Stamping out corruption in the Guatemalan health sector

Aim

The central aim was to uncover the alleged wrongdoings of corrupt government officials and health care providers.

Landscape

In February 2015, a group of patients with kidney failure in Guatemala suddenly started coming down with dangerous infections. They suspected their new provider of dialysis — a treatment meant to keep them healthy — was actually making them ill.

Earlier that month, PISA, a Mexican supplier of medicines with a branch in Guatemala, had taken over in providing peritoneal dialysis to 530 patients of the Guatemalan Institute of Social Security (Instituto Guatemalteco de Seguridad Social (IGSS)). As this is an invasive technique, it carries a high risk of infections and careful hygiene is essential.

The patients complained that they were given sub-standard equipment and products which were poorly used, and that the protocols for maintaining hygiene were not being followed. Less than one month after PISA took over, two patients had died and fifteen more were suffering from infections. Patient Sorayda Macz, a 43-year-old businesswoman from Guatemala City, asked Transparency International’s Guatemalan chapter, Acción Ciudadana, to intervene. Accion Ciudadad provided legal support through its Advocacy and Legal Advice Centre (ALAC).

Activities

1. Research on how the contract had been awarded to PISA by the IGSS
   Research & analysis
2. During spring 2015, as the number of patients with infections rose, they set up a patients’ association led by Ms. Macz. Acción Ciudadana alerted the Guatemalan media and managed to hold a special session in the Guatemalan parliament to try to get the contract cancelled, but without success.
   AdvocacyAwareness raising
3. Working towards the rescindment of the contract and the prosecution of the offenders by gathering evidence for the trial.
   AdvocacyAwareness raising

Achievements

1. Acción Ciudadana found that the 116 million quetzales (US$14.9 million) contract had been awarded to PISA in late November 2014 under suspicious circumstances. At the time of the bid, PISA did not employ any medical personnel, had no previous experience of providing the service and was not licensed to provide it. The company also only operated out of three rooms sublet from a private hospital. Nevertheless, the tenders committee disqualified the other bidder — incumbent Baxter — and gave the contract to PISA.
2. By May 2015, with the help of the United Nations-backed International Commission Against Impunity in Guatemala (La Comisión Internacional Contra la Impunidad en Guatemala (CICIG)), Acción Ciudadana had gathered enough evidence to get the contract between PISA and the IGSS rescinded and convince the Guatemalan public prosecutor to issue orders for the arrest of 15 people, including the managers of IGSS and PISA. A criminal investigation, leading to a trial, was set in motion.

Future Plans

In September 2018, the four members of the IGSS governing board, five members of the tenders committee, plus another manager were found guilty of fraud. PISA’s managers and an IGSS doctor were cleared of all charges.

Those found guilty appealed and in July 2019, Judge Beyla Estrada reversed the ruling. The public prosecutor’s office has since taken this second not-guilty verdict to the court of cassation.

September 2019 saw CIGIG shut down, following an announcement by Guatemalan President Jimmy Morales in the previous summer that he would not renew its mandate. The decision, believed by some to be motivated by CIGIG’s investigation of his family members, ended the operations of a key institution in the fight against corruption in the country.

Today, the patients and families affected by the PISA scandal are still waiting for justice.