To Taryn Vian, corruption is defined as whenever public officials act for their own private good. A good start, for sure, but Vian misses something. A public official is no less corrupt sitting on his hands than he is by putting those hands to work in his self-interest.
We see both cases in India, where Tuberculosis, a disease the West largely shrugs at, runs rampant. The New Yorker lays out the problem in thorough detail, but here’s the gist: India sees two million new cases of the disease a year, and every day loses a thousand people to it.
To call India’s identification methods antiquated might be generous. One involves spitting on slide and waiting for stains to appear. Then there are the blood tests taken at the unregulated private labs and clinics. These tests are responsible for the deadly misdiagnosis for tens of thousands each year. Deadly because the test results lead many to seek a toxic cocktail of anti-viral drugs when their sickness doesn’t warrant them.
Two machines are available that could largely eradicate the disease. One is called the GeneXpert and a recent study reports a ninety-eight percent success rate in identifying active TB infections. The next device is a DNA reading called a P.C.R. Both machines are costly, but one hospital was given a P.C.R. machine as part of a grant. Unfortunately, when the reporter stopped by to check it out, the device was sitting on a shelf, still packed in its mailing paper unused. Why?
If you need TB medication or a test or an X-ray, [touts] will get you quickly to a [private] clinic that charges for services people are entitled to receive at no cost in public hospitals… Much of the time, the referring physician from the public hospital is also the private clinician who does the work. That earns him seventy-five per cent of any fee.
In other words, if doctors used the machine properly, it would interfere with their private practice.
There are, of course, moral issues with having technology that could save countless lives, but ignoring it for the financial benefit of a few. Looking through the Vian lens, though, we see these actions as a corrupt byproduct of too much discretion. These physicians are double dipping, plain and simple.
There is also some room to work on the detection and enforcement level. India’s government does try to shut down these unregulated clinics, but is often unable to keep pace. One powerful enforcement tool could be increasing doctor pay, thereby destroying the incentive for doctors to keep operating on the black-market. As more and more doctors leave their unregulated private practices, it will be easier to round up those that refuse to do so.
Going through the rest of Vian’s conceptual model of corruption, we see our real-life example does apply, but only on the margins. The lack of accountability occurs in India because of the country’s fiscal challenges. The lack of citizen’s voice occurs not because poor people have no desire to get healthy, but because their country offers no legitimate substitutes. These poor get sick if they don’t go to the doctor. If they do, they have at least some chance of being accurately diagnosed and moving forward accordingly. Transparency doesn’t matter here either. The sick know public hospital services are free, but often opt out for the more costly, but more expedient private “care” offered by their same physician. Furthermore, if all physicians are sending their TB patients to their private practices, I’m not sure how much good a report card would do.
Unfortunately, reforms aren’t likely for quite some time – at least until India continues its economic development. Yet the decision to do nothing is a difficult one considering however expensive these machines are, the loss of human capital and economic productivity is worse. TB might not be as hip a cause as HIV/AIDS, but India has tremendous opportunity to leverage its might as a budding world power to spur private investment in public health. And it should, because to do nothing, to sit on its hands, would be worse than corrupt. It would be immoral.