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Legal Monitor - Issue 64
Zimbabwe Lawyers for Human Rights (ZLHR)
September 27, 2010

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Corruption: Lives compromised as nurses sell drugs on black market

People Living With HIV and AIDS (PLWHA) are being forced to pay bribes to access treatment that is supposed to be free, as corruption silently kills a large population unable to pay its way into the system, according to findings of a new research.

A report on the research findings by Zimbabwe Lawyers for Human Rights (ZLHR) paints a grave picture of how public healthcare workers are milking PLWHA who are already too poor to afford private treatment.

Nurses and hospital support workers such as nurse aides and administrative staff are the chief culprits, according to 88 percent of respondents who took part in the study, commissioned in March this year in Masvingo, Harare, Bulawayo and Manicaland.

"Most cases of corruption were reported at Government hospitals and Council clinics," reads the executive summary of the study, titled: Corruption burns universal access. There were "no significant" cases recorded at hospitals run by churches, while direct evidence implicating doctors was "very thin and sporadic".

The research noted four major types of corruption in the roll out of essential medicines and services for PLWHA: informal bribes, bribes for enrolment, bribes for services and conflict of interest/self referral.

"The research findings reinforced the view that corruption in health care discourages treatment, testing, and other health-seeking behaviour. In these circumstances, the general attitude has been observed to shift towards resentment and resignation by PLWHA who then give up on accessing essential medicines and diagnostic services," reads the executive summary.

The report was done by ZLHR's HIV/AIDS, Human Rights and Law Project, one of the organisation's key projects which occupies critical space within the rights organisation's scheme of community interventions around socio-economic rights.

Zimbabwe-one of the countries most affected by the HIV/AIDS pandemic-has been registering steady declines in the HIV/AIDS prevalence rate, meaning more could be achieved if corruption is eradicated. HIV prevalence has fallen from 16 percent in 2007 to the current 13 percent.

But those already living with HIV are having to tough it out in an environment where lowly paid health workers are resorting to corruption as a coping strategy. The research found that the majority of PLWHA lived in extreme poverty, with 89 percent of respondents surviving on a monthly family income of below $100. This is against latest official Zimstats figures showing that a family of five needs $477 for survival, $146 for food and $331 for other expenses monthly.

According to the ZLHR HIV/AIDS report, 45 percent of respondents have between two to five dependants, and 27 percent have more than five dependents.

The report stated that the strain of corruption on household economies should not be underestimated considering more than half of health care financing in Africa was out of pocket, Zimbabwe being no exception.

Accessing HIV drugs in public hospitals has become an everyday challenge to PLWHA, while drug stock-outs have become commonplace. At times, these stock-outs are engineered by health personnel in an attempt to source bribes or promote their own private enterprise by referring patients to buy from their own pharmacies, according to the findings.

Of the PLWHA who paid bribes, 57 percent paid kickbacks to access drugs, 24 percent needed diagnostic services, and 19 percent paid a bribe for initial enrolment. 63 percent of those who were asked to pay a bribe at one point were declined access to drugs or services, resulting in PLWHA defaulting or outsourcing for drugs or the required services.

The research revealed that drug stock-outs had become commonplace because a "moribund health system underwritten by phony accountability mechanisms and a tired bureaucracy" allowed drugs to be diverted to the black market through covert fraud and dispensing to ghost patients. This particularly affected those on second-line treatment who were at times given prescriptions to buy over the counter at their own expense.

"Discussions with PLWHA indicate that absenteeism by senior doctors usually impairs monitoring of these (ethical) codes. As a result, junior staff and nurses are given enormous latitude to police themselves," read the report. In his keynote address at the launch of the report on Friday, ZLHR board chairperson Andrew Makoni said the findings of the research were worrying and called for urgent corrective action to stem out corruption.

"The findings of this research are tragic and grave. Corrective action should start yesterday. Treatment should not be conditional to corrupt practices," said Makoni.

Dr Owen Mugurungi, the director, AIDS and Tuberculosis programmes in the Ministry of Health and Child Welfare welcomed the report and called for concerted efforts to fight corruption in the health sector.

The research was based on a sample population of 1 024 PLWHA. Urban areas provided 83 percent of respondents, with the remaining 17 percent of respondents coming from rural areas.
77 percent of the respondents were female and 23 percent male.

Anne Lugon Moulin, Deputy Head of CIS Countries Division, Swiss Agency for Development, said in a foreword to the report that corruption in the health sector was most detrimental because life was at stake.

"If treatment is made conditional to corrupt practices, it could well that the lives of those who cannot afford to pay bribes will be endangered. In the case of HIV/AIDS, the danger is even higher, as there is no cure for the disease, despite the mitigation effect of anti-retroviral treatments," said Lugon Moulin.

"The issue is even more pressing in a country like Zimbabwe-one of the countries affected the most by the pandemic."

According to the report, 1 102 864 people out of a population of about 12 million are estimated to be HIV positive. The report states that 997 123 of these are adults above the age of 15, and 594 847 are females. At least 343 460 adults are in urgent need of anti-retroviral therapy. But only 150 000 people are currently receiving ARVs from the government programme.

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