Widespread corruption in government hospitals in Colombo is preventing the poor and vulnerable from benefiting from free health services. A study by Transparency International Sri Lanka and the Friedrich Ebert Stiftung (FES) titled ‘Integrity in Government Hospitals in the Colombo District’ and released this week shows that Sri Lanka’s free health care system is in bad health because of corruption. Various types of malpractices were reported at government hospitals in Colombo. A majority of the respondents have experienced drug shortages at government hospitals, negligence, discrimination and favours to relatives/friends and unequal power relations with hospital staff.
Bribery was also widespread. The study found that hospital workers abused their position by getting patients to bribe them for services. “As a result, patients often cannot access services that should be free of charge as they have to pay informal payments to personnel,” says the report. Nepotism seemed to be the most frequent form of corruption. An alarming 98.5% of respondents were of the view that personal connections are needed to get a better service. Interviews with nurses and attendants also revealed that patients are better treated if they have personal connections with staff members of the hospital.
The report quotes one of the nurses interviewed for the study as saying; “.. Sometimes there are drug shortages in wards. If we know the patient personally somehow we try our best to find the required medication even from other wards. If our friends or relatives come and ask a favour we cannot refuse it.”
Bigger fish, bigger corruption
Most of the reported incidents of corruption involved minor workers but the report notes that the higher layer in the hospital management hierarchy may be even more corrupt than minor workers.
“The indepth interviews conducted with doctors, nurses, medical officers, administrators, leaders of trade unions, private practitioners and sales representatives of pharmaceutical companies have revealed many incidents that illustrate the forms and magnitude of bribery and corruption among high level officers of the health sector in Sri Lanka,” said the report. Therefore, the report recommends that measures to control bribery and corruption be implemented at all levels.
Protecting free health system
While the public often resorted to corruption to get better and faster services and hospital staff also resorted to corruption, most people participating in the survey felt that hospital workers who ask for, or receive bribes should be punished.
“All the respondents in the household survey and all key informants emphasised the need to control bribery and corruption in order to protect the free health service,” says the report.
Many people also suggested that a location be established for the public to make complaints regarding bribery and corruption. To control corruption in the public health sector the report is also calling for a strong community awareness programme to raise public awareness about their rights as patients. Awareness of their rights, says the report, will allow people to demand better services instead of resorting to bribery and other forms of corruption.