Abstracts

74 African population who rely on it (Department of Health, 2003), the public health sector already suffers from government negligence and insufficient provision. As an illustration of the magnitude of the problem, the South African Institute of Race Relations gathered more than 100 media reports about incidents of negligence, corruption, and mismanagement in the public health sector, with extreme cases leading todeathanddisability (Roodt&Fleming, 2018). Failing to address corruption and hold offenders accountable risks the South African public health system collapsing. To mitigate these threats, the South African government must promote transparency, accountability, and good governance, which will enable health departments and providers to be efficient in allocating their resources to improve access, quality, and financial protection in the public health sector. Why Is Corruption a Significant Issue in the Health Sector? Corruption, defined by Transparency International (2019) as “the abuse of entrusted power for private gain,” manifests itself at various levels in society in many different forms, including but not limited to fraud, theft, bribery, cronyism, nepotism, and embezzlement. It corrodes the social, political, and economic fabrics of a society and undermines the people’s trust in the government, in other institutions, and in each other. Health care systems, because of the substantial amounts of public money involved, are especially vulnerable, and, without procedures ensuring transparency and accountability, such systems may well deteriorate and inflict detrimental effects on the health and well-being of the people they aim to serve. For example, corruption leading to an increase in the prices of medical supplies, life- saving drugs, and equipment makes health care unnecessarily expensive, if not unobtainable, for those in need. With uncertainty in the face of information asymmetry, that is, when patients have far less information than doctors about their clinical condition and needs, and when numerous parties, starting with the government all the way down the supply chain to the patient, are involved, opportunities for corruption are rife (Hussmann et al., 2006, pp. 3–13). The South African public health sector is not immune to the pandemic of corruption. Within the past decade, South Africa underwent a crisis called state capture under the infamous Jacob Zuma administration. State capture is a type of political corruption where “powerful individuals, institutions, companies, or groups within or outside a country use corruption to influence a nation’s policies, legal environment, and the economy to benefit their own private interests” (Transparency International, 2019). In South Africa, when state capture is discussed, the attention has been focused mostly on institutions such as the South African Revenue Service, South African Airways, and Eskom, South Africa’s public electricity utility, 2 due to the large sums of money being directed to these entities. However, the national and provincial health departments have a combined budget amounting to around R190B (approximately $10.5B) per year (Heywood, 2017). As discussed in the Health Sector Anti-Corruption Forum of 2019, R39B ($2.2B), or a staggering 20% of the government’s budget, is subject to corruption. Therefore, the South African health care system warrants serious attention as it, too, demonstrates vulnerability to corruption and theft. Historical Context The current health care system reflects South Africa’s political administration and economic capabilities as well as the nation’s health status; however, inequities between the private and the public health sectors and weaknesses in governance that create an environment conducive to corruption can be attributed to the legacy of apartheid. Under apartheid, the South African government forcibly separated the population based on race and designated black South Africans to live in Bantustans, also known as the homelands. Each Bantustan managed its own health department separately but overall was controlled by the national government in Pretoria (Coovadia et al., 2009). The apartheid system institutionalized disparities within the health care system because of the government’s 2 For an analysis of Eskom, see Petros’ article in this volume.