Abstracts

76 al., 2016). A report compiled by Corruption Watch, a nongovernmental organization (NGO) that seeks to combat corruption in South Africa, claims that of the reports they received dealing with corruption in the health sector, roughly 40% of those reports involved health departments, predominantly provincial government departments of health (Rauch & Johannes, 2015). A content media analysis conducted from 2009 to 2012 posits the same conclusion, with its results demonstrating that 45% of the reports dealing with corrupting activities occurred at the provincial level (Rispel et al., 2016). The large budgets located in provincial health departments call for a greater need for the government to assume responsibility of ensuring financial accountability. A report consolidated by the auditor-general of South Africa from 2016 to 2017 found little improvement over four financial years in internal controls in national and provincial government departments (AGSA, 2017). Insufficient internal controls in provincial health departments may hinder financial oversight and facilitate unethical use of budgets. Procurement Corruption Medical procurement—the acquisition of products, pharmaceuticals, and equipment—is prone to corruption due to the complexities of delivering these materials from suppliers to patients. The NDoH manages the advertising, awarding, and monitoring of pharmaceutical tenders, and provinces request their needs to the NDoH, whereas contracted suppliers deliver directly to depots or health facilities (Magadzire et al., 2017). Since all levels of government, suppliers, and health facilities are involved in the procurement process, the health sector attracts the potential for corrupt activities to occur. In fact, the head of the Special Investigating Unit reported that the area with highest risk of corruption, fraud, and abuse is in supply chain processes (The Presidency, 2019). Akeyweakness in the procurement system contributing to corruption is the absence of a strong monitoring and evaluation process as to where medicines are directed. To reform the health sector and enhance access and use in both the public and private health sectors, South Africa adopted the National Drug Policy (NDP) in 1996. The World Health Organization suggests that for successful implementation of the NDP, the country must have a system for monitoring and evaluating its impact. However, no official comprehensive review of the South African NDP and its impact has been conducted since its adoption (Pharasi & Miot, 2013), resulting in the government’s failure to enforce its own corruption prevention policies. As a result of the of the deficient monitoring system, pharmaceutical stockouts, especially of antiretroviral treatments for tuberculosis and HIV, are common at primary health care facilities. Corruption, along with mismanagement, labor disputes, and limited oversight of pharmacists, contributes to drug shortages (Bateman, 2013). Stockouts affect one in every five health facilities in South Africa, and, with approximately 420,000 South Africans relying on antiretroviral medicine (Stop Stockouts, 2013), procurement corruption puts many at risk of developing and transmitting drug-resistant viruses, ultimately increasing the risk of illness and death. For instance, in May 2011, the Mthatha depot, located in the Eastern Cape province, was unable to deliver antiretroviral drugs to the 100,000 patients who depend on them for their treatment. A sting operation by the Hawks, South Africa’s Directorate for Priority Crime Investigation, discovered that the depot was rife with corruption involving three of the depot’s pharmacy assistants and a municipal official who were in a “theft-for-sale” scheme. Consequently, R220,000 ($12,000) worth of medicines was stolen (Bateman, 2013). Fortunately, these health care workers were held accountable for their corrupt actions and were arrested, but, without transparency and enforcement of the law, like activities may endure under the radar, thereby affecting patients at the end of the supply chain. Deficiencies in Leadership and Accountability All public service departments are required to develop and implement fraud prevention systems. In a study conducted by the Public Service Commission (2007),