Health and medicines

Health and medicines (continued)

TOP DRUGS BY VALUE AND VOLUME

By value•1. Tenofovir US$130 million•2. Pneumococcal vaccine: US$ 122 million•3. Efavirenz: R US$120 million•4. Pentavalent vaccine: US$100 million 

• By volume:•1. Hydrchlorothiazide tablets: 40.8 million packets •2. Lamivudine: 27.9 million packs •3. Water for injection: 25.2 million amps.•4. Efavirenz: 24.3 million packs

Corruption reports made to CW to 31 August 2012

0.1%

0.3%

0.7%

1.2%

1.7%

2.1%

4.3%

7.3%

11.3%

19.3%

23.0%

28.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Election Fraud

Abuse of government resources by a public official (travelclaims)

Abuse of Union Funds

Threat against Whistleblower

Abuse of Charity Funds/Lotto

Ghost Workers

Abuse of government resources by a private person/ company

Unknown

Abuse of government resources by a public official(employment/hiring/nepotism)

Bribe

Abuse of government resources by a public official(procurement)

Abuse of government resources by a public official

Reports by Corruption Type

1%

1%

3%

3%

6%

14%

16%

20%

36%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Union

NGO

Private Sector

State Owned Enterprise

Unknown

National Goverment Department

Metropolitan Municipality

Local Municipality

Provincial Government

Reports by Institutional Context

12.7%

1.7%

1.7%

2.5%

2.5%

2.9%

3.1%

3.1%

7.3%

9.8%

9.8%

10.4%

13.1%

19.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

Other

Agriculture

Land Reform/ Land Claims

Public Works

Service Delivery

Social Development

Home Affairs

Justice

Police

Health

Housing

Licensing

Traffic

Education

Reports by 'Sector'

Transparency International Rating •Corruption perception index

• Rank: 64/183 - Score: 4.1/10•Bribe payers index

• Rank: 15/28 – Score: 7.6/10•Control of corruption

• Percentile rank: 61 – Score: 0.093919992•OECD Anti-Bribery Convention (2011)

• Enforcement: Little or None

Health corruption reports

2.0%

2.0%

5.9%

7.8%

23.5%

23.5%

35.3%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Bribe

Threat against Whistleblower

Abuse of government resources by a private person/company

Ghost Workers

Abuse of government resources by a public official

Abuse of government resources by a public official -Employment/Hiring/Nepotism

Abuse of government resources by a public official -Procurement Corruption

Health reports by type of corruption • 35% of all cases reported are procurement related

• Largely related to procurement of equipment and maintenance services

• 30% of reports relate to employment procedures, nepotism and ghost workers, principally around:

• Nepotistic appointments of hospital staff

• Doctors employed in the public sector running concurrent private practices in a manner not permitted

• Payment to staff members who do not exist or who have not rendered services due to continual absenteeism

• Remaining reports relate to a variety of other kinds of abuse of government resources, many of which relate to theft of hospital supplies (cleaning materials and food), but significantly of hospital equipment for the purpose of private sale.

Health corruption reports

3.9%

15.7%

25.5%

54.9%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Unknown

Provincial Capital

Metro

Small Towns

Health reports by geographic context • Majority of procurement corruption reports are located in the metropolitan areas of the Gauteng province (may be reporting bias rather than indicative of any specific trends)

• 33% of reports from provincial capitals, and a further 33% from smaller towns around South Africa

• Large proportion of the procurement related reports locate the institutional site of corruption within provincial departments

• Employment corruption located mainly in hospitals themselves rather than at a provincial government level, and pertains specifically to doctors and nurses rather than administrative staff

Case study

• Recent ongoing investigation into the Eastern Cape Department of Health identified three core focus areas:• Employee Irregularities

• Principally regarding ghostworkers as well as specific individuals that raise a number of red flags regarding additional interests and relationships with other employees (544 employees with invalid ID numbers)

• Deceased staff still being paid (1694)• Officials / Spouses with a conflict of interest

• Employees or their spouses that are directors of active companies that are listed on the supplier databases (929 employee companies, 35 spouse companies) of the Department

• Procurement Irregularities: Suppliers & Officials• Duplicate payments• Payment close to thresholds at which supply chain management rules change• Splitting of orders to avoid supply chain management rules

Official efforts ongoing to combat corruption in health

• National Treasury placement of certain provincial health administrations under curatorship

• Special Investigations Unit (SIU) proclamations regarding investigations into various health departments (Gauteng, Eastern Cape)

• SAPS investigations

Access to Information legislation

•The Promotion of Access to Information Act (PAIA) was passed in 2000;•The PAIA aims at giving effect to the Constitutional right of access to information held by the State; or by a private body if the information is required to exercise or protect rights;•In practice, most requests for information under the PAIA are denied thus undermining the aim of the Act. This often results in time-consuming, costly litigation;•Access to information will also be undermined if the Protection of State Information Bill (known as the ‘Secrecy Bill’) is passed.•The Secrecy Bill will prevent the disclosure of any information that is ‘classified’. The power to classify information lies with intelligence and defence structures as well as certain police officials;• Unlike in the PAIA, there is no public interest defence that can be raised in a prosecution for unlawful disclosure.

Governance

Oversight bodies that monitor corruptionCONSTITUTIONAL OVERSIGHT BODIES:

• Office of the Auditor-General – no primary mandate for fighting corruption but does undertake forensic investigations in cases of corruption;

• Office of the Public Protector – mandate to investigate Government departments and make recommendations;

• The Public Service Commission - mandate to investigate and monitor the administration of public service.

CRIMINAL JUSTICE OVERSIGHT BODIES / BODIES WITH INVESTIGATORY POWERS

• Status of the HAWKS:• The HAWKS were part of the South African Police Services (SAPS)

Directorate for Priority Crime Investigation;• the SAPS Amendment Bill came about due to a Constitutional Court

Judgment that found that the HAWKS needed to be structurally independent from (SAPS).

• Bill still has shortcomings.• SIU – investigates cases of fraud and corruption; brings civil actions.

Governance (continued)

Laws dealing with Organised Crime and Corruption

The Prevention and Combatting of Corrupt Activities Act (2004) (PRECCA);• Limited convictions under the PRECCA;• Failure of people in positions of authority to report corruption under

PRECCA.

The Prevention of Organised Crime Act (POCA);• Certain provisions of the POCA have been challenged in a September 2012

Court case;• Challenge based on ‘vagueness of offences’ – in particular, the definition of

racketeering;• Outcome of court case awaited.

Whistle-blower protection• The Protected Disclosures Act (PDA) came into force in 2001;• Under-utilised;• Only applies to employees – no protection for independent contractors or

volunteers;• In practice, protection for whistle-blowers is insufficient.

Governance (continued)

Laws governing procurement generally

Section 217 of the Constitution – principles of procurement:• Fairness;• Equity;• Transparency;• Competitiveness; • Cost-effectiveness.

The Preferential Procurement Policy Framework Act and Regulations:• Pills and capsules must be manufactured locally – according to the

Department of Trade and Industry’s designation under the Regulations that allow for ‘local content’.

The Public Finance Management Act and Regulations:• Governs procurement at National and Provincial level;

The Municipal Finance Management Act and Regulations:• Governs procurement at local level

Governance (continued)

Civil society response and opportunities

Civil society response and opportunities

Health and media

Health and media (continued)

Health and media (continued)

Health and media (continued)