New non-profit attempts to develop production facility for new tuberculosis vaccines

A man named Jerald Sadoff rushes from room to room down a corridor sealed by air locks from the outside world, pointing toward elegant contrivances of pipes and valves and vessels. Afternoon sun filters through thick plate windows, and stainless-steel surfaces gleam.

Theft, bribery and extortion deprive millions of proper healthcare

(London, February 1, 2006) Corruption in the health sector deprives those most in need of essential medical care and helps spawn drug-resistant strains of deadly diseases, says Transparency International’s Global Corruption Report 2006, published today.

For the millions of poor held hostage by unethical providers, stamping out corruption in health care is a matter of life and death. “Corruption in health care costs more than money. When an infant dies during an operation because an adrenalin injection to restart her heart was actually just water – how do you put a price on that?” said Huguette Labelle, Chair of Transparency International. “The price of corruption in health care is paid in human suffering.”

Hemorrhaging health systems

The report shines a powerful light on the global US $3 trillion health sector, exposing a maze of complex and opaque systems that are a fertile field for corruption. While the majority of people employed in the sector perform their functions with diligence and integrity, there is evidence of bribery and fraud across the breadth of health services, from petty thievery and extortion to massive distortions of health policy and funding fed by payoffs to officials.

Corruption permeates the provision of health care, whether public or private, simple or sophisticated.

  • Public health budgets become subverted by unethical officials for private use.
  • Hospitals function as self-service stores for illicit enrichment, with unclear procurement of equipment and supplies and ghost employees on the payroll.
  • Health workers demand fees for services that should be free. In Bulgaria, as in much of South East Europe, doctors frequently accept small informal payments or gifts for medical treatment. This can be anything from between US $10 – US $50 and in some cases can rise to US $1,100.
  • In the Philippines, a 10 per cent increase in the extortion of bribes by medical personnel was shown to reduce the rate of child immunization by up to 20 per cent.
  • In Cambodia, certain health indicators have worsened partly because of direct embezzlement of public health funds and despite increased health aid. In contrast, in the United Kingdom tighter control mechanisms have reduced losses to corruption by US $300 million since 1999.
  • In Costa Rica, nearly 20 percent of a US $40 million international loan for health equipment wandered into private pockets.

“Corruption eats away at the public’s trust in the medical community. People have a right to expect that the drugs they depend on are real. They have a right to think that doctors place a patient’s interests above profits. And most of all, they have a right to believe that the health care industry is there to cure, not to kill,” said David Nussbaum, Chief Executive of Transparency International.

Market distortions and counterfeit drugs

Aggressive marketing techniques buy physicians’ support for specific drugs, leading to a high rate of prescriptions that are not always based on patient need. With individual “blockbuster” drugs pulling in tens of billions of dollars each year for pharmaceutical companies, ballooning marketing and lobbying budgets have outpaced the research and development outlays necessary to create new and critical medicines that could save lives in low-income countries.

Corruption underpins a lucrative counterfeit drugs trade. Payoffs at every step of the chain smooth the flow of counterfeit drugs from their source to the unwitting consumer. With pharmaceuticals often the largest household health expenditure in developing countries – estimated at 50-90 per cent of total individual out-of-pocket health expenses – corruption in the pharmaceutical industry has a direct and painful impact on people struggling for survival.

Undermining the fight against HIV/AIDS

Corruption has hampered the success of global efforts to reign in the HIV/AIDS pandemic. The international response to the growing crisis has been to scale up aid in order to fund prevention programs and the disbursement of life-saving anti-retroviral medications. Increased aid alone will not be effective if corruption is not curbed. Accountability mechanisms need to be introduced to prevent money from leaking at every level.

  • Theft by ministries and national AIDS councils of funds allocated for treatment leave sufferers without critical care. Kenya’s National Aids Council was hijacked by a few high-level civil servants, diverting critical resources through shell organizations expressly formed to siphon off public funds.
  • Corruption can contribute directly to infection when relatively low-cost measures, such as sterile needles and screening of blood donations, cannot be carried out because a corrupt procurement or distribution process holds up supplies.

Millennium Development Goals under threat

Corruption is undermining progress towards the United Nations’ Millennium Development Goals, in particular the three related directly to health: reduced child mortality; improved maternal health; and the fight against HIV/AIDS, malaria and other diseases. With the target date for achieving the goals just nine years away, the global community is already off target to meet them – and corruption is one of the primary causes.

“Poor families, particularly in rural areas, who cannot afford private health care face the agonizing choice of food or medicine. Feed your child or cure his illness, but not both? No parent should face that awful choice,” said Huguette Labelle.

Transparency International recommendations

The cure for corruption in the health care industry starts with transparency.

  • Donor and recipient governments should grant easy access to information on key aspects of health-related projects, budgets and policies. Budget information should be available on the internet and subject to independent audits.
  • Adopt and enforce codes of conduct for health workers and private sector companies and provide ongoing anti-corruption training.
  • Incorporate conflict-of-interest rules in drug regulation and physician licensing procedures.
  • Public health policies and projects should be independently monitored, both at the national and international level, and their reports should be open to public scrutiny.
  • Procurement processes should be competitive, open and transparent, and comply with Transparency International’s Minimum Standards for Transparency and Public Contracting. Rules on conflicts of interest must be enforced and companies that engage in corruption debarred from future bidding. No-bribe pledges such as TI’s Integrity Pact should be adopted to level the playing field for all bidders.
  • Rigorous prosecution will send the message that corruption in health care will not be tolerated. To facilitate this, there must be robust whistleblower protection for both government employees and private sector health, pharmaceutical and biotech employees.

State of corruption worldwide

The Global Corruption Report 2006 also presents reports on the state of corruption and governance in 45 countries around the world, including troubling evidence of financial irregularities in post-tsunami relief operations. The report’s final section surveys the cutting edge in corruption research.

Transparency International is the global civil society organization leading the fight against corruption. The full Global Corruption Report 2006

Orphans and vulnerable children are now 5 percent of Nambia’s population and expected to be 10 percent within 15 years

The European Commission has deferred a decision on Kenya’s request for €125 million (about US $153 million) in budgetary support to allow for further discussions on the issue of governance, amid concerns that high-level corruption had not yet been properly addressed.

Dispossessing Africa’s wealth

(November 24, 2005) There is a timeless line of argument from Walter Rodney’s 1973 book ‘How Europe Underdeveloped Africa’: ‘The question as to who and what is responsible for African underdevelopment can be answered at two levels. Firstly, the answer is that the operation of the imperialist system bears major responsibility for African economic retardation by draining African wealth and by making it impossible to develop more rapidly the resources of the continent.’

‘Secondly, one has to deal with those who manipulate the system and those who are either agents or unwitting accomplices of the said system.’

Sub-Saharan Africa today still suffers the dispossession of wealth, along two trajectories: South-North resource flows, and adverse internal class formation. In the former case, the central processes are associated with exploitative debt and finance, phantom aid, capital flight, unfair trade, distorted investment, ecological exploitation and the ‘brain drain’.

In the latter case, instead of accumulation and class formation via an organic middle class and productive capitalist class, Africa has seen an excessively powerful ‘comprador’-oriented ruling elite whose income is based upon financial-parasitical accumulation and political-bureaucratic patronage power, which in turn is then subject to vast capital flight.

Although remittances from the Diaspora now fund development and even a limited amount of capital accumulation, capital flight is far greater. At more than $10 billion/year since the early 1970s, collectively, the citizens of Nigeria, the Ivory Coast, the DRC, Angola and Zambia have been especially vulnerable to the overseas drain of their national wealth. A major factor during the late 1990s was the relisting of the primary share-issuing residence of the largest South African firms, from Johannesburg to London.

In Washington, perhaps the most highly regarded of African elites is South African finance minister Trevor Manuel, who until late last month served as chair of the World Bank/IMF Development Committee. Having failed for four years to get even partial democratisation of the Bretton Woods Institutions onto the committee’s agenda, Manuel gloried in the return of attention to Africa: ‘Right now, the macroeconomic conditions in Africa have never been better. You have growth across the continent at 4.7%. You have inflation in single digits. The bulk of countries have very strong fiscal balances as well.’

These statements are true only if we take misleadingly narrow economic statistics seriously. Fortunately we don’t need to because even the Bank is occasionally compelled to confess how Africa is drained of ‘genuine savings’ through depletion of minerals and forests, and other eco-social factors which ostrich-like economists invariably ignore.

Manuel’s riff sounds impressive. Indeed, because of structural adjustment austerity, African states reduced their early-1990s deficit rates of around 6% of annual output, to just under 4% today.

However, the fastest growing economies actually increased their deficits by a full percentage point over the last decade, suggesting that Keynesianism still works as well for African elites as it does for George Bush.

Meanwhile, monetary policy was tightened, interest rates soared and African central banks – typically run by IMF or ex-IMF staff – were discouraged from printing money (which sometimes fuels inflation).

Price increases were reduced from double-digit rates prior to 2004 to an average of 9% this year. However, that level is far too low for a developmental trajectory, former Bank chief economist Joseph Stiglitz argued in his ‘Post-Washington’ critique of economic orthodoxy.

Bank president Paul Wolfowitz – architect of the Iraq War – was in a sporting mood at Manuel’s Development Committee press conference on September 25: ‘The path has been cleared to complete debt relief, and at the risk of a dangerous metaphor, I think Trevor has given us the ball right in front of the goal, and the goalie has tripped, and all we have to do now is kick it in.’

A dangerous move indeed, for Manuel warned of at least one more hurdle: ‘a legal challenge because countries may feel that some have been favoured against others. My understanding is that both Rodrigo [Rato, IMF managing director] and Paul will go before their boards, sort out what the equality of treatment principle would be in each of the instances, and ensure that there is equality of treatment.’

It seems the Inter-American Development Bank and Asian Development Bank won’t participate in the debt relief pantomime. So 14 African countries favoured by the G8 – and four others in Asia and Latin America – will get a few crumbs of relief, costing the G8 less than $2 billion per year to service (on $40 billion in outstanding debt).

But because their leaders have ceased putting up a fuss, the debt of these 18 is reduced: not to nothing, but to levels where the Bank and IMF retain macroeconomic control, so that capital flight and ultra-cheap commodities can continue their outward flow.

None of the trade reforms proposed for the Hong Kong WTO meeting in December will alter the basic calculus of long-term decline for their (non-oil) primary commodity prices. Christian Aid recently estimated the damage done to African countries by trade liberalisation at $272 billion since 1980.

Even in the face of those ‘internal contradictions and conflicts’–including vast overcapacity, wars, real estate bubbles, hurricane repairs, debt crises and balance of payments problems – men like Wolfowitz can afford to make small concessions. After all, Third World repayments of $340 billion each year flow northwards to service the $2.2 trillion debt. This is more than five times the G8’s development aid budget (and ten times the level of Northern donations once we subtract the ‘phantom aid’ which never reaches the masses).

As Brussels-based debt campaigner Eric Toussaint concludes, ‘Since 1980, over 50 Marshall Plans worth over $4.6 trillion have been sent by the peoples of the Periphery to their creditors in the Centre’.

Consider, as well, the South as ecological creditor. According to ecologist Joan Martinez-Alier, ‘The notion of an ecological debt is not particularly radical. Think of the environmental liabilities incurred by firms under the United States Superfund legislation.

Although it is not possible to make an exact accounting, it is necessary to establish orders of magnitude in order to stimulate discussion.’ Martinez-Alier and Jyoti Parikh of the UN International Panel on Climate Change argue that based upon the Third World’s role as a carbon sink, an estimated annual subsidy of $75 billion flows South to North. Africans are most exploited because non-industrialised economies have not begun to utilise more than a small fraction of what should be due under any fair framework of global resource allocation such as carbon emissions.

The amounts involved would easily cover financial debt repayments. Instead, the G8 Gleneagles scam keeps poor countries down in several ways. According to Jubilee South: ‘The multilateral debt cancellation being proposed is still clearly tied to compliance with conditionalities which exacerbate poverty, open our countries further for exploitation and plunder, and perpetuate the domination of the South. Even if the debt cancellation were without conditionalities, the proposal falls far too short in terms of coverage and amounts to demonstrate a bold step towards justice by any standard.’

However, almost by accident another Bank document began to do the rounds just prior to the Bank/IMF Annual Meetings: ‘Where is the Wealth of Nations?’ Here at least, World Bank environmental staff recognise that foreign investors may diminish overall wealth and savings, once resource depletion and pollution are factored in.

(To be sure, the Bank adopts a minimalist definition based upon current pricing – not potential future values when scarcity becomes a more crucial factor, especially in the oil sector. Nor do Bank economists yet deign to calculate the damage done to local environments, to workers’ health/safety, and especially to women and vulnerable people in communities around mines. And unpaid household and community work is still left out of national statistical accounts, reducing women’s labour to a nil value.)

What investments are most important, then? Dating to the mid-1990s, foreign direct investment has flowed mainly into oil rigs in the West African Gulf of Guinea and Angola’s offshore Cabinda field, aside from an ill-fated South African privatisation spree in 1997.

Meanwhile, corrupt host regimes waged war against their people, not only in Angola (where formal conflict ended after a rightwing Unita guerrilla movement faded following Jonas Savimbi’s death). In addition, as Amnesty International pointed out last month, the Bank was meant to finance the multi-billion dollar Chad-Cameroon pipeline to add human rights sensitivity, but deepening repression is the actual result.

Other Africans suffering oil depletion under dictatorial or militarised conditions include citizens of the Republic of the Congo, Equatorial Guinea, Gabon, Nigeria and Sudan.

South Africans are also implicated in a kind of subimperial looting of oil. At the country’s annual Political Science Association conference in KwaZulu-Natal last month, senior government researcher John Daniel shifted from claiming in 2003 that ‘non-hegemonic co-operation has in fact, been the option embraced by the post-apartheid South African state.’

After reviewing the record of the African National Congress (ANC) in the continent’s energy sector, especially Sudan and Equatorial Guinea, he conceded, ‘The ANC government has abandoned any regard to those ethical and human rights principles which it once proclaimed would form the basis of its foreign policy.’

Big Oil celebrated this state of power relations at the World Petroleum Congress in Johannesburg last month. Opponents also came together, invited by the excellent NGO groundWork. The Ogoni people, for example, demanded reparations not only for the thorough destruction of their Delta habitat, but also for the depletion of what economists call ‘natural capital’.

How much natural capital value is removed from Africa? In South Africa, the value of minerals in the soil fell from $112 billion in 1960 to $55 billion in 2000, according to the UN, while Africa as a whole suffers negative net annual savings.

Adding not just oil-related depletion but other subsoil assets, timber resources, nontimber forest resources, protected areas, cropland and pastureland, the Bank calculates that Gabon’s citizens lost $2,241 each in 2000, followed by people in the Republic of the Congo (-$727), Nigeria (-$210), Cameroon (-$152), Mauritania (-$147) and Cote d’Ivoire (-$100).

In addition to mineral depletion worth 1% of national income each year, the Bank acknowledges that South Africans lose forests worth 0.3%; suffer pollution (‘particulate matter’) damage of 0.2%; and emit C02 that causes another 1.6% of damage. In total, adding a few other factors, the actual ‘genuine savings’ of South Africa is reduced from the official 15.7% to just 6.9% of national income.

These analyses, documents and calculations are new and fresh, and should shame those who claim international integration can enrich Africa. The opposite is more true.

Unlike Trevor Manuel, African justice activists like those who met at groundWork’s conference know it. They wrote to officials of the World Petroleum Congress: ‘At every point in the fossil fuel production chain where your members “add value” and make profit, ordinary people, workers and their environments are assaulted and impoverished. Where oil is drilled, pumped, processed and used, in Africa as elsewhere, ecological systems have been trashed, peoples’ livelihoods have been destroyed and their democratic aspirations and their rights and cultures trampled.’

The letter concluded, ‘Your energy future is modeled on the interests of over-consuming, energy-intensive, fossil-fuel-burning wealthy classes whose reckless and selfish lifestyles not only impoverish others but threaten the global environment, imposing on all of us the chaos and uncertainty of climate change and the violence and destruction of war. Another energy future in necessary: yours has failed!’

Indeed the Southern African Social Forum in Harare earlier this month generalised this sentiment to the entire set of economic relations that dispossess Africa of all kinds of wealth.

Patrick Bond is based at the University of KwaZulu-Natal Centre for Civil Society. This work is part of a larger study carried out in collaboration with the Johannesburg-based Southern African Centre for Economic Justice and Harare-based Equinet, and participants at their 10-12 October workshop in Harare are thanked for feedback. Comments are welcomed, at pbond@mail.ngo.za. This article first appeared in Pambasuka News, a “weekly forum for social justice in Africa,” which may be accessed at www.pambazuka.org and where signup is available for its weekly email newsletter.

Drought Magnifies Hunger, Suffering of Children in Malawi: Rural Village Tracks Malnutrition’s Toll on Young

MBADZO, Malawi — One by one, the women of this hungry village untied their babies from their backs and hung them on a scale dangling from the limb of a mango tree. As a volunteer called out the weights, Anna Bande, a nurse, grimly plotted the toll of southern Africa’s latest drought on Malawi’s young.