A global report from the good governance group Transparency International says there are many ways corruption occurs in health care systems, sometimes with fatal results.  Kenya and other African countries are particularly vulnerable to corruption in the HIV/AIDS prevention and treatment field.

A big problem in public hospitals is bribery, according to Transparency International's Kenya chapter.

For instance, some people seeking treatment have been told that there are no empty beds unless they bribe the attendant.  Patients are sometimes forced to purchase syringes, bandages, and other important supplies directly from attendants or pharmacists who are their accomplices.

The deputy executive director for Transparency International - Kenya, Lisa Karanja, describes the extent of the bribery problem.

"According to our bribery index reports, the percentage of people interacting with the public hospitals reporting the consequences of declining to bribe as severe has increased," she said.  "And the percentage of respondents affected by bribery encounters in public hospitals has been on the rise."

Transparency International's 2006 annual report pinpoints common types of corruption in procurement, payment, pharmaceutical supply, and service delivery practices in health care systems around the world.  It says the corruption is costing consumers, patients, and governments billions of dollars.

These include: diversion of public supplies and equipment to private practices: overpayment of goods and services because of kickbacks and bribery, and performing unnecessary medical interventions to maximize fee revenues.

The report says that in sub-Saharan Africa, corruption is common in the HIV/AIDS prevention and treatment field.

For example, last year only 11 percent of HIV-positive people in sub-Saharan Africa who needed anti-retroviral treatment actually received it.  According to the report, the drug shortage means that requests for additional payments are common.

The report highlights the case of Kenya's National AIDS Control Council, which allegedly was used for years by high-level civil servants as a personal cash cow.  It is alleged much of the corruption involved the formation of shell organizations to receive the massive HIV/AIDS funding coming into the country.

The council ordered 20 organizations to refund money that had been squandered, but none has done so nor have they been taken to court.