Corruption in Mozambique’s public health service

Corruption in Mozambique occurs at the last place that it should happen… in the health sector. Sick people wait for hours upon hours outside of public health centers because they don't have enough money for bribes. The people that have money or connections are treated right away. The low wages earned by nurses and receptionists is believed to be the cause of the corruption.

From IRIN, this story looks into how the corruption effects the health of the public. 

Eulalia Laichela caressed her six-year-old son, Leosio, who lay on the pavement, coughing from beneath a blanket. They had been waiting in the park outside José Macamo, one of the largest hospitals in Mozambique's capital Maputo, since early morning.

Laichela hoped her sister-in-law, who works at the hospital, would help find a doctor to attend to Leosio before the end of the day. Waiting in the queue at the hospital's reception area was not an option, she said.

"If you don't have extra money to pay the doctor, there is no point in doing that. There are many people outside waiting, and they sit there hour after hour without being attended to," she told IRIN.

Ansina was among the patients waiting in the queue. She feared she had malaria but lacked family connections or money for a bribe. "Something is wrong. I have number 142, and they are calling 188. I have been waiting here since this morning," she complained to the man next to her. He told her that it is patients’ money that determines who goes first, not their medical conditions.

"That´s why we are still here," he said. Ansina agreed.

Corruption is rife in Mozambique's public health sector. According to a 2006 study by the Centre for Public Integrity (CIP) in Maputo, corruption is present at all levels in the system: from the reception to the laboratory, during appointments with doctors, and even at the morgue.

A 2011 regional household survey by Transparency International found that nearly 40 percent of Mozambican respondents had paid bribes for medical services in the past year - the highest such figure in the region. In Mozambique, it was second only to the percentage that had paid bribes to the police.

Poor pay

The CIP study identified low salaries as one of the main causes of health sector corruption. A doctor identified as Cossa*, who has worked at hospitals in Maputo over the last 18 years, agreed. Doctors earn between US$700 and $1,000 per month, and the lowest paid nurses earn just over $100 - no more than a domestic worker.

Cossa maintained that most bribes are paid to the nurses and other workers who see patients before they reach a doctor. But he added that doctors earn additional income in other ways. For example, most public-sector doctors also work at private clinics; according to the CIP study, this makes them chronically tired. The study links the deterioration of public sector health care to a 1998 government decision to allow public-sector doctors to also work in the private sector.

Cossa noted that by 10am, the majority of doctors have already left the city's public hospitals for their private-sector jobs.