New York Times, The Opinion Pages
Step One to Fighting Ebola? Start with Corruption
By Josh Ruxin
October 16, 2014 12:33 pm
The story of the current Ebola pandemic appears still in its opening chapter. Will the virus be contained, or will it spread its horror across Africa and beyond? The question is being raised around many family tables, including ours, particularly as my wife and I and our three small children, New Yorkers, live in Rwanda where I work in public health and she operates a job training program and a gourmet restaurant. There is a bit of fear in the air here as everywhere, but it is tempered by what we know about Africa.
Since March, more than 4,000 people, including over a hundred medical workers, have died of the Ebola virus in Western Africa. Why have the health systems in these countries, after billions of dollars in international aid, lost control of this modern plague? For starters, most African nations scarcely have anything we would call a health system, despite aid programs and waves of dedicated medical and development volunteers. As fast as we can pour resources in, the thousand cuts of corruption and poor business practices let it leak out. Like Ebola itself, corruption is a hemorrhaging disease. When aid programs fail because of corruption, further aid programs are discouraged. Ultimately, little health clinics with empty shelves, peeling paint and no staff are left to rot under the jungle trees.
I have seen those pathetic health facilities, but in Rwanda I’ve seen them cleaned up, restocked with the best medicines, nurses and doctors, and now prepared for what may come this way from West Africa. What has been done in Rwanda, however, is not possible in countries rife with corruption. Here in Rwanda, no one has ever put a hand out to me for a bribe – not once in the near decade I’ve lived here. That lack of hemorrhaging is what will enable us to stop Ebola here. Ebola is a marker for corruption on high, just as entrenched poverty is a marker for corruption on high. In the great influenza plague of 1918, when twenty million people died worldwide, the great difference between a country that suffered greatly, like India, and a country that suffered little at all, like Denmark, was the strength of the middle class. The strength of the middle class is most commonly a function of public and private health, and clean, just governance.
If we want to get serious about addressing the current and coming plagues, we must create universal access to quality health care, and that is only possible if the corruption that is now taken so much for granted in poor countries is eliminated. According to Transparency International, Guinea – the origin of this pandemic – is ranked 150 out of 177 countries for corruption, while Sierra Leone is ranked 117 and Liberia is ranked 83. Improving the health systems in the most corrupt and poorest nations should be at the top of our To Do list. Taking actions is not simply the moral thing to do, it’s in our own best interest. Let’s start now, before the next virus, perhaps many times more communicable, rises up to challenge us all.
Of course, corruption is not entirely to blame. Many Asian nations were famously corrupt while channeling substantive resource to build out their infrastructure and health systems. There’s an old development joke about a couple wealthy guys – one from Africa, one from Asia – who go to university together and years later meet up in their respective nations. The African arrives at the Asian’s residence – a massive estate with a few smart cars in the driveway and remarks, “You’ve done well, how’d you do it?” The friend replies, “You notice that superhighway you rode in on from the airport?” “Yes, it was stunning!” “5 percent of that project went in my pocket.” A few months later the Asian finds himself in Africa and heads out to his friend’s residence. It’s gigantic with dozens of Rolls Royces and sports cars scattered around. “Wow, I thought I had done well, but you’ve certainly beaten me. How’d you do it?” The African responds: “See that superhighway you rode in on?” “No,” he replies, “The road was atrocious!” “Ahh,” replies the African, “100 percent of that project in my pocket!”
Rwanda certainly doesn’t fit the caricature. My wife and I are encouraged by what we have seen here. Soon after the close of the 1994 genocide, the government of Rwanda recognized that health is, literally, wealth, and set out to refurbish and build out several hundred facilities across the country. Today, twenty years on, its national health insurance program enables citizens to access regular lifesaving treatments without going into destitution. Its maternal and child health have, arguably, improved faster than in any other country, ever. Its health care system has become adept at handling HIV by offering free testing and treatment with no waiting list for drugs. The system is quick on its feet, well connected with communication and ambulances to handle new disease threats. Indeed, national community initiatives such as Umuganda (a monthly day of service) are already educating the population about best hygiene practices. Most importantly, the people trust the medical system and the government. Panic is the greatest threat to the containment of a pandemic. Panic happens easiest where there is little trust.
What’s needed today is agile funding for health systems, both public and private. Where corrupt ministries are bound to squander funds, private centers must be built and staffed, funded by private donors and forward-thinking foundations. Where well-meaning ministries exist, their efforts must be bolstered with technology and management interventions – good, American-style management systems, such as the ones introduced so successfully in Rwanda. At the same time, international pressure against corruption in poor nations must finally begin in earnest. In the long run, that will do more than all the aid groups can achieve. Where corruption is ended, prosperity thrives, and in a prosperous land, people can afford their own family health care. That is when they are safe from such things as Ebola. When they are safe, we all are safe – and only then.
Corruption and Ebola are essentially the same hemorrhaging disease. If we cure corruption, we will have the healthy planet we all truly want and our children deserve.
Josh Ruxin is the author of A Thousand Hills to Heaven: Love, Hope and a Restaurant in Rwanda and executive director of Health Builders.