Author(s): Hannah Mitchell

Date of Publication: Wed 8 Mar 2017

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Corruption in healthcare is a taboo subject, with both patients and staff often reluctant to admit its existence. But it does exist. And it extends from mismanagement at high levels of government to bribes and unauthorised charges for frontline services. It is widespread and under-reported and can have devastating consequences.

Sierra Leone in west Africa was at the epicentre of the recent Ebola crisis. A 2015 Transparency International survey reported an astonishing 84% of Sierra Leoneans had paid a bribe for government services. There is huge systemic corruption, up to a third of money given to fight Ebola remains unaccounted for. An internal government audit showed ￡11m was missing from the first six months of the outbreak alone.

Despite having rich natural resources, the majority of the population live in grinding poverty. The country has one of the highest rates of maternal and infant mortality in the world with 1,360 mothers dying per 100,000 live births.

It was in an effort to tackle this horrifying statistic that the the president, Ernest Bai Koroma, introduced the Free Health Care Initiative in 2010, specifically granting free care for under-fives and pregnant and lactating mothers. This was a bold and much needed move for which he should be applauded. However, in spite of this campaign there are widespread reports of charges for frontline services. A 2016 report by the Campaign for Human Rights and Development International describes “rampant bribery” throughout the healthcare system in Freetown.

Sierra Leone has an adult literacy rate of 40%. Many people are not empowered to stand up for their right to free healthcare, and are often not even aware that the charges they are being asked to pay are unauthorised. There is inevitably a fear of reporting corruption as people are afraid they may be victimised or excluded altogether next time they come.

But the government is trying to make changes to that culture. At the state run hospital in the centre of town there are now posters which proclaim “pay no bribe”, urging people to report any cases of bribery they may encounter. This new initiative organised by Sierra Leone’s Anti-Corruption Commission, and funded by the UK Department for International Development, allows people to call a toll-free number to report cases of corruption across the education, electricity, health, police, water and sanitation sectors. This innovation goes some way to putting some of the power back into the hands of the people using these services. In the last quarter of 2016, 23.2% of bribes reported on these hotlines were paid to healthcare officials.

Research shows that charges at the point of access to healthcare reduce a person’s likelihood of seeking help and the seeking of bribes must surely act in the same way no matter how small. They lead to people delaying access to healthcare or not seeking it at all. For a woman, living in one of the town’s slums with a sick baby, the cost of transport to the healthcare facilities will make access almost impossible, and any charges on arrival will prohibit it all together. People being charged bribes are disempowered, if they refuse to pay they will be denied services. Government officials syphoning funds away from their intended uses are harming the vulnerable who they are there to serve.

Although corruption remains a significant problem in Sierra Leone, it is very little spoken about, so innovations like the “pay no bribe” campaign are a hugely important step. Recognising corruption and making it visible is a crucial first act. People may be reluctant to report corruption because of fears of retribution, so allowing anonymous reporting is a great innovation and a first step to empowering people, so long as it is followed up without fear or favour.

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