Abstracts

77 a sample drawn from both national and provincial departments ranging from health to education to housing to agriculture was analyzed for their implementation of fraud prevention plans. The report found that more than 39% of the departments had not yet reviewed their plans at all, and only 29% reviewed theirs annually. The report also suggested that management accountability and the implementation of these plans could be improved by delineating the roles for fraud prevention among departmental staff. The poor enforcement of regulations perpetuates a culture and an attitude that people can escape the consequences of corruption. A clinical director in a public tertiary hospital expressed this frustration by noting that although policies have been developed to provide technical guidance during procurement processes, they are simply ignored (Rispel et al., 2016). The scant awareness of these fraud prevention plans contributes to minimal will to combat corruption within public health departments. Due to inadequate accountability, health departments often allow those who commit malfeasance to remain in office and thereby run the risk of continued corruption. The now infamous Life Esidimeni tragedy exemplifies this issue. In 2015, the Gauteng province Department of Mental Health transferred 1200 mentally ill patients to facilities that were falsely certified and hence unsuitable for the patients’ conditions. Evidence suggests that senior officials such as Dr. Makgabo Manamela, the department’s director, may have had personal financial ties to the facilities to which the patients were transferred. Investigators of the incident thus suspected that corruption was the main cause of the tragic incident. While the department argued that the decision to transfer the patients ostensibly aimed to save money, a health ombudsman concluded after the fact that it almost certainly would drive up the costs (“How 143 Mentally Ill South Africans…,” 2018). Although 143 patients died over 9 months due to neglect and mismanagement by the providers, none of the officials involved was fired (Heywood, 2017). The Life Esidimeni scandal is just one example of how corruption can lead to death and disability of patients, but without stricter accountability, other similar incidents may continue to jeopardize the lives of additional South Africans. Current Efforts to Mitigate Corruption Several organizations in South Africa are currently attempting to combat corruption in the public health sector. These organizations can be categorized generally as law enforcement, civil societies and NGOs, and health sector regulators. To decrease the levels of corruption in the South African health sector, these organizations must address the weaknesses conveyed in the previous section. Law Enforcement and Criminal Justice Agencies Respect for the rule of law is required for fighting against corruption. Since the end of apartheid, the South African government has introduced a plethora of anticorruption laws and regulations to tackle almost all aspects of corruption, and the country also cooperates with other nations by being a signatory to the United Nations Convention against Corruption, the Southern African Development Community Protocol against Corruption, and the African Union Convention (Pillay & Mantzaris, 2017). The government also promulgated key laws such as the Protected Disclosures Act of 2000, also known as the Whistle-blowing Act, and the Prevention and Combating of Corrupt Activities Act (PRECCA) of 2004. PRECCA is comprehensive, classifying a wide range of acts as corrupt and criminal, and addresses corruption with regard to supply chain and procurement violations, public contracts, suppliers and agents, politicians, and administrators—all of which interact within the complicated health care system (Pillay & Mantzaris, 2017). The government also protects whistleblowers who disclose unlawful or corrupt conduct in their workplace by the Protected Disclosures Act. Although these anticorruption laws provide a strong basis for the prosecution of offenders, they are highly contingent on the political will to enforce them and thereby prosecute criminals. South Africa’s decentralized approach toward fighting against corruption poses a