Whistleblowing as strategy for reducing health sector corruption in Nigeria

If all goes well as expected, the whistleblowing and whistleblower protection draft bill which sprung from a five-day stakeholders’ retreat on the whistleblowing policy organised by the federal ministry of finance, budget and national planning in May 2021 in Keffi, Nasarawa state, would be considered this month at a federal executive council (FEC) meeting and then transmitted as an executive bill to the national assembly for passage into law.

Many stakeholders, local and foreign, including citizens who are enthusiastic about the efficacy of whistleblowing as an anti-corruption instrument, agree that in addition to mustering the political will for action against corruption, Nigeria is long overdue for stand-alone legislation that offers robust protection for whistleblowers. The enactment of the law would put Nigeria in the same progressive basket as African countries like Ghana, South Africa and Uganda, which already have whistleblower protection legislation as a means of achieving accountability and good governance.

As Nigerians anxiously look forward to this important law and joining the league of countries hungry for accountability, it is apt to state that much as whistleblowing is sorely needed to curb corruption in all sectors of the Nigerian polity, nowhere is the urgency to have it as a reporting mechanism more biting than in the health sector which happens to be clearly more susceptible to corruption for a variety of reasons related to the way it is organised. The first is that health is a complex sector, much more so than other sectors, and is also mostly governed by uncertainty, much unlike other sectors.

Two years ago, the COVID-19 crisis created a great deal of anxiety and uncertainty for Nigerians and people around the world. The pandemic also brought into stark reality the importance of accountability and the need for regular and reliable information from our public health institutions and our leaders.

As the world battled the COVID-19 pandemic, whistleblowers were instrumental in exposing inadequate health system capacity and delivery, public procurement problems, violations of health and safety and labour laws, inequitable and ill-prepared global supply chains, unfair competition practices and market abuses, and large-scale violations of personal privacy rights.

In many instances, Nigerians spoke out about their concerns about health and safety, fraud or other types of wrongdoing in the public interest in the management of the COVID-19 crisis.

Understandably, experts are unanimous in their assessment that corruption in the health sector is a serious and growing problem, especially affecting citizens who are less privileged and, therefore, most disadvantaged. It also makes the difference between life and death, with poor people often dying needlessly because of its lethal consequences for access, quality, equity, efficiency, and efficacy of services.

In one of its reports, the U4 Anti-Corruption Resource Centre, a repository of information on health and corruption for development specialists and policymakers, said an estimated $500 billion in public health spending is lost globally to corruption. Nigeria’s share of this amount is not available but given the alarming rate of corruption in the country, it would no doubt be staggering and scandalous.

One of the major adverse impacts of health sector corruption in low- and middle-income countries such as Nigeria is the unsatisfactory use of available resources to achieve global health goals. Unfortunately, Nigeria has some of the worst healthcare statistics in the world. A few years ago, the World Health Organisation (WHO) positioned the country at 197 of 200 WHO countries evaluated. A report by UNDP also stated that life expectancy declined drastically from 47 to 43 years.

In 2015, the WHO noted that Nigeria accounts for 10% of the world’s maternal mortality rate whereas it constitutes only 2% of the world’s population. The report also said one in every five Nigerian children dies before their 5th birthday while over a million Nigerian children die from preventable diseases. The immunization record of Nigeria also showed that only 18% of Nigerian children are fully immunized by their first birthday. Malaria kills the Nigerian child more than any other disease.

Corruption as well as the near-total collapse of the Nigerian primary healthcare system is largely responsible for these grim indices. As observed by one health researcher (Hadi, R.) in 2015, primary healthcare centres are in disarray with structures adorned with “expired drugs and cobwebs”. And not just the primary healthcare centres, secondary and tertiary healthcare centres, the hospitals and specialist clinics to which people are referred from primary healthcare services are also progressively deficient in the management of cases because the system is so lousy as to encourage health professionals to indulge in all kinds of unethical practices that undermine health outcomes.

The online newspaper, Sahara Reporters, in a story published September 3, 2021, in partnership with Civic Media Lab, under its Grassroots News Project, reported that staff bribery and payment to private accounts are common practices at the National Hospital Abuja, one of Nigeria’s leading healthcare institutions managed by the government. Quoting a staff of the hospital, the report said there are many acts of corruption at the hospital, and in some cases, patients pay directly into doctors’ private accounts. It’s as bad as that.

In a recent study, researchers identified 19 corrupt and illicit practices in Nigeria’s health sector. The top five of these are

1. Absenteeism at 53%
2. Procurement-related corruption at 34%
3. Health financing-related corruption at 34%
4. Under-the-counter payments at 33%
5. Employment-related corruption at 26%.

Out of the nine suggested approaches to reducing corruption in the health sector, whistleblowing is number one. Experts identified whistleblowing as an accountability tool that shows promise for reducing corruption in health service delivery.

Over the years, anti-corruption initiatives in the health sector have been targeted at specific problems and processes, or even institutions. Now is the time for a more holistic, strategic, and long-term initiative like whistleblowing, which can also go as far as helping to address lapses in health regulatory and oversight agencies. There is no doubt that whistleblowing can enhance the prevention of disease transmission through the detection of fraud and corruption, and subsequent enforcement and prosecution.

The African Centre for Media and Information Literacy (AFRICMIL) is working with partners to seek ways of mainstreaming whistleblowing as a sector-specific anti-corruption strategy in public health institutions owned by the federal government. There is a need to encourage patients who can not afford to pay medical bribes to blow the whistle on health workers who obstruct their access to care. In the same vein, it is important to have a system in health institutions that enables workers to feel free to report wrongdoing through as many channels as possible and be assured of their safety.

In the end, it will be a great relief to get development partners, based on their understanding of the dynamics of the sector, to actively support whistleblowing as a long-term strategic approach to health sector integrity and accountability.

Onyeacholem coordinates the whistleblowing project, Corruption Anonymous (CORA), at AFRICMIL