The state of health corruption in Guatemala

Bribes, medicine stockouts caused by theft, and workers’ absenteeism—considered forms of corruption—impede access to and the quality of healthcare. Rural indigenous communities in Guatemala experience these issues. However, these are only some of the challenges faced when seeking healthcare. Discrimination also represents a significant barrier.

Access and quality of care are affected by both corruption and discrimination. Therefore, conventional, top-down, government-led anticorruption efforts only provide partial solutions to poor access and quality. Experience from Guatemala shows that rural indigenous communities mobilise to address the various causes of poor healthcare – including, but not limited to, corruption.

Effects of corruption on community health and associated community action

In Guatemala, a grassroots network (REDC-SALUD) and a local NGO (CEGSS) worked together to consult rural indigenous communities and map out the most frequent issues that affect access to and quality of health care. These issues — all communicated in indigenous languages and lay terms — were then transformed into categories of complaints aligned with what the national legal framework recognises as barriers to accessing the right to health. The list of 23 different types of complaints were organized around seven categories: (1) Lack of medicines and medical supplies; (2) corruption and illegal charges; (3) denial of healthcare rights among service users; (4) dissatisfaction of service users with the provided services; (5) providers not adhering to rules and regulations; (6) obstructing access to information by providers; and (7) any other form of complaint.

Communities use the aforementioned categories to monitor local services. Previously, CEGSS trained ‘Community Health Rights Defenders’ who learned about the legal framework, including the right to health and non-discriminatory public health services, participatory monitoring, and reporting of complaints. After understanding their rights and the shortcomings of local services according to national standards, community defenders launched information campaigns on health rights, teaching their communities how to identify and report issues—including, but not limited to, corruption. This community-led monitoring is carried out at least once a year. Additionally, individual complaints are collected whenever a service user approaches community defenders. Therefore, without framing it as anti-corruption work, Community Health Rights Defenders monitor and report corruption and mobilise to demand action from authorities.

 

It is important to recognise that citizens who monitor and report corruption face the risk of backlash. To minimise this risk, REDC-SALUD and CEGSS encourage the participation of as many service users as possible (to prevent singling out community leaders) and highlight the aim of enhancing access to and quality of care (to avoid accusations of political motives). Additionally, lawyers are part of the CEGSS team, and the organisation maintains alliances with legal aid groups. Consequently, communities involved in this work feel supported, especially with unrestricted access to legal representation when needed.

Mainstreaming community anti-corruption actions in organised civil society

Social movements advocating for greater equity, fairness, and health rights are not new and are already active in many countries. Instead of pursuing a “new” anti-corruption social movement, we might be more successful by integrating anti-corruption efforts into the knowledge, strategies, and tools of existing community-based social movements.

An example of such a strategy developed by CEGSS and REDC-SALUD in Guatemala is an open-access virtual platform for recording complaints about bribery and other practices that affect healthcare access. The complaints were shared with authorities and even caught the attention of national news media, who wrote a report about how corruption, among other issues, affects timely access to maternal care and other health emergencies. These actions led to improved monitoring of bribery by higher-level authorities. As a result, communities reported a significant decrease in bribery demands by service providers. Furthermore, health and other officials acknowledged the significant role and contribution of community defenders to improving health rights and reducing corruption in the health system.

Community groups already mobilised for safe motherhood might be willing to monitor and report corruption if they see how it directly impacts maternal care. A recent study showed how bribery affects maternal mortality in sub-Saharan Africa. As the experience from Guatemala demonstrates, communities and service users can report bribery and government actions without necessarily using the label ‘anti-corruption’.

Here is another example. Civil Society Organisations in different countries are already working to improve diagnosis and access to tuberculosis (TB) treatment. There is evidence that corruption contributes to increases in multi-drug-resistant TB in various countries. Therefore, it might be possible to engage with TB advocates to identify the specific diagnostic and service activities that could be affected by corruption and seek to address them.

Conclusion

Mobilising communities for anti-corruption efforts involves demonstrating how corruption affects healthcare daily. Starting with issues at the point of service delivery, communities and civil society organisations may become interested in addressing other sources of corruption higher up the system, as seen in other sectors.

This approach of involving organised civil society is different from and complements focusing on addressing corruption at the national level. The initial role of communities as service users is to report corruption where they see and experience it firsthand. By elevating their actions, they can ultimately collaborate with reformist policymakers and other actors aiming to tackle corruption at the structural and systemic level.