Independent bodies like the Lokayukta can check systematic corruption in the healthcare delivery systems under strong leadership, says a report released earlier this month on the role of the Karnataka Lokayukta (KLA) and the vigilance director.

The study was conducted jointly by the University of Leeds, Karuna Trust and Indian Institute of Management, Ahmedabad. An article published on the findings recently appeared in the Health Policy and Planning by Oxford journal which says that many health providers and users in Karnataka felt that lack of political will and wider contextual issues prevented long term effects of the KLA.

“Systemic corruption is the prime challenge for the state health system, widening health inequality and distorting policy implementation. Though minor corruption cases are being handled, legislators and state ministers have failed to declare assets, there are a large number of pending cases and low conviction rates,” the report says.

One of the investigators from Karuna Trust, Karnataka, Dr Sylvia Karpagam said, “We did several case studies and visited hospitals and drug procurement offices. We even spoke to medical superintendents of various hospitals and healthcare users to come to these conclusions.”

She added that the worst victims of healthcare in corruption are those who are refused services because of their inability to pay. “It was shocking to see the magnitude of corruption in our health systems,” she said.

Private hospitals often exploit the loopholes in the system through practices like unnecessary surgery for BPL cardholders, for which they are reimbursed by the government.

Corrupt tendering process for infrastructure development in health sector, free government medicines supplied to private pharmacies and sold to patients without prescription are some of the cases reported to the KLA after the change in leadership in 2001.

Corruption and poor governance in the health system exists in medical education, drug procurement, infrastructure tendering, strategic planning, service delivery, service use and work-force management, the report adds.

“The KLA as ombudsmen of good governance can change the entire system. It is sad that these processes are not institutionalised and last only as long as the good leaders last,” said Karpagam.

The study includes some recommendations for the Karnataka Lokayukta include making KLA transparent and accessible, targeting of senior public servant’s governance behaviour, restoration of ‘suo moto’ authority against senior public health servants and educating the public about good governance and determinants of corruption.

Globally, approximately $3 trillion is spent annually on healthcare, with average losses from corruption of up to 10 percent (Transparency International 2006).