This blog examines the role of international organizations in addressing global challenges and highlights the need for reform, especially in the context of the World Health Organization's response to the COVID-19 pandemic.

It introduces prominent international organizations like the UNO, NATO, EU, WTO, G20, and ICC.

For instance, the UNO plays a crucial role in coordinating global health initiatives, while the WTO regulates international trade of health-related goods. These organizations enable cooperation between nations to tackle health issues that are too big for any country to handle alone.

Concerns are raised about their adaptability to evolving global challenges and the effectiveness of the WHO during the pandemic.

What are the main criticisms of the World Health Organization mentioned?

For example, the UN and NATO have collaborated on various health initiatives, such as providing aid during health emergencies and coordinating vaccination campaigns. These efforts demonstrate how these organizations foster international cooperation in the health sector.

Summary of International Organizations and Corruption in Global Health

What are international organizations? 

International organizations facilitate cooperation and diplomatic solutions to global problems.

These organizations, such as the UN, NATO, EU, WTO, G, and ICC, aim to promote peace and prosperity by governing international security, trade, and monetary policy.

International institutions must adapt to evolving global issues. They face criticism regarding outdated rules, power imbalances, and nimbleness in responding to urgent issues.

It's a call to action, underlining the urgency and importance of reforming the WHO's flawed framework.

A hearing examined the WHO's effectiveness, COVID response, and areas for improvement. Officials agreed that reform is needed due to the CCP's lack of transparency.

The Select Subcommittee aims to expose any wrongdoing by China, the WHO, and other public health officials to prepare for future health crises.

The WHO allegedly prioritized CCP interests over global public health during the COVID-19 pandemic.

Key Takeaways

The Biden Administration agrees that the WHO requires urgent reform to strengthen its governance, management, and oversight.

USAID recognizes the WHO's failures during the pandemic and is pushing for reforms to increase effectiveness, transparency, and accountability.

Protecting American sovereignty is essential when discussing WHO reforms.

Member Highlights 

Chairman Brad Wenstrup highlighted the CCP's lack of transparency and the WHO's debatable handling of COVID-19 investigations.

Oversight Chairman James Comer questioned the HHS Global Affairs Assistant Secretary's effort to evade questions about China's culpability during COVID.

Rep. Nicole Malliotakis presented evidence that the WHO covered up CCP failures throughout the pandemic.

Member Highlights:

Rep. Rich McCormick emphasized the importance of prioritizing U.S. sovereignty in discussions on reforming the WHO.

Rep. Michael Cloud criticized the WHO for prioritizing the CCP's political interests over global public health.

Rep. Marjorie Taylor Greene outlined concerns with the Biden Administration's proposed amendments to the International Health Regulations.

Comments on Transparency and WHO's Handling 

Concerns were raised about China's role in the WHO's COVID-19 origin investigation, including its influence on the selection of investigators and the editing of reports.

Officials expressed disappointment with China's lack of transparency and cooperation with the WHO during the pandemic.

The need for a trusting relationship and timely information sharing to respond to global diseases effectively was emphasized.

Discussion on Enforcement and Sovereignty 

The discussion covered the need for enforcement mechanisms for WHO members who don't adhere to the rules and the importance of U.S. leadership in applying pressure.

The need to respect U.S. sovereignty and limit WHO's control was emphasized.

The U.S. advocates for a clear-tiered response system to address health issues of concern and improve transparency and reporting requirements.

The WHO's handling of the Zambon case

The WHO withdrew a report investigating Italy's pandemic preparedness, and Ranieri Guerra allegedly threatened the study's lead researcher.

Francesco Zambon registered concerns about the report's scientific integrity and Guerra's potential conflict of interest, but he received unsatisfactory feedback and no internal inquiry.

Whistleblowers often face retaliation for trying to expose wrongdoing rather than receiving the protection they are entitled to.

Calls for Reform in the Zambon Case 

Transparency International and other organizations requested an independent review of Zambon's disclosures and the WHO's commitment to reform its whistleblowing mechanisms.

Civil society organizations are concerned by the suppression of a scientific report of significant public interest.

An external auditor's report flagged a steep rise in misconduct complaints at the WHO and recommended that the organization strengthen its measures for preventing and punishing wrongdoing.

Whistleblowing and Corruption Impacts 

Strong whistleblowing systems are essential to expose wrongdoing when lives are at stake during crises.

Calls were made for the G20 to strengthen whistleblower protections.

Continuing efforts will seek accountability in Zambon's case and proper recognition of the global public interest in his disclosures.

EU Residents' Beliefs and Corruption 

Calls resulted in the World Health Assembly agreeing to study independent experts' recommendations for bold reforms to strengthen the agency.

Research indicates that most EU residents believe ordinary people can make a difference in the fight against corruption.

Knowing they can safely report wrongdoing encourages people to report corruption, which is essential for preventing corruption.

Concerns about WHO's Power 

The WHO is seeking absolute powers for its director-general, raising concerns about potential corruption and misuse of authority.

The organization has shifted from a broad, interdisciplinary vision of health to a top-down, command-and-control approach, which has failed in crises.

The proposed amendments to the International Health Regulations represent a significant power shift from nation-states to the director-general without accountability.

Potential Impacts of Amendments 

The amendments would change WHO recommendations to commands and loosen the definition of a Public Health Emergency of International Concern (PHEIC).

The director-general could declare a PHEIC based on a potential threat, regardless of the views of the affected state.

The director-general would gain the power to close borders, require vaccine passports, mandate vaccinations, impose quarantines, and censor media.

Evolution and Influence of WHO 

WHO was founded to promote a broad vision of health and coordinate national efforts, but it has been colonized by a narrower biomedical vision.

The focus has shifted to vaccines rather than community engagement, with interventions imposed without considering local contexts.

WHO's dependence on donations from companies and foundations influences its priorities, favouring technology and pharmaceuticals over community-based solutions.

Implications and Governance 

WHO's original mission was to advocate for people with low incomes, not for those who profit from medications or surveillance technologies.

Governments should debate and consider the social, political, and legal aspects of regulation and governance before accepting the IHR amendments.

The WHO should not grant absolute power based on panic during pandemics.

The Critical Health Impacts of Corruption 

Approximately billion of the trillion spent on health care worldwide is lost to fraud and corruption annually.

Corruption contributes to .% of annual deaths in children under, resulting in over deaths.

Insufficient funding, regulatory oversight, and transparency in governance can breed corruption and reduce healthcare quality.

Corruption's Reach and Strategies to Combat It 

One-third of OECD citizens and % of global citizens believe the health sector is corrupt.

Corruption ranges from small-scale acts by doctors and nurses to larger-scale acts at the ministerial level.

Adequate health worker remuneration, public health care system financing, social accountability, and strengthening institutions outside the health sector are strategies to reduce corruption.

Impact and Scope of Corruption 

Corruption remains a significant problem in several countries, hindering the provision of quality health services.

Corruption occurs in health facility construction, supply purchasing, pharmaceutical distribution, and health worker education.

Corruption undermines immunization, increases patient wait times, decreases patient satisfaction, and reduces accessibility of clinics.

Health Consequences of Corruption 

Corruption contributes to .% of annual deaths in children globally.

Infant and child mortality rates in countries with high corruption are almost twice as high as in those with low corruption.

Corruption leads to poor staffing, longer wait times, inequitable care, poor drug quality, and increased financial burden.

Types of Corruption in Health Care 

Types of corruption include fiscal, intellectual, and ethical offences.

Absenteeism healthcare among workers is a common issue, often due to their working in the private sector.

Informal payments (bribes or kickbacks) are made to access care or receive better attention.

Fraud involves false claims to insurance companies or administrative fabrication of patients.

Mismanagement of resources and theft of supplies, such as drugs and equipment, are also common.

Studies show that people who report issues like absent doctors and drug stockouts are more likely to report paying bribes.

Fraud and Mismanagement 

Fraud plagues countries regardless of income status, with false claims to insurance companies being common.

Mismanagement of resources includes purchasing unnecessary equipment or engaging in corrupt deals with companies.

Pilfering of supplies involves diverting medicines and equipment along the supply chain for resale.

Corruption Publications and UHC Challenges 

A literature search identified articles related to corruption in health care, showing increasing interest in understanding and reducing its occurrence.

The healthcare sector suffers from market failures due to its complex nature and information asymmetry.

Due to the linkages among governance, spending, and health care, achieving UHC is impossible in countries plagued by corruption.

Determinants of Corruption and UHC 

High out-of-pocket (OOP) spending percentages open the door to informal payments and corruption.

Mixed healthcare systems often suffer from poor performance due to insufficient state funding, regulatory oversight, and transparency in governance.

Lack of transparency in governance includes administrative malpractices and laws benefiting only a few.

Public-Private Mix and Leadership 

The public-private mix does not guarantee poor quality, but local-adapted public policies are needed.

Transparent stewardship is required to ensure quality healthcare services, regardless of the national health infrastructure.

Stronger governance is associated with higher life expectancies and lower mortality rates.

Linkages Among Governance, Spending, and Health Outcomes 

Quality governance exists when the exercise of public power is based on impartiality.

Studies have found a positive association between a country's quality of governance and its population health measures.

Good governance is necessary for national healthcare systems to work optimally.

Strategies for Reducing Corruption in Health Care 

Strategies include adequate remuneration of health care workers and public health care system funding.

Community, public, and social accountability and the strengthening of institutions outside the health care sector are important.

Labour laws, professionalization, codes of conduct, and monitoring of payment schemes should support remuneration.

Accountability Measures and Leadership 

Accountability strategies involve direct engagement between users and providers.

Transparency in pricing and procurement can decrease price variations and collusion.

Community accountability needs to be backed by leadership and oversight.

Institutional Strengthening and Summary 

Strong institutions are necessary to detect, correct, and prevent corruption.

Systems of well-performing government can be created through an apolitical civil service, budget processes, and transparent financial management.

Corruption leads to declining trust, reduced quality of care, and worsened health outcomes.

Solutions and Recommendations 

Social accountability, government institutions, and transparency can curb corrupt practices and improve healthcare system responsiveness.

Transparency in the pricing of medical supplies decreases price variation.

Hiring outside individuals can roll back vested interests and create an impetus for positive change.

Recommendations and Context 

Ministries of health should include safeguards against corruption in their national healthcare quality strategies.

The health sector should draw on expertise and resources outside the healthcare system to combat corruption.

Until these safeguards are in place, universal health care may be subverted.

Introduction to Corruption in Global Health 

Global health breakthroughs are undermined by corruption.

Corruption threatens global health, requiring research and funding for new models to combat it.

Corruption can be seen as a coping mechanism, but it is an open secret and a substantial cost-related driver affecting sustainability.

The Impact of Corruption 

Foreign aid for health has fueled corruption globally, creating unsustainable practices such as paying for training.

Corruption affects the poor and most vulnerable, violating the rights of individuals and communities.

Corruption annually takes the lives of at least children and undermines efforts to control diseases.

The Origin and Spread of Corruption 

Corruption is "the abuse of entrusted power for private gain".

There are apparent differences in what happened with nations in the north compared with the south, which could explain the endemicity and higher corruption in the latter.

The spread of corruption is linked to profound changes after World War and with the Cold War.

Factors Influencing Corruption Spread 

Global markets facilitated corruption through expedited interactions with new places.

The role of developed countries must be recognized in developing countries' supply side of the corruption equation.

The health sector is an attractive target, influenced by organizational factors and societal adherence to the rule of law.

Corruption's Impact on Health 

Corruption threatens efforts to reach universal health coverage and achieve the UN's Sustainable Development Goal.

Corruption limits access to health services, affecting equity, quality, efficiency, and health outcomes.

Corruption demotivates human resources and is a "cancer of our health systems".

Financial Costs of Corruption 

The world spends over US$ trillion on health services, with -% lost through corruption annually.

The true cost of corruption is immeasurable, representing the difference between wellness and illness, life and death.

The amount of corruption could be expressed as C=M + D – A.

Characteristics and Susceptibility 

The characteristics of health systems are such that the amount of corruption will be higher.

The system's complexity, high public spending, market uncertainty, information asymmetry, and the presence of many actors interact, increasing susceptibility to corruption.

Global healthcare expenditures are on the rise due to growing ageing populations, chronic and more complex diseases, and pressure to acquire high-tech and costly equipment.

Types of Corruption in Health 

Corruption in health ranges from petty to high-level national or multinational and presents in different ways, such as bribery, extortion, theft, embezzlement, nepotism, and undue influence.

It appears in service provision, purchase and distribution of equipment and drugs, regulation, hiring, and construction of facilities.

Absenteeism is a common form of corruption, affecting -% of employees globally.

Informal Payments and Embezzlement 

Corruption also takes the form of informal payments from patients, which often represent bribes.

Embezzlement and theft of money, supplies, and medications are clear-cut forms of corruption.

Corruption in service provision includes treatments, procedures, and referrals not driven by medical considerations alone, causing over or under-provision.

Corruption Examples and Issues 

One example in Peru is the conflict between health professionals who refuse to allow trained midwives to do procedures due to fear of losing clients.

Favouritism means that care is given preferentially, affecting other patients' care.

Data manipulation includes billing for goods and services never sent or performed and misreporting public health activity coverage.

Day-to-Day Corruption 

Individual acts of corruption at the level of patient-provider interactions have a damaging effect.

These acts include delaying services, diverting supplies, overcharging patients, and collusion with external pharmacies.

Health workers may deliberately damage equipment in public facilities to force patients to pay for private services.

Illustrative Corruption Cases 

Commuting medications from public hospitals to private pharmacies is one of the worst problems in Peru.

Jaladores (pullers) outside hospitals direct patients to private pharmacies where they can buy medications.

Corruption was one of the biggest challenges as Minister of Health, including fraud in the comprehensive health insurance programme.

Corruption Control Measures 

To be effective against corruption, actions should be informed by theory, guided by evidence, and adapted to the context.

Theories for controlling corruption include creating strong institutions and focusing on people's thinking.

International efforts to combat general corruption have gained attention, and good governance is crucial for a well-functioning health system.

Corruption Prevention Strategies 

Key factors to address include power abuse, financial pressures, and a culture that accepts corruption.

Suggested measures include strengthening accountability, improving data and supervision, providing incentives, increasing transparency, and law enforcement.

A lack of research on corruption in the health sector was found using PubMed.

Research and Real-World Anti-Corruption Measures 

Success in tackling corruption is possible, even though it can be difficult initially.

Suggestions for strategies to confront corruption include improving financial management, managing conflicts of interest, and using technology platforms for surveillance.

Countries working in this area can help us better use data, with electronic health records potentially upholding accountability.

Research Gaps and Future Directions 

The cost-effectiveness of technologies for authentication or verification of products should be measured.

Key questions need to be answered through well-designed research focused on preventing corruption in the health sector.

Researchers from several disciplines must participate, and funders must commit to supporting serious research.

Call to Action 

Anti-corruption interventions for the health sector should be designed and tested, starting from the bottom up.

Interventions against corruption should receive more significant funding.

All countries should be committed to eliminating corruption in health.

What are the main criticisms of the World Health Organization mentioned?

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