**14. Corruption in the health sector**

Corruption in the health sector can make a difference between life and death. Health sector corruption affects access to healthcare, equity in the treatment of patients, efficiency of the system and efficacy of health services. Corruption reduces the speed at which the world would achieve global health coverage. It is estimated that annually, over USD\$500 billion is lost to corruption in the health services sector alone. Ironically, the world needs less than USD\$500 billion to reach the UHC (Universal Health Care) target ([13], p. 9). It thus means that all we budget for above-average UHC is going into a leaking bucket of a system infested with greedy, corrupt individuals either operating solo or in some group, corporate or syndicate. In a 2011 study covering 178 countries, it was found that annually over 140,000 children die because the budgets that could save them have fallen into corrupt hands. Friedman [14] asserts that the number of HIV-AIDS patients across the world has remained high because of

#### *Corruption: Drivers, Modes and Consequences DOI: http://dx.doi.org/10.5772/intechopen.106826*

corruption. Corruption has caused a build-up to antimicrobial resistance and also due to over-dose-induced resistance [15]. There is just not enough left for training, supporting and doing all the necessaries for the millions affected in the various continents. Hussmann [13] affirms that there are chances the Patient-Provider interaction in poor countries is suffering a 51% risk of being corrupted. Similar corruption is rated at 1% in the least corrupt countries. The main routes through which corruption siphons away the money are bribery, theft and embezzlement. The corruption just restricts the human population from accessing needed medicines, supplies and equipment. Bate [16] observed that USD\$1 million worth of anti-malarial medicines was siphoned through corruption. The budget for tuberculosis was equally scammed by the corrupt hands of officials. Among the countries whose health systems are badly affected by corruption are Ukraine, Uganda and the United Republic of Tanzania [13].

In the health services sector of many countries, patients can be charged for treatments and diagnoses that never were, or that were substandard. Referrals are also done for kickbacks and 'patients' may be subdued to irrelevant and unnecessary procedures for which they are circumstanced to pay. The World Health Organisation has established that over 6.2 million Caesarean sections performed are unnecessary, About 10% of drugs used across the globe are fake and sadly around 50% are in the African health system. The selfishness of the corrupt involved is that they do not regard that fake drugs can lead to resistance, illness or death and that it is already poor that need health care the most. In most poor countries, the poorest can spend up to 20% of their hard-earned income buying fake medication. Worldwide about 25% of public health budget is lost to corruption, in the UK the figure lost to corruption hovers at 37%, in Germany at 10% and at USD\$75 billion in the USA.

Delavallade [17]; Disch and Natvig [18] and Hussmann [13] present a harrowing picture of corruption in the health sector. A study of 64 countries shows that corruption lowers public spending on social protection health and education. In Chad, corruption in the central government is estimated to consume above 66.7% of the health sector budget leaving a meagre 33.3% to trickle and reach the local regions. In Cambodia, corrupt hands at the central government grab around 10% of the health budget. In the United Republic of Tanzania, local district councils consume up to 41% of centrally disbursed funds. In Uganda as with Chad, as much as 66.7% of official user fees would go into corrupt hands. The 2020 annual global spending on health was USD\$8.3 trillion and this went to USD\$8.8 trillion in 2021. This figure is 4% of the GDP of low-income countries, and with the OECD countries, it stands at 15% of their GDP. The multiple resources in the health sector offer numerous opportunities for corruption.

Other examples of corruption include the collection of the water that has been used to wash dead bodies and sell it for ritual purposes and is said to be a prime resource for those practising witchcraft. It is also alleged that in some countries those working with dead bodies to determine their causes of death do engage in the collection of some fat and sell it for rituals as well. One of the forms of corruption in the health sector that is causing huge suffering and self-aggrandisement of doctors on a huge scale is when private doctors working as well in the public sector enter into collusion of 'stealing' drugs out of public health facilities and take them to their private surgeries. There are also reports of collusion, where public hospitals fake that they will not be having a doctor soon to attend to ambulanced patients or that they are fully booked. They then refer the patient to a private doctor who will then fake diagnosis and then refer the patient to a public hospital. The patient will receive a bill with the referral cost, drug costs, bedding costs, consultancy fee, and everything until the bill satisfies the writer.

While the poor and desperate were timidly consuming every herb recommended on social media in the fear of contracting COVID-19, there was a lot of corruption involving donations and COVID-19 loans [19, 20]. Taking advantage of the regulations around medicine procurement during the COVID-19 pandemic corrupt officials did the following: In South Africa, the then minister of health was alleged to have played wilful blindness to corruption involving USD\$10 million and another involving over USD\$900 million [21, 22]. Cuadrado [19] and Alkins [21] show the following from research: in Malawi, COVID-19-related investigations focused on USD\$1.3 million involving public-private sector collusion [21]; in Kenya, one investigation focused on USD\$400 million, another on USD\$71.9 million, and USD\$69 million; in Zimbabwe, the minister of health was dismissed; in Ghana, the minister was alleged to have bought vaccine units at USD\$9 above the market price; in Lebanon, politicians were bribing for votes in exchange for free vaccination; in many countries, those who were afraid to vaccinate could still buy proof-of-vaccination cards on the black market while fake vaccines were availed on the black market; in Uganda, COVID-19 patients were being billed up to USD\$15000 for hospitalisation in state facilities. This is deadening for a country whose average annual income is USD\$1000. Admission to Ugandan state hospitals is normally free. In Bangladesh, the Sinopharm vaccine had an official price of USD\$10 but was being sold for USD\$100; in Guatemala, the government is said to have paid for 16 million units of vaccine but could only show 350,000 units; the social media is awash with medicines for various ailments. Corrupt individuals are rushing to open street surgeries practising with these faked claims of medicinal value.

## **15. Corruption in wildlife trade**

Trade becomes corrupt when the items being traded, and the considerations exchanged are not allowed but still get done and more so involving parties or persons that should be enforced against such trade. The sale of live or dead wildlife pieces is illegal in most countries as much as their hunting in the unprotected areas. The hunting and trade of wildlife in protected areas with the help of police, warders, the army, officials or any person who should be stopping the hunting and trade has become rife across the globe. This corrupt trade involves animals, birds, reptiles, molluscs, fish and other aquatics.

In the most shocking instances, warders give information to poachers, who then make their incursions to places where they will easily find the game and where they will not be detected. Bribe payments are reported to be left at indicated places including rocks, trees and dugouts near the carcasses. With the advent of technology, GPSs are sent to a third person, who passes the GPS to another then to the intended person. In all cases, the devices used are not registered with any of these persons, and in some cases, they are bought in ways that do not get them registered. The gadgets have no other purpose and after the GPS messaging they are switched off and have their batteries removed and stored away from their properties. This is part of their SWOTing and concealment of identity strategies.
