Sustainable Procurement in the Health Sector: A Call for Structural Reforms Against Corruption

Sustainable procurement in the health sector is a critical component of effective healthcare delivery, financial stewardship, and public accountability. The International Federation of Biomedical Laboratory Science has selected “Sustainable procurement, workforce development, and sustainable testing” as the theme for International Biomedical Laboratory Science Day, which is celebrated globally on 15 April each year. Health institutions rely on procurement systems to secure medicines, medical devices, medical laboratory consumables, infrastructure services, and other essential inputs required for patient care. When these systems function efficiently and transparently, they promote value for money and long-term sustainability. However, where procurement processes are weakened by corruption, internal dealings, and fraud, the consequences are far-reaching, affecting service quality, patient safety, and public trust.

Procurement fraud remains one of the most pervasive challenges confronting health systems. It often manifests through bid rigging, where suppliers collude to manipulate tender outcomes, thereby eliminating fair competition and inflating prices. In other cases, procurement specifications may be deliberately tailored to favour certain vendors, effectively excluding more qualified or cost-effective suppliers. Falsification of procurement documents, including delivery notes and inspection reports, further compounds the problem by creating the appearance of compliance where none exists. Sole sourcing is another deliberate means of healthcare procurement fraud.

Over-invoicing and payments for substandard or undelivered goods are additional forms of procurement fraud that drain scarce public resources. In the health sector, these practices are particularly harmful because inflated costs often translate into shortages of essential medicines, poorly equipped hospitals, and compromised diagnostic and treatment services. Ultimately, patients bear the burden of these inefficiencies through reduced access to quality healthcare.

Internal dealings and conflicts of interest represent a more subtle but equally damaging threat to sustainable procurement. These arise when individuals involved in procurement decision-making have undisclosed financial, personal, or professional relationships with suppliers or contractors. Such relationships can influence procurement outcomes, leading to biased evaluations and decisions that prioritize personal gain over institutional needs. For example a former head of a hospital in Ghana was championing privatization of cleaning services in the hospital and surprisingly we are learning that the janitors in some unit are employees of a company owned by that former Chief Executive Officer.

In the absence of strong disclosure requirements and effective enforcement mechanisms, internal dealings may persist undetected for extended periods. This undermines the principles of fairness and transparency that are essential to public procurement and erodes confidence among ethical suppliers who are discouraged from participating in tenders perceived as compromised.

A growing concern within health sector procurement relates to allegations of hidden costs that emerge after contracts have been awarded. These costs are often not reflected in the original contract values but are reportedly paid later through contract variations, inflated maintenance agreements, or unexplained additional charges. In some instances, such payments are alleged to benefit certain hospital managers or officials involved in procurement decisions.

Although such allegations require thorough investigation and adherence to due process, their recurrence points to weaknesses in contract management, financial controls, and oversight systems. Hidden costs distort budgeting, undermine transparency, and reduce the resources available for core healthcare services. They also create an environment in which accountability is weakened and unethical practices may flourish.

To address these challenges, health sector procurement systems must be anchored in strong governance structures. Clear separation of roles in procurement planning, evaluation, approval, and contract management is essential to prevent concentration of power and reduce opportunities for abuse. Procurement officials and hospital managers should be required to declare any potential conflicts of interest, with strict penalties for non-disclosure. Strong governance frameworks ensure that procurement decisions are based on objective criteria, institutional priorities, and value for money, rather than personal interests.

The adoption of digital procurement platforms offers significant opportunities to improve transparency and reduce human discretion. E-procurement systems enable open advertisement of tenders, standardized bid evaluation, and traceable procurement records. Public disclosure of awarded contracts, prices, and suppliers further strengthens accountability by allowing civil society, oversight institutions, and the general public to scrutinize procurement outcomes. Transparency is a powerful deterrent to corruption and a key pillar of sustainable procurement.

Effective procurement oversight requires robust internal and external audit systems. Regular independent audits help detect irregularities early and provide assurance that procurement processes comply with established laws and regulations. Internal audit units within health institutions must be adequately resourced and empowered to function independently without undue influence from management. Oversight bodies play a critical role in ensuring that procurement misconduct is identified, investigated, and sanctioned appropriately.

Sustainable procurement also depends on the competence and integrity of those who manage it. Continuous capacity building for procurement officers, hospital managers, and finance personnel is essential to ensure compliance with procurement laws, ethical standards, and best practices. Ethical codes of conduct must be enforced consistently, with sanctions applied fairly and transparently to deter misconduct. An institutional culture that values integrity is fundamental to long-term reform. A clear policy on conflict of interest covering persons from top management to technical personnel will go a long way to help Ghana’s health system.

Whistleblowers play a vital role in exposing procurement fraud and internal dealings. However, without effective protection mechanisms, individuals may be reluctant to report wrongdoing due to fear of retaliation. Establishing secure reporting channels and providing legal and institutional protection for whistleblowers is critical to strengthening accountability within the health sector. Encouraging reporting helps uncover systemic weaknesses and promotes corrective action.

Sustainable procurement in the health sector cannot be achieved in an environment compromised by fraud, internal dealings, and alleged hidden costs. These practices undermine value for money, weaken service delivery, and erode public trust in health institutions. Addressing them requires comprehensive structural reforms that prioritize transparency, accountability, ethical leadership, and robust oversight. The call for reform is urgent and unavoidable. Protecting public resources and ensuring quality healthcare delivery demand a procurement system that is not only efficient but also just, transparent, and sustainable.

By: Dr. Solomon D.Y. Kwashie,
Medical Laboratory Scientists and General secretary of the Ghana Association of Medical Laboratory Scientists

solomonskydo@yahoo.com

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