“The public health of a country is the foundation on which all else rests.” – Justice Oliver Wendel Holmes
Throughout centuries of the journey of humanity, one basic truth has emerged – that the wealth of a nation rides on the health of the public. Virgil said that the greatest wealth is health, reiterated years later by Ralph Waldo Emerson – that the first wealth is health. Li Keqiang had the same message – “a healthy population is the foundation of a prosperous and happy nation.” Benjamin Disraeli also associated good health with happiness when he said “The health of the people is really the foundation upon which all their happiness and all their powers as a state depends.” Mahatma Gandhi assessed the benefits of health against material wealth when he said: “It is health that is real wealth and not pieces of gold and silver.”.
Public health is an investment, not a cost. To corrupt it is nothing short of a heinous crime.
The Supreme Court of Sri Lanka seemingly gave these sage observations an implicit nod when it recently issued an interim order suspending further imports of pharmaceuticals from a company reputed to have sold pharmaceuticals of an inferior quality to the authorities of Sri Lanka. These had caused serious deleterious effects on the patients who were administered with them. According to some reports patients had died and some had been rendered blind after ingesting the inferior medication. The court also issued a second interim order that the quality and safety of the drugs which were imported at the time should be proven through tests conducted by an independent party.
According to a report “These interim orders were given on the basis that there was a prima facie case to show that the proper procurement procedure had not been followed and that there was no assurance of the quality and efficacy of drugs obtained through that entity. The matter will be gone into detail in the coming months”.
Deputy Executive Director Sankhitha Gunaratne of Transparency International Sri Lanka (TISL) is reported to have said: “Any procurement needs to be done in a transparent and accountable manner, following competitive bidding in as many situations as possible to get the best value for money. Obtaining good quality, efficacious, and safe drugs and medical supplies for the best possible price should be the objective when it comes to health sector procurement.
If a procurement process is not competitive, that is, if unsolicited proposals are given or the Government proceeds on the basis of single sourcing, it raises a red flag on corruption.
As a watchdog organization on corruption, we believe the Health Minister and the authorities have to act with responsibility and transparency. They must be willing to be accountable to the people for their actions. Making more information public would also allow them to prove their innocence to the public, if there has been no irregularity in the process followed. The committee appointed to look into the recent incidents of drug allergies reported in several hospitals points to a conflict of interest, because the appointments have been made by the Health Minister himself, whose conduct has also been questioned in this instance. The Government should not, in any instance, attempt to bypass Sri Lanka’s procurement process. We have to ensure that our domestic laws are followed to the letter even in emergency contexts”.
Corruption and Public Health
At its core, corruption is the abuse of power or position by individuals, institutions, or authorities for personal gain. In most instances, corruption occurs at the expense of the public good or the well-being of others. It involves dishonest, unethical, or illegal practices, such as bribery, embezzlement, nepotism, favoritism, and other forms of exploitation of entrusted authority. It is said that “corruption can take various forms and can be found in both public and private sectors, affecting governments, businesses, organizations, and societies as a whole. It undermines the principles of fairness, transparency, and accountability, eroding trust in institutions and hindering social and economic development. Many countries and international organizations consider corruption a significant challenge and strive to combat it through legal measures, increased transparency, strengthening of institutions, and public awareness campaigns. The fight against corruption is essential for fostering a just and equitable society where resources are utilized for the greater benefit of all”.
Corruption becomes even more heinous when it involves public health, as the importance of public health has been acknowledged as a paramount human right on a global scale. There are several articles addressing public health in The Universal Declaration of Human Rights (UDHR), adopted by the United Nations General Assembly on December 10, 1948. Admittedly, the Declaration cannot be enforced at law although it is universally recognized as a moral compass for honesty and integrity among nations of the world. It is also a foundational document for the development of international human rights law and sets the standard for the protection and promotion of human rights worldwide.
Article 25 of the Declaration provides : “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” Emphasis is on access to medical care that ensures health and well-being. It recognizes that healthcare is an essential aspect of a dignified life, and that countries should take measures to guarantee access to medical services for all.
There is also Article 12 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR), adopted in 1966, which specifically recognizes the right to the highest attainable standard of physical and mental health which obligates countries to take measures to improve public health and prevent and control diseases.
The United Nations Convention against Corruption (UNCAC) – an international treaty that was adopted by the United Nations General Assembly on October 31, 2003 and entered into force on December 14, 2005 – aims to combat and prevent corruption on a global scale. UNCAC is the first legally binding and comprehensive international anti-corruption agreement, providing a framework for cooperation between countries in the fight against corruption. Its main objectives are: to promote and facilitate international cooperation in combating corruption; to promote measures to prevent corruption and strengthen integrity in both the public and private sectors; to promote the criminalization of various forms of corrupt practices; to enhance transparency and accountability in public administration and management of public finances; and to promote the participation of civil society and the private sector in combating corruption.
Aspects of corruption covered by the treaty include but are not limited to bribery of public officials, embezzlement, money laundering, and illicit enrichment. UNCAC encourages countries to implement effective measures to prevent corruption, such as establishing anti-corruption bodies, enhancing transparency in public administration, and promoting public awareness about the negative effects of corruption.
The main theme of UNCAC is to emphasize the importance of international cooperation and mutual legal assistance in investigating and prosecuting corruption-related offenses. It provides a platform for countries to work together in recovering assets that have been stolen through corrupt practices and returning them to their rightful owners. This treaty has been ratified by a large number of countries..
Sri Lanka signed the Convention on 15 March 2004 and ratified it on 31 March 2004. The Convention entered into force for Sri Lanka on 14 December 2005. Signing the treaty conveys a country’s intent to become a party to the treaty, and ratification is the formal process where the country officially agrees to be bound by the convention’s provisions.
World Health Organization (WHO) – the specialized agency of the United Nations addressing issues of global health – considers it paramount that corruption be eliminated from the public health sector in its member countries. As proactive measures the WHO has developed tools and guidelines that promote transparency, accountability, and good governance in healthcare systems. The organization also advocates for the establishment of robust anti-corruption policies and mechanisms in member countries’ health systems.
It is understood that the bailout of the International Monetary Fund (IMF) to Sri Lanka was conditioned in part on the basis that Sri Lanka takes measures to eliminate corruption. Accordingly, The Parliament of Sri Lanka recently passed the Anti-Corruption Act which is aimed at aligning governmental policy more with UNCAC. One commentator says: “The Act calls for the establishment of a body corporate, known as the Commission to investigate allegations of bribery and corruption. The Commission will consist of three members appointed by the president on the recommendation of the Constitutional Council and one among them will be appointed as the chairman. The members shall hold office for a term of three years. Furthermore, upon the recommendation of the Constitutional Council, the president shall appoint a Director-General, who shall have the powers to: institute criminal proceedings on an indictment or a charge; be the CEO and the CAO of the Commission”.
Under the new Act all public officials including: the President; the PM; Members of Parliament; Governors; members of Provincial Councils and staff; elected local authorities staff and members; judges; judicial officers; staff in Ministries and Departments; officers of the Sri Lanka Army, Navy and the Air Force; Trade Union executives; Chairmen, Directors and staff officers of the registered Companies; Heads of diplomatic missions and officers attached to the missions, are compelled to declare their assets, liabilities of theirs, spouse, dependent children and any other are. Such declared assets and liabilities will be accessible to the general public in centralized electronic system,
A fine equivalent to one thirtieth of the last drawn gross monthly salary, will be charged daily for a person failing to submit the annual declaration or the post-retirement declaration. Election nominees failing to declare are liable to face sanctions. Failure to submit a declaration can also led to legal consequences, including fines based on their income and/or imprisonment for up to one year.
The Anti-Corruption Act declares that some existing acts such the Commission to Investigate Allegations of Bribery or Corruption Act No 19 of 1994, and Declaration of Assets and Liabilities Law No 1 of 1975 as well as The Bribery Act (Chapter 26) are repealed.
Any credible effort at fighting corruption must be transparent and corruption in the health sector in particular and would require sustained efforts and collaboration at the international, national, and local levels. Strengthening institutions, improving data transparency, protection of whistleblowers, and enhancement of citizen engagement to hold authorities accountable for their actions should be paramount. There seems to be no point in ratifying international treaties and palavering the IMF if the Deep State (bureaucracy) does everything to justify the definition of corruption. As the much celebrated and venerated poet once said කෝපමන ගුණ කලත්, dudano නෝවෙති යහපත්, කිරි දියෙනි දෙවියත්, අඟුරු සුදුවන කාලෙක් නම් නැත්. In English this means ” However much you do good to them, the corrupt and evil will not change their ways, inasmuch as charcoal will not turn white just because it is bathed in milk.