Transforming Health in Honduras
A small group of people is transforming health in Honduras. They’re not doctors or nurses or healthcare administrators – members of Transformemos Honduras and employees of the Association for a More Just society are saving lives through their expertise in transparency, accountability, and the efficiency of public systems, doing the difficult work of getting the Honduran Health system to work for its people.
Historically, Honduras’ health system was crippled not just by a small budget and the demands of a poor population facing injuries and epidemics – it was crippled by corruption, the intentional theft of money and medicines by powerful people.
The impotence of the Secretary of Health was well-known. Medical brigades and other charity work had been coming to Honduras for decades, but nothing was changing for the vast majority of Hondurans.
In September 2009, a group of concerned Hondurans came together with a simple goal – to make sure that the most vulnerable in Honduras got the health care they needed. “We’re not going to just sit here with our arms crossed,” their website would later state, “We’re going to act.”
This group created a coalition called Transformemos Honduras (TH), or Let’s Transform Honduras, with the justice organization Association for a More Just Society as their core member. Armed with allies such as development organizations Compassion International, World Renew, Project Global Village, World Vision, and the Evangelical Church in Honduras, they decided to look into the Health System to see why medicines had become a luxury.
They started by going to the government for information about the purchase of medicines and medical supplies.
Honduras’ Law of Transparency and Access to Public Information, an important law passed in 2006, required public officials to provide public information to anyone who asks. But practically, it wasn’t enforced, and government documentation was hidden or went missing.
“We were testing the law and the system to see if it worked,” remembers Maribel Muñoz, who works with Transformemos Honduras. Information that the government should have provided within ten days took months and repeated requests to be delivered. Finally TH had lawyers from AJS’s anti-corruption project ALAC helped them draft letters calling public servants’ attention to all the laws they were breaking and all the fines they were theoretically accruing by not delivering the requested information.
About six months later, the pressure began to work. Transformemos Honduras began to collect the haphazard records of the Health Systems purchases and processes over the previous five years, from 2005-2010.
What they found was that, at the time, there was no oversight over government purchases of medicine and medical supplies. Nor did there seem to be much documentation of the million-dollar life-or-death purchases.
TH’s experts pored over the records, and immediately began to see things that didn’t line up. Purchases weren’t being made in the competitive way the law required, meaning that medicines were up to 50 times more expensive than global averages. TH began to dig deeper.
No one had ever investigated the companies that were supplying medicines and medical supplies to the Honduran government. TH found a few small businesses that jumped in a matter of months from tiny companies to bringing in millions of dollars. Some of these companies had no listed phone number or physical address – they were “briefcase companies” that acted as a front to provide the appearance of competition. This drove the price of medicines up astronomically, as elites played fake bidding wars against themselves.
TH found that these companies were even involved in drafting the Health System’s buying lists, telling them to buy only the medicines they wanted to sell. The already-strained Ministry of Health was overpaying for medicines that weren’t even necessarily the ones that were needed. Even worse, some of these medicines were never delivered, while others were delivered in unacceptable quality – after audits started, auditors found some medicines infected with bacteria, while others were delivered with only four of their 11 essential ingredients.
“We’re not talking about medication not being available for [the poor], but rather providing them with poor-quality medications — on purpose,” said Carlos Hernández in an interview with the PanAmerican Post.
In 2011, Transformemos Honduras published their first report – and the Honduran health system began to change.
The hallways of Honduras’ Hospital Escuela, a teaching hospital that serves thousands of poor Hondurans, are packed with people waiting for medical attention. Many of the people waiting are here because they have no other option.
About 70% of Honduras’ population relies on free public clinics and hospitals like the Hospital Escuela. Yet too often they’re sent home without desperately-needed medicine to treat illnesses from heart disease to schizophrenia because the hospitals don’t have the necessary medicines in stock. While Honduras’ Health System promises care and medicines to all its citizens, those who can pay prefer private hospitals that are better stocked and better equipped.
A well-functioning public health system in Honduras is desperately needed – but transparency in the health sector goes against the interest of the wealthy businesspeople and politicians who control medicine production and distribution.
“These were very controversial themes, very dangerous – no one wanted to risk themselves,” said Muñoz. The people involved were some of the wealthiest and most powerful people in Honduras. TH moved boldly, but wisely, sending an undercover sub-contractor to pose as an employee in the medical warehouses themselves.
They found chaos – the government’s central medicines warehouse was run by a woman who appeared to use the stash as her personal piggybank, forging medicine orders and selling the excess, mismanaging the disorganized warehouse so that expensive pills were left to spoil while people in hospitals died for lack of drugs.
In 2013, Transformemos Honduras presented another report detailing the mismanagement of the warehouse. The effect was electric. The Honduran government immediately removed the director from her position. She, along with five other wealthy, powerful people would eventually face consequences – caught in their corruption by a missing trail of paperwork.
Transformemos Honduras kept pushing for transparency in the medical purchasing system. A second report detailed expenses made between 2010 and 2013. On multiple occasions, regulations were flouted and competition was ignored, allowing steeply overpriced direct purchases.
Between 2008 and 2012 alone, Honduras lost 30 billion Lempiras in direct purchases – about $1.4 billion.
Furthermore, companies that earlier reports revealed to be overcharging for medicines or offering low-quality medicines continued to be contracted.
One of these companies was Astropharma, a company owned by then-vice-president of Congress Lena Gutiérrez. Her position made Astropharma’s conflicts a clear conflict of interest, and the low quality of their medicines left multiple Hondurans dead.
AJS’s journalism website Revistazo published multiple accounts of Astropharma’s corruption, and ALAC, the legal anti-corruption assistance project, provided legal support to take the case to the Public Ministry.
Their work paid off. On June 18th, 2015, the Public Ministry formally presented charges against then-Vice President of Congress Lena Gutiérrez, her father Marco Tulio, and her siblings Ginnette and Julio Cesar, all of whom held stakes in Astropharma. The Gutiérrezes and 12 others implicated in the case faced charges for crimes against public health, falsification of public documents, and fraud for selling drugs of “dubious quality at inflated prices”.
Not only have powerful people faced consequences for their corruption, the Honduran government has taken concrete steps towards transparency. In 2013, the government initiated a trust with a national bank to oversee payments, while the United Nations has stepped in to offer technical assistance for the contracting process. The government has also specifically asked Transformemos Honduras to act as a social auditor throughout the process of purchasing and delivery.
The results have been dramatic. Five million Hondurans now have better access to basic medical care because the government is buying medical supplies at real costs. Eleven people accused of corruption in the health sector are currently facing trial, showing others that corruption has a cost. Though the cost of living is rising, the cost of medicine has dropped every year since 2012.
The fight isn’t over. AJS and TH are pressing forward to new levels of transparency. Last year, they participated in 54 discussions on the subject of health with representatives of the Honduran government. They also filed 14 corruption cases with the public ministry, many of which are currently being investigated.
They also haven’t stopped digging. Last year, TH presented five investigations into medical centers and delivery processes, and empowered 60 new volunteers to do social auditing in public hospitals.
Now AJS’s work in social oversight can go even farther. In 2014, AJS as a representative of Transparency International was invited to formally audit five different government ministries, including Health. The ground-breaking agreement will allow AJS to investigate the effectiveness of processes and procedures even as TH continues to participate in their improvement, creating a baseline from which to measure progress.The first report will be presented in September of 2016.
After years of brave commitment and hard work, AJS has placed itself at the center of the conversation about transparent and effective healthcare in Honduras. They’ve seen health improve against great odds, and are committed to continuing to support the government systems that serves millions of Honduras.