Even during years not beset by a global health crisis, around 7 percent (an astonishing USD 455 billion annually) of global health spending is lost to corruption. Health systems are unusually vulnerable to corruption and fraud, given the availability of large financial resources; involvement and fragmentation of multiple stakeholders both within government, at the central and local levels, and within the global supply chain for medicine and medical equipment; asymmetries in information across the health system; and inherent difficulties in controlling inventories at service-provider level, which often opens the door for outright theft. The pervasiveness of health system corruption, implies that transparency, and the accountability it enables, are indispensable in achieving health objectives more front of mind in normal times, such as universal health coverage, and now, to mitigate the spread and manage the impact of COVID-19.
More than half a year into the pandemic, there remains consensus that governments must do whatever they need to prevent loss of lives and economic hardship. However, as we become more settled into our new normal, greater emphasis is, understandably, on transparency of and accountability for COVID-19-related expenditure. While anti-corruption conversations seem to centre around developing country governments, fraud and corruption within healthcare procurement and service provision prosper in countries at all levels of income. And given that governments across the world have introduced emergency procurement regimes and are funnelling money wherever it is needed, as quickly as possible, all face far greater potential for fraud, mismanagement and general inefficiencies than usual. Moreover, parliamentary scrutiny and oversight may be a less effective accountability measure now, given that many parliaments are either not meeting in person or only meeting for matters of absolute necessity, such as voting on urgent bills or those vital in addressing the pandemic.
However, throughout Africa, we see a fiscal transparency deficit, pervasive information asymmetries in health systems, and weak budgetary oversight due to unsupportive legal frameworks, under-funded and poorly capacitated accountability institutions, disproportionately strong executives and limited mechanisms for participation. This status quo, compounded by the need to mitigate against abuse of chronically, and now acutely, limited financial resources for health in Africa, implies that COVID-19 transparency and accountability is perhaps of even greater concern for African governments. Experience with the Ebola epidemic reiterates this: in Sierra Leone, a 2015 audit of the government’s Ebola response effort reflected gross mismanagement by officials, particularly within the Ministry of Health and Sanitation. Payments for supplies and education campaigns were duplicated and 30 percent of funds were disbursed without supporting documentation, funds were given to private individuals instead of established organisations, and procurement rules set out in the Public Procurement Act of 2004 were frequently circumvented. Audits of international development organisation expenditure also reflected that healthcare workers’ salaries and bonuses were paid to private individuals.
It is therefore unsurprising that over the past five months, African governments have committed to stringent measures to ensure accountability of emergency spending and limit the risk of corruption and fraud. These have included committing to (i) publishing COVID-19 procurement contracts above a minimum value, (ii) publishing names and beneficial ownership of companies awarded contracts, (iii) validating delivery of services and goods, (iv) undertaking more frequent internal audits, (v) publishing COVID-19-specific, (vi) reporting more frequently, (vii) publishing expenditure reports, and (viii) developing specific budget lines for COVID-19 reporting. While governments would and have made these commitments independent of third parties, development partners, particularly the international financial institutions, have also demanded that funding recipients commit to greater transparency and accountability. Through CABRI’s COVID-19 Public Finance Response Monitor, we have been closely tracking these measures, a summary of which is presented in the following table:
| Country | Publishing COVID-19 procurement contracts | Publishing names of companies awarded contract | Publishing beneficial ownership information of companies receiving contracts published | Validation of delivery of products and services | More frequent internal audits | Specific COVID-19 external audit | Audit findings to be made publicly available | More frequent reporting of COVID-19 expenditure | Publishing expenditure reports | Specific budget lines for COVID-19 reporting |
|---|---|---|---|---|---|---|---|---|---|---|
| Algeria | ||||||||||
| Angola | ||||||||||
| Benin | x | x | x | x | ||||||
| Botswana | x | |||||||||
| Burkina Faso | x | |||||||||
| Burundi | x | x | ||||||||
| Cabo Verde | ||||||||||
| Cameroon | x | x | x | x | x | |||||
| CAR | x | x | ||||||||
| Chad | x | |||||||||
| Comoros | x | x | x | x | x | x | ||||
| Congo | ||||||||||
| Côte d'Ivoire | ||||||||||
| Djibouti | x | x | x | x | ||||||
| DRC | x | x | x | |||||||
| Egypt | ||||||||||
| Equatorial Guinea | ||||||||||
| Eritrea | ||||||||||
| Eswatini | x | x | x | x | x | x | x | x | x | |
| Ethiopia | x | x | ||||||||
| Gabon | x | x | x | x | x | x | ||||
| Gambia | x | x | x | |||||||
| Ghana | x | |||||||||
| Guinea | x | x | x | x | x | x | x | x | x | |
| Guinea-Bissau | ||||||||||
| Kenya | x | x | ||||||||
| Lesotho | x | x | x | x | x | x | x | x | ||
| Liberia | x | x | x | x | x | x | x | x | ||
| Libya | ||||||||||
| Madagascar | ||||||||||
| Malawi | x | x | x | x | x | x | x | |||
| Mali | x | x | x | x | x | x | x | |||
| Mauritania | x | x | x | x | x | x | ||||
| Mauritius | x | |||||||||
| Morocco | ||||||||||
| Mozambique | x | x | x | x | x | |||||
| Namibia | ||||||||||
| Nigeria | x | x | x | x | x | x | ||||
| Rwanda | x | x | x | x | ||||||
| Sao Tome and Principe | x | |||||||||
| Senegal | ||||||||||
| Seychelles | x | x | x | x | ||||||
| Sierra Leone | x | x | x | x | x | x | x | |||
| Somalia | ||||||||||
| South Africa | x | x | x | x | x | x | ||||
| South Sudan | ||||||||||
| Sudan | ||||||||||
| Tanzania | x | x | ||||||||
| Togo | ||||||||||
| Tunisia | ||||||||||
| Uganda | x | x | x | x | x | x | ||||
| Zambia | ||||||||||
| Zimbabwe |
Other measures captured in the PF Response Monitor include passing of supplementary budgets or spending plans; the establishment of dedicated COVID-19 bank accounts at either central banks or commercial banks; supervisory committees for COVID-19 funding and expenditure; and development of COVID-19 websites inclusive of budget and expenditure data. While the information on the Monitor is sourced both directly from countries and publicly available sources, including the IMF’s Anti-corruption Tracker, it is likely that some commitments have been excluded. It is therefore blatantly clear that, at least on paper, governments across the African continent are committed to ensuring that funds allocated to COVID-19-related expenditure go to COVID-19-related expenditure. However, as with most PFM efforts, de jure commitments are often worlds apart from what happens on the ground. Commitments to accountability are limited without the institutional capacity and capability to monitor compliance and enforce sanctions. While the pandemic has only been on our continent for five months, we are already seeing news reports of corruption related to COVID-19 procurement in the DRC, Lesotho, Botswana, Mauritius, Mozambique, Malawi, Namibia, South Africa and Zimbabwe.
However, it would be unfair and unwise, if we were to become entirely despondent about government’s COVID-19 accountability efforts because of these incidents of corruption. That we know about these incidents already, reflects, in some instances, governments’ commitment to transparency. We are also seeing that, where ex-ante controls and transparency measures have been insufficient to mitigate corruption, governments are putting in place ex-poste anti-corruption measures. In South Africa, President Cyril Ramaphosa has appointed a Committee of Ministers to deal with allegations of corruption associated with the country’s response to the coronavirus pandemic, chaired by the Minister of Justice and Correctional Services. To assist the committee in its assessment of COVID-19-related procurement, President Ramaphosa has requested all Ministers and Premiers to provide information on the names of companies and details of tenders and contracts that have been awarded in national departments, provincial governments and public entities during the period of the National State of Disaster.
In other instances, it is not through government efforts that we come to hear about instances of corruption, but rather through civil society organisations (CSOs) who have demanded accountability from state actors. CSOs and non-profit organisations throughout the continent have been demanding those accused of corruption face sanctions. In Malawi, for example, CSOs, operating under the banner Anti-Corruption Alliance, came out “with guns blazing” following the allocation of K1-billion (USD 1.3 million) COVID-19 funds to then-first lady, Gertrude Mutharika’s organisation, Beautify Malawi. There were concerns that members of the Cabinet committee on coronavirus were each receiving K300,000 (USD 407) for each news media briefing they held to update the public on the pandemic, and the total had blown up to K1-billion (USD 1.3 million) in allowances by 7 April. In Namibia, the Institute for Public Policy Research (IPPR) has been tracking COVID-19 emergency procurement through its Procurement Tracker and found that the price of masks procured by the Ministry of Industrialisation, Trade and SME Development were increased drastically by some of the state-sponsored mask manufacturers, resulting in a public uproar.
CSOs have also been proactive in calling on governments to ensure adequate transparency and accountability measures are in place to mitigate against corruption before it happens. In Kenya, in a Joint CSO Memorandum on the Public Finance Management (COVID-19 Emergency Response Fund) Regulations, 2020, it was suggested that, amongst other measures, Cabinet Secretaries of Finance and Health (i) ensure designated budgeting and accounting codes are introduced to ensure traceability of all COVID-19 allocations and expenditures; (ii) mandates and controls related to COVID-19 should be effectively delineated and delegated through designation and decentralisation of decision making and reporting; (iii) payments made outside the IFMIS need to be recorded ex-post in IFMIS with minimal time lag; (iv) should provide standardised costing to guide all procurement for essential items; and (v) all procurement information related to COVID-19 should be posted on government portals and the responsible officer and department at each stage of the procurement should also be published. It is clear that CSOs have an important role to play in mitigating corruption through demanding adequate prophylactic measures are in place. However, the reality is that not all CSOs have the necessary expertise and understanding of the budget process to effectively demand this. This is why CABRI, and networks such as the Global Initiative for Fiscal Transparency and International Budget Partnership, work with CSOs to strengthen their technical capabilities and provide a space for constructive dialogue with ministries of finance.
Through the COVID-19 PF Response Monitor, we will continue to track how governments fare against their grand commitments to track, account, report, publish and audit emergency expenditure, allowing us to illustrate what rules, processes, practices and capabilities do or do not contribute to efficient and effective management of resources during times of extraordinary budgetary pressures.