Corruption in the healthcare sector in South Africa is not new.

Between 2009 and 2012/13, just over R8 billion in health expenditure by the combined provincial departments was classified as unauthorised, while R24 billion was deemed “irregular.”

In 2017/18, health departments accounted for 57% of unpaid bills by government.

And in 2019, a spokesman from our National Treasury said, “Budget constraints are exacerbated by fruitless, wasteful and irregular expenditure.”

But it is the Covid-19 pandemic of 2020/2021 that has finally thrown a much-needed spotlight on the rampant corruption that is crippling our healthcare system. Indeed, as an article in Good Governance Africa recently said, “The bigger pandemic is corruption.”

According to Corruption Watch, there are different systems of financing within the different sectors of healthcare that facilitate different forms of corruption. But they’ve found certain types of corruption are prevalent across all systems:

  • Embezzlement of funds, especially when they are transferred from national to regional entities.
  • Procurement of medical supplies and pharmaceuticals, including fraudulent and counterfeit equipment and drugs.
  • Nepotism and other forms of favouritism in hiring and promotion of staff.

The organisation also found the players most commonly implicated in corrupt acts are:

  • High ranking public officials in managerial posts
  • Administrators and medical professionals (doctors and nurses.
  • Companies that are either bidding to do business with the state or that are already providing services and/or products for the state.

In addition, officials and employees of various hospitals and clinics mismanage funds and use state resources to benefit themselves and their families. According to the reports:

  • Money allocated by Treasury for particular projects and programmes is frequently squandered or deceptively redirected to other interests.
  • Doctors use state funded medical equipment and medication in their own practices.
  • Officials illegally use state vehicles, fuel and accommodation for themselves, their friends, and their family members.

The result?

A desperate shortage of medication, equipment that is either lost or damaged, and the state (and by that, we mean the taxpayer) paying exorbitant amounts of money to fund the extravagant lifestyles of officials.

This level of corruption and mismanagement don’t just happen incidentally. They are direct by-products of how our country has been run. Calculations during former President Zuma’s second term put the cost of corruption at about R1.5 trillion – enough to cover South Africa’s public healthcare budget for about eight years.

South Africa is seen as the best prepared of any country in sub-Saharan Africa to cope with the crisis created by the pandemic. The fact we’re not coping is the harvest we’re now reaping after years of rampant corruption have brought our public healthcare system to the brink of complete collapse.

It is corruption that is the reason why our hospitals are struggling to deliver basic services, never mind cope with the high numbers of patients with Covid-19.

It is corruption that means we don’t have the money to buy enough vaccines to vaccinate everyone in the country.

And it is corruption, not the lack of a National Health Insurance scheme, that stops thousands of people getting access to the quality healthcare they need, when they need it.

“The proposed National Health Insurance (NHI) has nothing to do with improving the delivery of healthcare or bringing about operational efficiencies,” says Michael Settas, a member of the Free Market Foundation’s Health Policy Unit, in an article for the Daily Maverick. “It is no more than a reshuffle of finances – and a truly bad one at that.”

He goes on to say: “The NHI roadshows [which took place in February last year] amply illustrate the horror ordinary citizens suffer under poorly delivered public health services. Additionally, we hear public health specialists and NGOs enjoining all citizens to support the NHI. ‘We need an NHI to fix our inequitable health system’ is the usual argument.”

Ironically, however, when government bleats about the current situation, it inadvertently exposes, for everyone to see, its own dramatic failures in delivering adequate healthcare to all.

If the public sector was functional, as it should be, then the existence of the private sector would be inconsequential. Does anyone in the UK blame British private health insurers for the woes of the NHS?

“South Africa does not need the NHI Fund or any other form of revised financing structure,” says Settas. “What we do need to do immediately is fix the management and delivery of public healthcare services.”

He makes such an important point. Even if we had unlimited money to throw at the problem, it wouldn’t improve the quality or availability of services because the money would still keep finding its way into the same greedy pockets. And you all know by now how I feel about throwing money at a problem anyway! It just creates a more expensive problem.

We need to stop treating the symptoms and find a cure for the disease. Touting the NHI as the miracle cure to all South Africa’s healthcare woes is like trying to put a small plaster on a gaping wound. We need to solve the real problems: Corruption, lack of maintenance and a general ineptitude.

Let’s fix the system, deal with the people milking it, and deliver a transparent system that offers true value for money.

Ultimately, if the cost of corruption is not merely a stolen rand here and there, but a precious life, how much farther do we have to drift from our moral compass before we act?”
Melusi Ncala, Corruption watch researcher