PERBAIKANBISNISKESEHATAN:PERSPEKTIFMASYARAKATSIPIL

NataliaSoebagjoBoardMember,TransparencyInternational

WHYWECARE

• AccesstoHealthcareisafundamentalhumanrightandakeyfeatureofSDG(Goal3:GoodHealth&Well-being

• Healthcareaccess&outcomesareoftencompromisedbycorruption

TIUKPharma&HealthcareProgram• Thepharmaceuticalandhealthcaresectorisvulnerableto

corruptionasthereisaclearknowledgegapbetweentheprovidersandusersofhealthcare,leavingpatientssubjecttotheknowledgetheyareprovidedbyhealthcareproviders,suppliers,andregulators.Thisinequityofinformationisopentoexploitationforprivategain,openingpossibilitiesofcorruption.Inaddition,the necessityofhealthcare,andvolumeoffundsinvolvedinthesectorcanhelpprovideincentiveforprivategain. Finally,duetothehighnumberofpeopleinvolvedindecisionmaking,andtheoftenbureaucraticnatureofthepharmaceuticalandhealthsectors,itis susceptibletoindividualdiscretionandregulatorycapture.

TheApproach

• Research&informationgathering• Engagementtoraiseawareness&buildcoalitions

• Developmentofpracticalsolutionsthroughtools&capacitybuilding

• Advocacy,partnershipsandcampaigning,underpinnedbytransparency&accountability

Latestpublicationsa.o.

• CorruptioninthePharmaceuticalSector:DiagnosingtheChallenges(June2016)

• MakingtheCaseforOpenContracting(Jan2017)

• BusinessPrinciplesforPromotingIntegrityinthePharmaceuticalSectorinLatinAmerica(May2017

THESIZEOFTHEPROBLEMININDONESIA

• Accordingtoa2015KPKstudyofthehealthcaresector,therewere175,774hospitalclaimspronetofraudvaluedatRp.440billion.ThisdoesnotincludefraudbyotheractorssuchasBPJSstaff,patients,medicalequipmentsuppliers

ICWStudy• Intheperiodof2010-2016,therewere219corruptioncasesinthehealthsectorcausingRp.890.1bioinstatelosses,involving519suspectsofwhich57%werecivilservantsand22%privatesector

• Ofthe219cases,107(49%)wererelatedtotheprocurementofmedicalequipmentworthRp.543.1bio(61%)

• Thepreferredmodusisbysimplymarkingupprices• RecommendationsmadetotheMinistryofHealth,Parliamentandlawenforcementagencies

TRANSPARENCYINCORPORATEREPORTING

• 100companiesbasedonincomeinthe2014FortuneTopHundredIndonesia

• Questionnairefocusingonthreedimensionstotalling 26questions:– thereportingofkeyelementsoftheiranti-corruptionprogrammes;– thedisclosureoftheircompanystructuresandholdings;– thedisclosureofkeyfinancialinformationonacountry-by-country

basis.• Datesources:

CodeofConduct,AnnualReport,FinancialStatement,andSustainabilityReport

• Scoring:0unsatisfactory,0.5quitesatisfactory,and1satisfactory

1.Anti-corruptionprogrammes1. Doesthecompanyhaveapubliclystatedcommitmenttoanti-corruption?2. Doesthecompanypubliclycommittobeincompliancewithallrelevantlaws,

includinganti-corruptionlaws?3. Doesthecompanyleadership(seniormemberofmanagementorboard)demonstrate

supportforanti-corruption?4. Doesthecompany’scodeofconduct/anti-corruptionpolicyexplicitlyapplytoall

employeesanddirectors?5. Doesthecompany’santi-corruptionpolicyexplicitlyapplytopersonswhoarenot

employeesbutareauthorised toactonbehalfofthecompanyorrepresentit(forexample:agents,advisors,representativesorintermediaries)?

6. Doesthecompany’santi-corruptionprogramme applytonon-controlledpersonsorentitiesthatprovidegoodsorservicesundercontract(forexample:contractors,subcontractors,suppliers)?

7. Doesthecompanyhaveinplaceananti-corruptiontrainingprogramme foritsemployeesanddirectors?

8. Doesthecompanyhaveapolicyongifts,hospitalityandexpenses?9. Isthereapolicythatexplicitlyprohibitsfacilitationpayments?10. Doestheprogramme enableemployeesandotherstoraiseconcernsandreport

violations(oftheprogramme)withoutriskofreprisal?11. Doesthecompanyprovideachannelthroughwhichemployeescanreportsuspected

breachesofanti-corruptionpolicies,anddoesthechannelallowforconfidentialand/oranonymousreporting(whistleblowing)?

12. Doesthecompanycarryoutregularmonitoringofitsanti-corruptionprogramme toreviewtheprogramme’s suitability,adequacyandeffectiveness,andimplementimprovementsasappropriate?

13. Doesthecompanyhaveapolicyonpoliticalcontributionsthateitherprohibitssuchcontributionsor,ifitdoesnot,requiressuchcontributionstobepubliclydisclosed?

Doesthecompanypubliclycommittobeincompliancewithallrelevantlaws,includinganti-corruptionlaws?

Isthereapolicythatexplicitlyprohibitsfacilitationpayments?

Doesthecompany’santi-corruptionpolicyexplicitlyapplytopersonswhoarenotemployeesbutareauthorisedtoactonbehalfofthecompanyorrepresentit(forexample:agents,advisors,representativesorintermediaries)?

Doesthecompanyhaveinplaceananti-corruptiontrainingprogramme foritsemployeesanddirectors?

UNSATISFACTORY

2.Organisational Transparency14. Doesthecompanydiscloseallofitsfullyconsolidated

subsidiaries?15. Doesthecompanydisclosepercentagesownedineach

ofitsfullyconsolidatedsubsidiaries?16. Doesthecompanydisclosecountriesofincorporation

foreachofitsfullyconsolidatedsubsidiaries?17. Doesthecompanydisclosecountriesofoperationsfor

eachofitsfullyconsolidatedsubsidiaries?18. Doesthecompanydiscloseallofitsnon-fully

consolidatedholdings(associates,joint-ventures)?19. Doesthecompanydisclosepercentagesownedineach

ofitsnon-fullyconsolidatedholdings?20. Doesthecompanydisclosecountriesofincorporation

foreachofitsnon-fullyconsolidatedholdings?21. Doesthecompanydisclosecountriesofoperationsfor

eachofitsnon-fullyconsolidatedholdings?

SATISFACTORYREGARDINGDISCLOSUREOFITSFULLYCONSOLIDATEDSUBSIDIARIESANDOWNERSHIPPERCENTAGEBUT…ATHIRDOFTHECOMPANIESWEREUNSATISFACTORYINOTHERASPECTS

3.Country-by-countryreporting22. Doesthecompanydiscloseitsrevenues/salesincountryX?23. DoesthecompanydiscloseitscapitalexpenditureincountryX?24. Doesthecompanydiscloseitspre-taxincomeincountryX?25. DoesthecompanydiscloseitsincometaxincountryX?26. Doesthecompanydiscloseitscommunitycontributionincountry

X?

SATISFACTORYINALLASPECTSEXCEPTFORDISCLOSUREOFCOMMUNITYCONTRIBUTIONS

Recommendations• Acommitmentneededfromcompanies(particularlypharmaceuticalcompanies)andrelatedpartiestogoodcorporategovernance,integrity,transparency,accountabilityaswellaspatientwelfare

• Needforstrongercommitmenttothedevelopmentandimplementationofapracticalandeffectiveananti-corruptionprogramme

• Betterdisclosureofitsoverseasholdings• Needforzero-tolerancepolicytowardsbriberyandrelatedconflictsofinterest