Corruption in health systems: view from Peru

Corruption is defined as the misuse or betrayal of public trust, in order to achieve a personal or private goal, instead of seeking the best for the community or country (1, 2). This is a serious problem for health systems in many places (3). It could lead to a waste of resources, and, even worse, to utterly negative health outcomes (1, 3, 4).

I would like to point out some similarities regarding corruption in healthcare, between India and Peru, two middle-income countries in different continents. According to Transparency International, India and Peru have a Corruption Perception Index of 3.1 and 3.4, respectively (http://www.transparency.org/country). This same entity provides the Global Corruption Barometer, in which statistics show that 85% of surveyed Peruvians assess as “ineffective” the current government’s actions in the fight against corruption; whereas in India, this opinion is held by 44% of surveyed Indians. In both countries, many cases of corruption are due to overcharging for supplies, infrastructure and new equipment, and to favours that benefit only a few.

Statistics from the Global Corruption Barometer (http://gcb.transparency.org/gcb201011/) indicate that in India, 21% of people have come into contact with medical services, and 26% of them have paid a bribe in this kind of institution in the last twelve months; on the other hand, for Peru it is reported that 72% of people have come into contact with medical services, and of them only 4% have paid a bribe, These differences are perhaps a clear indication that, where there is more corruption, less people may have the willingness to go to a health facility. However, this hypothesis should be further explored in different contexts, in order to arrive to a solid conclusion.

Corruption is a global problem, and definitely affects a population’s health (3), no matter where. Therefore, it should be included as a research topic worldwide, and among global health researchers, in order to fully understand the relationship between corruption and health, and its determinants (4).

The key is to develop strong programmes and strategies created to address the characteristics of corruption in a country, and that will prevent problems within the health care system, in matters of access, inequity and outcomes (1, 2). These anticorruption strategies should be based on theory, developed according to the evidence and adapted to suit the specific contexts where they are to be applied (1).