Wednesday, December 23, 2009

How to Give a Course on Corruption in the Health Sector

Just out from the U4 Anti-Corruption Resource Center is a brief paper on "Approaches to teaching and learning about corruption in the health sector."  (Note that U4 has a very useful web-page on corruption health care, also now appearing in the links in our side-bar.)

The paper begins by describing the overall goals of such a course:
The overall goals for training in anti‑corruption in health are to help people develop the knowledge, skills, and attitudes they will need to identify and understand problems of corruption in health, design anti‑corruption strategies, strengthen health systems for good governance,
transparency, and accountability, and advocate for integrity in governance. An additional goal is to prepare people to respond to individual experiences they may have with corruption, such as how to react when they suspect someone has engaged in corruption, when they are asked
to pay or accept a bribe, or other situations.

Then it lists a set of learning objectives:
- Define corruption.
- Identify the types of corrupt activities that occur in the health sector, and their scope and seriousness.
- Explain why corruption occurs, applying principles of economics, governance, and crime prevention to understand the issues involved.
- Assess risks and vulnerabilities which make corruption more likely in certain settings.
- Identify the consequences which can result from corruption.
- Discuss cultural differences in defining morality and corruption, including the blurred line between corruption and trading favours, giving gifts, using contacts, etc.
- Describe the core elements of corruption prevention and control programmes.
- Given a particular country situation or programme, explain how corruption can be reduced in drug supply, financial systems, and delivery of health services.
- Become an effective advocate for anti‑corruption strategies and reforms to promote accountability and transparency in health programmes.

The rest of the paper was devoted to specific content that might be included in such courses, and various activities that could facilitate learning.

Although the paper seems to be aimed at people in developing countries, I would submit that its content, and the sort of courses it proposes, would be equally useful in developed countries, including the US.  After all, Transparency International has pointed out that health care corruption seems to plague most countries regardless of income, level of economic development, or type of organization of health care systems.  The details of how corruption occurs just vary from country to country according to these factors.  On Health Care Renewal, we certainly have documented some striking instances of corruption in developed countries, mainly in the US, as well as corruption's little siblings, conflicts of interest and self-interested mismanagement.

However, I suspect that courses about health care corruption are rare, if not completely non-existent, in US medical schools, as are courses about corruption occuring "within country" at US public health schools.  In fact, the only "politically correct" way to talk about health care corruption in most developed countries is to talk about how it affects other, usually less developed countries. 

At least the author of the paper, Taryn Vian, has the courage to teach her course in the US, at the Boston University School of Public Health.  (She also drew on experience giving professional workshops in several countries.)  However, while the course does include examples from the US and developed countries, it is aimed at students interested in international public health.  I would guess that no one has invited Ms Vian to each the course for US medical students at BU or elsewhere.  (And if anyone knows about similar courses taught at US medical schools, US public health schools directed at in-country problems, or at medical or public health schools in other developed countries, please let us know.) 

It is a striking example of the anechoic effect that corruption in health care is not considered an important topic for US medical schools.  Of course, as long as we do not talk about the problem, we can pretend it does not exist.  Is it any wonder that our health care continues to get more expensive and less accessible?

1 comment:

Anonymous said...

My personal disappointment is the constant flow of stories involving fraud, waste and corruption.

The December 23, 2009 Wall Street Journal has two stories:

AstraZeneca Credits fines for Spotlight on Drug Ethics

Doctors Spat Exposes FDA Loophole

The December 20 2009 Akron Beacon Journal:

UA’s misguided “landscape for earning”

In Canada, a system many in America would like to duplicate via The Toronto Sun:

Aid program marred by wheelchair 'ripoff'
A fund intended to help the elderly and infirm haunted by tales of waste and profiteering
Last Updated: 20th December 2009

The common thread in all of these stories, all involving large organizations, that present a caring, above this type of thing front, is that people are out to personally benefit at the expense of those who can least afford it.

Drug companies are suppose to provide safe and necessary products. The FDA is suppose to protect us against all types of drug and device misuse. Universities are suppose to provide the best education possible at the lowest cost, while stressing ethics. Government programs are suppose to be run efficiently for the benefit of all.

These stories, all within a week, prove the system is broken, and action is slow at best, to resolve the inequities we find common in our medical and educational system.

Steve Lucas