Using the euphemistic “informal payments”, a joint publication of the African Development Bank and the World Health Organization Regional Office for Africa says that “around 1 percent” of people in Botswana reported paying bribes for healthcare.
“Informal payments are cash or material benefits given to healthcare staff to obtain healthcare or special treatment by means or in amounts that are not officially sanctioned. Staff may charge patients for reduced waiting times or access to better treatment. They may also charge fees for drugs and supplies that are supposed to be free. They may charge for making referrals to specialists or other facilities,” says the AfDB and WHO report adding that in extreme cases in countries where more people pay bribes for healthcare, “facilities may demand payment by detaining patients at a facility, even women with newborn infants.”
The latter is certainly not happening in Botswana but on account of its persistently long and unmanageable queues, the country is not spared some of the forms of bribery that the report mentions. At 5 percent, Botswana’s out-of-pocket health spending as percentage of total health expenditure is among the lowest in Africa and necessarily means that some 95 percent of Batswana use public healthcare facilities. Queues at healthcare facilities are among the worst managed in the country and this has created a market for corruption. When the Covid-19 national vaccination programme was rolled out last year and queues were extremely long, there was a newspaper article about a healthcare worker (possibly a nurse) offering vaccines at a fee when the vaccines are actually administered free of charge.
The AfDB/WHO report says that paying bribes for healthcare services creates barriers to healthcare services, primarily among lower income groups; distorts the decisions of staff members in terms of the allocation of resources across services and patients; interferes in the incentive and performance management systems of the formal institutions within which staff are employed; and is usually regressive, with poorer people paying larger shares of their income for healthcare than richer people.
In a different context, Covid-19 bred a species of crime that thrives in the health sector. The government has poured hundreds of millions of pula into the Ministry of Health and Wellness to help fight the pandemic but some of that money has either been mismanaged or criminally tricked out of the government system. One result has been the emergence of what has been referred to as “Covid-19 millionaires” who got filthy rich off the pandemic budget. Last year, the government ordered an audit into Covid-19 expenditure and the resulting report exposed what can be classified as financial mismanagement. Audit reports are typically edited by the powers-that-be who typically edit out what is downright criminal. The latter would certainly have happened with the Covid-19 audit report.