The Health Transparency Initiative supports projects to raise citizen voice and monitor health sector performance. The pilot project, in Kerala India, is introducing participatory and transparent procurement and distribution of drugs and medical equipment and conducting social audits of basic health service delivery.

In developing countries, corruption in the health sector represents one of the most significant challenges to the delivery of effective health care and to the efficient use of public resources. Drugs and medical supplies disappear from clinics, and available drugs are often counterfeit. Hospitals require prepayment for services that should be provided for free. Corruption in the procurement of drugs, medical equipment and supplies leads to diversion of scarce resources, and overpriced products and goods of inferior quality. It has been estimated that corrupt practices in the health sector may total more than $400 billion annually, or about 15% of the more than $3 trillion spent on health globally.

The situation in the Thrissur District of Kerala, India, is particularly acute.  At the General Hospital, all seven surgical theatres, intended to perform more than 2000 procedures per month, have remained closed for over a year after a court order deemed them inhabitable because of a rodent infestation. Likewise, an audit report from the Comptroller & Auditor General (CAG) of public health care in Kerala in 2014 noted that drugs expired drugs distributed to patients and irregular supply of medicines leading to artificial drug shortages, consequently forcing poor patients to buy essential medicines at higher prices from private sources.

In order to address the problems in Thissur and begin to build the knowledge base for fighting corruption in public healthcare worldwide, PTF is supporting a project led by local CSO, Jananeethi, to improve operational quality and efficiency of healthcare services reducing corruption in health service delivery. The year long project will focus on two primary objectives: 1) introducing participatory and transparent procurement and distribution of drugs and medical equipment and 2) produce Social Audits of basic health services delivered at Primary Health Centres (Panchayath Level), Community Health Centres (Block Level), and the District Hospital (District Level).

Through the program Jananeethi will:

  • File right to information applications to collect and analyze data on the quality/availability of health services and local fund utilization
  • Identify irregularities, inefficient and corrupt practices and inform the public and government officials, and when necessary and appropriate, file Public Interest Litigation in the High Court of Kerala
  • Conduct a baseline survey on the perceived quality of care of public health care users
  • Interview and conduct focus group discussions with medical and non medical staff, members of Hospital Development Committees, members of Local Governments, Civil Society Organizations and the Media
  • Disclose information on the services available at the hospital, rights of patients through display boards
  • Organize public hearings for aggrieved patients persons

These activities are expected to lead to increased citizen participation in monitoring and pressuring the government to insure the quality of public health service delivery.