"Don’t play with our health": Using ICTs to combat corruption
Choosing a single case to talk about corruption in Costa Rica in 2012 is a complex task because, unfortunately, during this period , there have been numerous cases of apparent corruption that have involved dismissals, lawsuits and citizen action. Despite this, the government sector provides little information supporting citizen participation in governance and strengthening its accountability.
Among many examples, for this GISWatch 2012 we are going to present the case of the Social Security Public Health Institution (CCSS), popularly known as “La Caja”. For 70 years, the CCSS represented an essential way of ensuring that public health in this country remained a human right. It is a product of the “solidarity” state model, which is itself a result of the struggle for social guarantees in the 1940s. It is the primary reason for an improvement in health indicators in Costa Rica, and La Caja has become an example of universal health care. The public institution has a prevention-oriented approach, which has ensured significant progress in the eradication and early treatment of diseases amongst the Costa Rican population.
Corruption in the health sector
As we know, the health business is very lucrative, and a people-orientated health model is against the interests of large international corporations and local economic and political sectors who have interests in making money in the health sector in Costa Rica. Because of this, public health in Costa Rica faces a major contradiction between the financial interests of the dominant sectors and the original CCSS model holding health as a universal human right.
There is much evidence of corruption resulting from this contradiction, as well as many other issues that have arisen: bad management, the use of public infrastructure for private services, the surcharge payment of overtime by doctors, the poor quality work of some administrative employees, a lack of transparency in the procurement of products and services (especially drugs), the waste of resources and equipment, and the misuse of drugs by addicted patients are just a few examples of the great difficulties that undermine the good work of La Caja.
As a people-centred model, one of the main sources of income for the CCSS is through taxing the economically active population, companies and institutions. All employees make a percentage contribution of their income, ensuring that a higher income makes a higher contribution. It is a good way to guarantee that the health service is equitable for all people, independently of the economic contribution of each individual. Similarly, companies and institutions must make a percentage contribution based on their payroll.
One of the crucial requirements for the financial health of the CCSS is the successful collection of these contributions. Generally, companies raise the money through payroll deductions for the workers’ contributions. They then add their own contribution and deposit the monthly fee into the health system.
However, at the time of writing this article, several companies and public institutions owed a total of CRC 160 billion (USD 320 million) to the CCSS. These are acts of high corruption for many reasons:
- Often companies have already deducted the appropriate amount from their employees’ salaries, but have not transferred the money to the CCSS.
- Although workers have made a personal contribution, they cannot access the health services offered by the CCSS because their employers have not paid what is owed by them.
- Companies use different mechanisms to avoid making the payments due , such as faking bankruptcy and creating parallel companies.
- The CCSS is not efficient when it comes to collecting money owed to it.
- The CCSS does not inform workers that their employers are not making their contributions.
- Many of these companies belong to the most powerful economic groups in the country.
- There is no public information available to citizens on this issue.
The case of Don Roberto
Don Roberto Mora, a Costa Rican citizen, just over 60 years old, is determined to monitor these forms of corruption and keep the public informed about the companies and institutions that evade social security payments. Don Roberto is not a CCSS employee; however, his constant and active work over the past 11 years has made a significant difference. "If we lose the Social Security Fund, we lose our democracy," he says, expressing the feelings of the majority of the Costa Rican population. And information and communications technologies (ICTs) have been the fundamental tools that have transformed his solo work into an important fight against corruption.
One day, Don Roberto realised that although his social security contributions were being deducted from his salary, his employers were not passing them on to La Caja; instead they kept his money and the money of one of his fellow employees. As a result, neither he nor his family could use the public health services. This situation motivated him to fight against the corruption until today.
The CCSS’s debtors list was originally only available if a person went and asked for it in person. Eleven years ago, Don Roberto would consult these lists and write up what he discovered in documents that he personally distributed to legislators, government ministers and the president’s office. He realised this process was not very effective.
However, he was determined to continue. With the support of his youngest child, Don Roberto learned how to use a blog and created his own called "The CCSS Collector".1 He began to use digital technologies and, in doing so, created a substantial qualitative change in his efforts at fighting corruption.
Don Roberto has become an expert in using ICTs for in-depth studies of companies that are not paying their dues. Every two months he collects the information about debtors. He then does online research using public information which is not necessarily available to the public in a quick, easy and timely way.
For example, he does assessments of market trends and historical analyses, maps relationships among debtors, and investigates cover-ups and the use of joint liability. In this way he not only analyses a company, but also follows the owners’ activities, discovering that often a debtor in one company has other business-related debts. For example, it has been found that many employers who do not pay social security contributions, leaving their workers unprotected, do the same in several other companies
Don Roberto is very careful, and offers comprehensive, rigorous and well-referenced research in order to defend himself from prosecution. He also discovers when a company goes bankrupt, disappears, then reappears later under another name when it has a large debt.
The CCSS Collector is known in the country as the person who is doing the work that the CCSS should be doing. He understands that there is a strong interest in weakening the public institution – that economic interests can be satisfied if health services are privatised in Costa Rica.
The companies which do not fulfil their obligations to the CCSS belong to multinationals or hegemonic economic sectors in the country. They would prefer not to appear on Don Roberto’s blog. They know that if this happens, there is on the one hand a serious study supporting the complaint, and on the other a massive dissemination of their irresponsible behaviour at all levels in the country. The very patient work that Don Roberto is doing has already recovered some CRC 22 billion (USD 44 million) owed to the CCSS.
Don Roberto’s opinion is heard by a significant number of decision makers who use the information on his blog to make political arguments in favour of the health institution. In turn, they contribute to requests for information and evidence from the CCCS Collector. Through his work, he has managed to get the list of defaulters distributed publicly, so all citizens can know whether or not the place where they work is fulfilling its obligations. His work has also contributed to the adoption of a procedure whereby all public procurement must be supported by proof that the bidder is up to date with its CCSS payments.
"Being indebted to the Fund is being indebted to the Costa Rican people," says Don Roberto. His blogs have inspired community protests outside companies that have high levels of debt. For example, a group of citizens will protest with signs that say "This company owes X millions to the CCSS and will not pay". His work has also helped to remove people who were not meeting their obligations from public posts.
Don Roberto has been taken to court on several occasions, but has never been convicted. He has also been threatened numerous times. However, he still prefers to sign all of his investigations and accusations using his own name.
Conclusions and action steps
As mentioned earlier, the issue of revenue collection is only one of the serious problems that threaten the public health system in Costa Rica. But in this instance we have observed how the use of ICTs contributes to combating corruption. We have found that:
- ICTs are being used by an elderly person. This is interesting because it is often argued that ICTs are best used by young people. The case demonstrates that older adults also have the ability to use these technologies effectively and with impact. Activities should be developed to encourage this potential.
- ICTs are used for inter-generational exchange. The case demonstrates the importance of ICTs in facilitating the relationship between young people and elderly people. Significant applications could be developed in this regard.
- Blogs make effective tools for dissemination to the public generally, as well as to powerful decision makers.
- Successful advocacy depends on a combination between online and offline activities. For example, a blog post backed up by some lobbying in Congress or a protest outside a company is more powerful than just a blog post, and vice versa.
- One person, with the support of digital technologies, can really make a difference. The ICT viral effect can generate a social movement. However, not all digital activity creates an impact. In this case, the effect is due to the seriousness of the documentation submitted and the consistency with which the process has been carried out over the past 11 years. The internet and social media required dedicated commitment and work to be successful as advocacy tools – there is little “ready-mix” advocacy that leads to sustainable results.