Corruption undermines healthcare systems and puts lives at risk. Studies show corruption has large financial costs and reduces access to healthcare. Corruption risk comes from the complexity of healthcare systems with multiple stakeholders and decision points, as well as imbalances of information. Transparency can help address corruption by supporting accountability, reducing corruption, and promoting equitable access to medicine. Critical areas for transparency include regulatory policies, prices, quality, quantities, and procurement data. Transparency solutions include harmonized regulation, greater access to information, and public reporting on anti-bribery programs. Transparency alone is not enough and must be accompanied by measures like integrity pacts and whistleblower protections.

1. www.transparency.org Corruption Risks in the Healthcare Marketplace: Why Transparency is the Right Medicine Robin Hodess Director of Policy and Research Transparency International [email_address] MeTA International Advisory Group Meeting London, UK – 16 September 2008

2. Why focus on corruption and health ? Corruption undermines achievement of human development priority Corruption puts lives at risk

3. What are the scale and impact of corruption in the healthcare marketplace? USA: Fraud and abuse costs $11.9 – 23.2 billion/year Costa Rica: $9 million skimmed off Finnish loan by head of health insurance Ghana: 80% non-salary funds ‘leak’ between central govt and district Philippines: 10% increase in corruption reduces immunisation rate by 10-20% UK: losses to patient fraud were $305m in 1999; $139m in 2004 Uganda: Leakage rate for drugs and supplies at 70%, according to 2006 study Kyrgyzstan: 50% patients paid informal payments in 1996; one third borrowed money/sold livestock Peru: nearly 15 tons of fake medicines seized What are the scale and impact of corruption in the healthcare marketplace?

12. www.transparency.org Robin Hodess Director of Policy and Research Transparency International [email_address] MeTA International Advisory Group Meeting London, UK – 16 September 2008