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Forget stock markets and GDP trends; there’s another annual report that genuinely reveals the health of a nation: Transparency International’s Corruption Perception Index (CPI). This year, the news for South Asia isn’t pretty. While the numbers don't directly measure coughs or broken bones, they paint a chilling picture of a region struggling with a disease that eats away at its very well-being—corruption.

Across the board, South Asia scores below the global average, like a student consistently failing basic integrity tests. Only Bhutan and the Maldives show signs of improvement, but what about the rest? Stagnant or slipping backwards. Afghanistan languishes at the bottom, Sri Lanka takes a worrying dip, and even giants like India and Pakistan fail to impress.

But why should we care about greased palms and shady deals when discussing health? Because corruption is a silent killer. It diverts lifesaving funds from hospitals, fuels the spread of counterfeit drugs, and silences voices that could expose public health failures. The lower the CPI score, the harder it becomes to guarantee equal access to quality healthcare, a fundamental human right that shouldn’t be a luxury. The CPI is a wake-up call that the fight for a healthier South Asia starts with tackling the rot at its core. 

Consider how public health budgets for lifesaving medications and equipment are diverted to enrich corrupt individuals, a harsh reality in many South Asian countries. In 2022, Pakistan’s Anti-Corruption Establishment (ACE) registered a Rs 800m embezzlement case against seven doctors and four other officials of the Mayo Hospital for a nefarious scheme, purchasing substandard items at inflated prices, effectively playing with people's lives.

Meanwhile, a few days ago, in India, the Central Bureau of Investigation (CBI) arrested two of its own officers investigating alleged irregularities in Madhya Pradesh nursing colleges. These officers face charges of setting up a cartel that would collect bribes from college officials in exchange for overlooking issues and granting clean chits. The fake nursing college scandal undermines public health by potentially graduating unqualified nurses, who could put patients at risk, raising concerns about the broader prevalence of such institutions nationwide.

When Covid-19 first made inroads into Bangladesh, doctors worried about the inadequate quality of personal protective equipment. There have also been instances of healthcare establishments providing fraudulent Covid-19 test results at a hefty cost. They went even further, charging a premium for Covid-19 treatment, which the hospital should have provided for free and reimbursed by the government. Instead, it did both.

Transparency International’s 2020 report on Pakistan paints a grim picture, highlighting the widespread practice of bribery for essential services like prenatal care and surgery. In this environment, the poor and marginalized, who are already struggling to make ends meet, are often left with no choice but to forego treatment, perpetuating a vicious cycle of illness and despair.

The Criminal Investigations Department (CID) arrested Sri Lanka’s former health minister and current environment minister in Feb 2024 for spending $465,00 on lifesaving medications that failed quality tests. Sri Lanka's National Medicines Regulatory Authority (NMRA) claimed that falsified paperwork was utilized to get this batch of low-quality human immunoglobulin, a lifesaving treatment for severe antibody deficiency. In the middle of last year, hospitals complained about patients’ drug reactions.

The ‘Pradhan Mantri Jan Arogya Yojana’ health insurance scheme, a source of hope for India’s low-income families, was rocked by allegations in 2021. Private hospitals entrusted with critical care have been accused of inflating bills, performing unnecessary surgeries and even refusing to treat those who are eligible. This breach of trust may have diverted significant funds to provide a lifeline for the underprivileged. While investigations continue, the possibility of large-scale corruption casts a cloud of suspicion over this critical program.

Nepal’s Omni scandal during Covid-19 starkly illustrates the insidious reach of corruption in South Asian healthcare. Amidst the pandemic’s urgency, a dubious contract inflated prices and awarded medical supply procurement to a politically-connected company (OBCI) lacking relevant experience. This case exposes the nexus between politics, business and bureaucrats, where public health takes a backseat to self-interest, jeopardizing lives during a crisis.

Looking beyond our immediate borders, the Maldives, despite its idyllic image, is not immune to healthcare corruption. A 2019 Transparency Maldives report found evidence of bribery in procuring medical equipment and pharmaceuticals, raising concerns about the quality and accessibility of care. Myanmar also faces significant challenges. A United Nations report in 2021 highlighted inadequate healthcare infrastructure and a shortage of qualified personnel, exacerbated by potential systemic corruption.

In Ghana, over 80 children tragically lost their lives after consuming cough syrup imported from India, a grim result of systemic regulatory failures and corruption. This incident underscores the severe consequences of compromised safety standards in pharmaceutical exports, driven by the prioritization of profit over human lives. The Ghana scandal highlights global ramifications of health sector corruption, demonstrating that lapses in regulatory oversight can have deadly international repercussions.

This discussion paints a bleak picture of how deeply corruption pervades South Asia’s health systems, with disastrous consequences for public health. This begs the question: Can we remain silent in the face of such widespread suffering? Given the lackluster and haphazard efforts of governments in this region to address corruption in meaningful ways, two key actors have a moral obligation to raise their voices and help tackle this issue head-on: WHO and other UN agencies.

As the world’s leading authority on public health, the World Health Organization (WHO) cannot ignore the insidious link between corruption and poor health outcomes. Its regional and country offices must become vocal supporters of clean and transparent healthcare systems. Issuing strong statements is a powerful way to effect change. The WHO director-general and regional directors should publicly condemn corruption in health, emphasizing its negative impact on populations. They can set the tone for prioritizing integrity and accountability in healthcare systems by stating their position clearly. Since WHO leadership now makes statements on ongoing wars and conflicts, corruption should no longer be taboo. 

WHO’s ambivalence on corruption and reluctance to highlight how privatization of health services harms public health outcomes has not helped either. The evidence for this correlation has long been available, but there has been no effective advocacy by the global custodian of health. Many of South Asia’s lawmakers and their families own private hospitals, medical colleges, nursing homes and schools. It is clear where they would stand in the privatization of health debate. WHO should advocate, in particular, with those international finance institutions constantly pushing for lower public-sector health spending and see privatization as the first line of treatment for failing healthcare systems. WHO enters into three to five-year country cooperation agreements with host governments to outline the agreed-upon work plan. Corruption in the healthcare sector should be a vital component of this agreement with allocated funds. Without this, the WHO becomes an accomplice to local politicians, who steal donated money.

Thorough country-focused research and reports showing the quantifiable effects of corruption on health outcomes are another essential strategy for fighting health corruption. Data encourages decision-makers to act, especially when it comes to citizen health. Rather than adding to its already overburdened issue list, the WHO should work closely with organizations like Transparency International and the Boston University School of Public Health, which have specialized expertise and credibility in this field. In such partnerships, the WHO can help develop clear policies, implement effective oversight mechanisms, and promote transparency in health procurement and resource allocation.

Supporting whistleblower protection within WHO, specifically its regional and country offices worldwide, is a critical aspect of combating corruption in health. WHO employees and collaborators who witness corruption firsthand should have safe and confidential channels to report it without fear of retaliation. The WHO can help expose corruption, hold wrongdoers accountable and improve healthcare delivery by creating an environment where whistleblowers feel empowered and protected. 

Development agencies, the United Nations and international donors are critical players because they provide the financial and technical support required to drive country-level development efforts. 

However, due to the pervasive influence of corruption, these organizations frequently face obstacles in their efforts. To effectively address this issue, they must take proactive measures and make more intentional decisions. First, they should include corruption assessments in their country reports. This allows them to better understand the scope and nature of corruption in each country, which is critical when developing effective anti-corruption strategies. Recent UN country reports rarely mention the words ‘corruption’ and ‘misgovernance’. Second, donors should tie aid to demonstrable anti-corruption efforts. Third, they should help civil society organizations (CSOs) combat corruption. CSOs play an essential role in holding governments and other institutions accountable, and they require financial and technical resources to do so effectively.

Corruption is a human invention; it can be dealt with, even in South Asia!

I had come to see off my 84-year-old uncle, who uses a wheelchair at Kathmandu’s Tribhuvan International Airport. He was flying to New Delhi. We had chosen to fly him with India’s premier airline, Vistara, which prides itself on its joint ownership by two iconic brands, TATA and Singapore Airlines. Not to leave anything to chance, his son booked him on Business Class.

Kathmandu airport has two business lounges—the one managed by Radisson Hotel is a 20-odd-step climb on the first floor. There are no elevators. Soaltee Hotel operates the second lounge, which is on the ground floor. While the airline had booked a wheelchair for my uncle, it invited him to the first-floor lounge as it only had an agreement with the Radisson lounge. Forty minutes of discussion with three staff levels later, Vistara finally agreed to make an exception and allow him to the ground floor lounge. Had I not persevered, my uncle would have been denied using a lounge he was entitled to because of his age and disability.

The Nepal office of the otherwise outstanding Vistara had not used the prism of disability and aging when deciding to make an exclusive contract with one lounge, while other international airlines operating out of Kathmandu hedge their bets and let passengers choose a lounge. Making policies and guidelines on disability and aging requires complex multidimensional advocacy and leadership communication. Ideally, the organizations would have an aging and disability focal point that would be empowered enough to examine all client-facing decisions of the organization through the aging and disability lens. The Human Resources heads need to ensure that in their induction programs, disability and aging are featured in the curricula.

Clearly-articulated leadership communication on a company's commitment to creating inclusive products is a must and needs to be frequently repeated. There are, of course, trailblazers–Satya Nadella, CEO of Microsoft, has spoken publicly about his commitment to making Microsoft products and services accessible to everyone. He believes that people with disabilities can significantly contribute to the workplace. Julie Sweet, CEO of Accenture, has said that her firm is committed to creating a culture of equality where everyone can advance and thrive and making its products and services accessible.

Soon, more airlines and airport operators will realize the economic imperative of using the aging lens in business decisions. WHO predicts that the number of people aged 65 years and older will increase from 1bn in 2020 to 1.6 billion in 2050. Also, the number of older adults who travel internationally will increase from 100m in 2015 to 260m in 2030. Growing up, I have known my uncle as a confident person whose wit and swift decision-making always got him out of any tight spot. He has been a sportsman for the better part of his life. However, with age, I see irreversible changes, which make airports and flights a challenge, especially when traveling alone.

Airports can be large and complex, with long distances, confusing signage and crowds. Elderly passengers may have difficulty finding their way around, especially if unfamiliar with the airport. Trust in the person pushing your wheelchair is critical for not getting an anxiety attack. A pleasant surprise was the Special Assistance staff at Delhi’s IGIA airport. The gentleman pushing the wheelchair was experienced in dealing with elderly passengers and showed patience and compassion at every stage of the journey. This highlights the importance of appropriately recruiting and training staff dealing with elderly passengers.

Airlines must understand the challenges elderly passengers face to provide them with the best possible experience. Luckily, there are global best practices that go beyond the standard priority boarding, wheelchair assistance, and special seating. Japanese airports have several features that make them more accessible for elderly passengers, such as clear and concise signage, elevators and escalators throughout the airport, and accessible restrooms. The UK government has a program called the ‘Passenger Assistance Request Service (PARS)’, which allows passengers to request assistance with tasks such as boarding and disembarking the plane, using the restroom, and managing their luggage. The United States has many laws and regulations in place to protect the rights of elderly and disabled passengers. For example, the Air Carrier Access Act (ACAA) requires airlines to provide reasonable accommodation to passengers with disabilities. The ACAA also prohibits airlines from discriminating against passengers with disabilities. This might be why Delta, United and American Airlines CEOs have often publicly committed to making their products friendly for older people.

It is important to note that the needs of elderly passengers can vary depending on their circumstances. Airports and Airlines should be prepared to work with elderly passengers to identify and address their individual needs and train their staff to deal with elderly passengers. This includes training on how to identify and address the needs of elderly passengers and provide them with the best possible service.

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) both recognize the importance of travel for older adults. Travel can allow older adults to stay active, learn new things and connect with loved ones. However, it is crucial for older adults to be aware of the challenges they may face when traveling and to take steps to mitigate those risks. 

Airplane manufacturers Airbus and Boeing are already working on several initiatives to make their aircraft more accessible to people with disabilities, such as wider aisles and more accessible lavatories. They are also working with airlines to create new training programs for flight attendants to assist passengers with disabilities. This is all great, however, for elderly passengers and those with disabilities, reaching the aircraft comfortably is the first challenge. It’s time for airlines and airports to put on the lenses of aging and disability and then up their game. 

The author is a global health diplomat-practitioner specializing in strategic partnerships, high-level advocacy, and strategic leadership communication