Honduras / Roy Fernando Millares Zavala
The Honduran Health system has been victim of corruption for years. This condition has caused, in normal circumstances, the entire health system to be inadequate and unprepared to provide the basic health services to the minorities and vulnerable groups with no regards to their human rights and the constitutional article 145. When Covid-19 reached the country it found a weak and highly unprepared health system that was still recovering from the last corruption scandal. The Honduran government swiftly approved the highest emergency budget in the whole region. Rather than solving a problem this budget trigger dozens of corruption cases and caused the private sector and National Medical Association to restrain from active cooperation with the government. The lack of medical infrastructure, equipment, personal and basic supplies have deprive the populations from their right to health, meanwhile the ones who manage to get some medical attention are treated in subhuman conditions.
Honduras is a small country with a rapidly growing population, currently 9.5 million people. It is one of the poorest countries on the American continent. According to the World Bank, in 2018, 48.3 % of Honduran population lived on an income below the international poverty line. This is aggravated by a huge inequality gap, estimated at 50.5 GINI coefficients, which measures the inequality of personal income at a country.
Over the last couple of years Honduran gross domestic product (GDP) has been growing steadily. This has been the case since it reached a trough after a political crisis in 2009. Due to covid-19 the Honduran National Bank estimates a fall of 2.9% to 3.9% on the nations GDP, as the virus is predicted to have strong impact on national industry. This decrease and the subsequent impact on the private sector will contribute to higher unemployment and will push scores to poverty and inequality indices upward. Growing inequality is not the whole problem in Honduras. To get a complete picture of how covid-19 has affected Honduras it is important to note the high level of corruption before and during the pandemic. This Corruption has damaged an already deficient health system that has been struggling for years.
Politics, Corruption and public health
Cases of corruption are not rare. Honduras has a score of 146/ 180 on Transparency International’s 2019 corruption Index. The current crisis has brought attention back to corruption in the national public health system, which has left it ill prepared and inadequate to deal with a high volume of covid-19 patients. There are hundreds of pictures on social media and news, of patients dying on the floor or receiving medical attention under a half build canopy in the hospital parking lot.
Corruption scandals linked to the national health system are not new. One of the most notorious cases was the embezzlement of funds from the National Security Institute for an estimated amount of 300 million USD, between the years 2010 to 2014. More recently Covid-19 has triggered dozens of accusation of embezzlement and corruption related to overvalued product purchased by the public health system.
The total amount of beds that the public health system provides is 6,015. An extra 575 beds is to be found in private hospitals, which can only be accessed by a minority of the population. That makes a total of 6,590 beds to deal with the 22,238 active cases registered at this moment. With the government carrying out a little less than 1,000 tests per day on average, it is highly likely the number of cases is higher. The inadequacy and poor management that has persisted for years combined with the covid-19 crisis were the framework and prologue to the biggest corruption scandal in years were millions of dollars were spent on Hospitals that never came.
The case of the missing hospitals
To confront the increasing number of cases and the lack of medical infrastructure the Honduran government took the decision to buy 7 emergency mobile hospitals between the months of March and April. The administration spent USD $47,462,500 to buy the hospitals through a governmental technical bureau called strategic investment Honduras (Invest-H). None of these hospitals has materialized and 4 months later people in Honduras are still wondering where the rest of the hospitals are?
The purchase was in fact just the tip of the iceberg. Thanks to investigations from independent civil institutions such as the National Counsel Against Corruption (CNA), who at that time was investigating overpriced purchase of basic medical supplies made by the technical bureau of the government, the whole affair involving the mobile hospitals came to light.
The first thing that the investigations brought to attention was that the government had made an advance payment of 100% of the whole transaction without asking for any guarantee whatsoever. Not only were the hospitals fully paid for in advance, but the seller was never able to set a fixed delivery date due to borders restrictions, a fact that was known by Invest-H at the moment of the purchase.
Furthermore, the Hospitals were not bought directly from the manufacturer, but through a middle man who overpriced the equipment. Of the total amount of the disbursed by the government to acquire the mobile hospitals, 69% was the commission the middle man, the resulting payment was for more than half the true market price. The equipment could have been purchase directly from the manufacturer for a significant lower price. After three months, the first two Hospitals arrived at port in the country; there is no official answer of what happened to the other five. Only two have arrived to date and are being held by the port officials due to irregularities on the bill of landing, while being examined by the prosecutors.
Economic and social rights
The case of the hospitals, which has been summarized above, is a clear example of how corruption has a deep impact on the poorest sector of the country. The case is just one example of dozens that have been exposed and publicly condemned in the middle of the covid-19 under this administration. The truth is that such crimes, as mentioned above, have been happening for decades, and the current health system has been on bad shape for years. The current pandemics just exacerbate the problem, having the worst repercussion on the population.
With the hospitals overrun and unequipped, the most vulnerable groups are not able to receive proper medical attention. This situation has been reported by the National Medical Association on repeated occasions. The mismanagement in the government and lack of transparency has also caused the private sector to withdraw their participation as consultants on the management of the crisis.
The government is for the second time, trying to the process of reopening the main cities on the 3rd of august, after the first attempt was set back due to a rise in cases. Without solid evidence of the cases going down, and with the health system still overrun the only possible rational are economic. The current estimate is that half million people have or are going to lose their job.
Honduras now faces a big challenge. With a damage economy the levels of inequality and poverty may rise. The country has slowly started to reopen due to economic reasons meanwhile the cases keep rising. The health system has been unable to respond to the number of cases, leaving the more vulnerable groups in the population without medical attention. Corruption has left its mark on the country.
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