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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)