options. Dishearteningly, we see organisations that ostensibly should be protecting their communities muted when they could be defending the defenselessness.
Corruption is complicated and therefore, one of the first things we did is to define and codify what “corruption” is and is not at RMH. The RMH definition of corruption is founded on authority and the ability to deny, limit or delay access to services beyond the publicly known prices, processes and timelines. We did this because our clinicians are in a position of authority which can easily be abused, intentionally, inadvertently and opportunistically but that does not mean we are immune to be a victimiser.
In mid-April, our motorbike driver was hit by a commercial van. Our driver suffered two breaks which required surgery to set but due to the pandemic, surgeries are not being performed in public hospitals. Fortunately, our senior nurse was able to reach out to other hospitals and an orthopedic surgeon to arrange a theatre and surgery. But patients without access to information, professionals and means to navigate the health system are shut out of services unless they can afford exorbitant fees.
An April analysis, “Assessing the Hospital Surge Capacity of the Kenyan Health System in the Face of the COVID-19 Pandemic” pointed out:
“In addition to these adaptive measures, the government will also need to make urgent additional investments to expand health system capacity. In doing so however, the government will need to be pragmatic and prioritize these investments in terms of what to invest in and when to optimize impact, given existing system gaps and financial constraints”.
The gap between service capacity and need is not a surprise but is still a sobering reminder that post-lockdown persistent shortcomings will only worsen. Yet even though we are part of the health system and have visibility of the vagaries of navigating the system, our initial inquiries were still two to three times what the normal price would be and those fees were to be paid directly to the surgeon rather than the facility.
Because we are a clinic, we know what the service charges should be, what supplies are required and how much is needed, information of which someone outside of the health system has no idea. When we pushed back on estimates which were three times the anticipated, because we knew what the costs should be, the surgeons relented but we still paid double pre-Covid prices. And if we, as part of the health system are relatively helpless, it is almost unfathomable how powerless the poor seeking health services are.
As nations and health systems begin to reopen, we should not forget opportunistic corruption exists because the system allows it. But for the poor, they may not even know they are trapped. Being a victim of corruption does not mean you are aware you are a victim, and this is where the defenseless are most vulnerable.
Michael Seo is the Managing Partner & Founder of ReaMedica Health. Khadija Rheto is CEO of Solutions International and an Advisor Board Member to ReaMedica Health.