Corruption and Lady Health Workers

HOW do you deal with deceit, dishonesty and debasement in your day-to-day life? Sounds like an existential question. Substitute the three D’s with a single word, ‘corruption’, and the question loses its dimensions and sounds almost clichéd.

Inducted into the Urdu lexicon and used ad nauseam in our popular political discourse, the word when deconstructed in a specific context holds a mirror up to ordinary lives made difficult through avarice and misuse of entrusted power. A look at ‘corruption’ through the perspective of Lady Health Workers (LHWs) explains why corruption is termed by the UN on the International Anti-Corruption Day (observed two weeks ago) as one of the biggest obstacles to achieving the Sustainable Development Goals and a formidable hurdle in the path of “development, peace and security”.

In a country that spends a pittance, ie 0.46pc, of its GDP on health and where basic health indicators are the lowest in South Asia, more than 130,000 LHWs struggle daily with corruption while servicing almost 80 million people, as per estimate, in rural and low-income urban areas across the country.

The Lady Health Workers Programme is recognised globally for its positive outcomes. Over 22 years, the programme has survived changes in government, devolution to the provinces and perennial underfunding. The health workers’ collective struggle and successful legal battle have won them the rights of minimum wage and regular service, though delay in the payment of wages and other issues persist. What remains is their silent fight against corruption in the health sector.

LHWs confront corruption of various types including sexual harassment. Though there are strict criteria in place for selection and interviews are carried out by a panel, cases of appointments made on the basis of nepotism and favouritism are not rare. There exist some 15pc to 20pc ghost LHWs appointed by corrupt officials who get a 50pc cut of these ‘workers’ salaries, I am told.

Health workers are subjected to cuts from their meagre salaries, field travel allowances, training allowances and payment for polio vaccination. Nomination for training programmes and crash courses is juggled by health officials who send their favourite women or female relatives. Monthly supplies of medicines are stolen or pilfered instead of reaching the LHWs for free distribution to the deserving.

The facility of vehicles given to women health supervisors are misused by higher officials. A supervisor’s vehicle was kept by a district health official for two years. She was told that the children of a lawmaker were using the vehicle. The log book had her signature apparently forged by the field officer; meanwhile the health supervisor commuted on public transport.

It appears corruption in the programme has increased since the Supreme Court ordered the provincial governments in 2012 to integrate health workers in the service structure. When the provincial governments finally complied after two years, the health workers were asked by respective officials to pay Rs1,000 each to receive the appointment letters under new terms and condition.

The LHWs’ union fought tooth and nail. It collected individual complaints on stamp papers from the workers and submitted the material in the Supreme Court, which then ordered the concerned departments to send appointment letters by courier to personal addresses. Now the union is strategising on how to fight corruption to receive full arrears of their raised salaries as the individual amount comes to Rs200,000 to Rs300,000 and the officials are said to be eyeing some Rs50,000 per LHW!

The union has filed many complaints about corrupt officials collectively and supported individual complaints to reach higher-ups in the department and the Supreme Court. Several officials saw their services terminated. There have been many honest officials whom LHWs remember by name. Unfortunately, there always remain some who have no scruples.

The union suggests a strategy to curb corruption: end provincial supervision of the programme. Abolish the post of the provincial coordinator like KP has done. Induct senior lady health supervisors for the post of assistant district coordinators.

Corruption affects the weak and poor the most. Poverty and corruption are now inseparably linked. According to the UN, corruption “is a dominant factor driving fragile countries towards state failure”. The UN estimates that, globally, $1 trillion is paid in bribes and $2.6tr are lost annually to corruption. The UNDP estimates that such funds are 10 times the amount of official development assistance.

It is time anti-corruption measures were integrated into the programme. The management and the system of the programme should be improved as recommended in past reviews. Also, a post-devolution review of the programme is due.

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