There is a sickness. It spreads quietly. It manifests in boardrooms, ministries, meetings and homes. It threatens healthcare, the economy and social futures of countries. Its name is corruption.
This art-based op-ed explores this disease through both analysis and art—specifically, a painting to visualize corruption as a systemic illness in the healthcare system embedded in South Africa’s past, present and potential future. This piece, serving as a conceptual backdrop, depicts a timeline of corruption starting from colonialism and its rigid structures on the left side of the painting to today’s chaotic and fragmented nature of power and governance in the middle, and finally, toward a hopeful vision of civil society engagement on the right side. The framing of corruption as an illness within a complex healthcare system is strengthened by the artwork to allow for abstract thinking, concerning systemic, structural issues in South Africa.
Transparency International defines corruption as“abuse of entrusted power for private gain”. Like many countries, South Africa’s corruption is not just a governance issue–it’s a public health crisis or ‘disease’ that embeds itself in the system, spreading and harming, fatal for the most vulnerable if not treated. As outlined by the South African Bill of Rights, healthcare services are a human right for all citizens. Yet, the disproportionate effects of this disease combined with a foundation of underfunding, healthcare privatization, increased medication and supply prices, lacking adequate reporting systems/oversight and inequitable resource distribution have turned healthcare access and quality into a privilege rather than a right. The healthcare system is akin to a complex organism and the disease of corruption erodes its ‘bodily’ functions of healthcare access and quality. The state must take steps to realize this right through community perspectives (bottom-up approaches) and increased governance cohesiveness. How did this organism acquire this disease (of corruption), what is its current health status and how can it be healed?
“Passage of Time”, Rinila Haridas, Acrylic and Oil Pastel on canvas, 14/04/25
The Past: Incubation Period
South Africa’s history shaped its present healthcare and governance systems. Years of colonialism and apartheid served as the incubation period for a system susceptible to the disease of corruption. Since the 17th century, South Africa faced colonization by the Dutch East India Company and then the British, leading to grave injustices such as displacement, racial segregation and discrimination until 1994, when a new constitution came to fruition. These historical effects fueled an overreliance on foreign governance; systems in the Global North were made by and for Western society and are based on exploitation of resources and populations in the Global South. A negative feedback loop is still felt today, marked by a lack of resources, funds and wages–especially within the healthcare system. In the past half-century, in foreign aid-reliant countries such as South Africa, this created a surge in corruption reflected in broader patterns of governance, including healthcare.
The Present: The Current Infection
Historical colonialism combined with a persistent concentration of power in the hands of a few, increased neoliberal economic interests (e.g. privatization), governance failures/fragmentation and political opportunism, has festered into an infection of corruption. All levels of government, medical procurement suppliers and health facilities are involved in some form of corruption. Common forms of healthcare corruption in South Africa are found mainly in the public sector and include petty bribery, tax evasion, inflated healthcare bills, ‘incentivized’ healthcare professionals (e.g. bribes, gifts, financial kickbacks), false healthcare insurance and medical aid claims or irregularly high institutional spending bringing in audits. Although some policies exist, they are “just ignored” as highlighted by the clinical director of a South African public hospital.
Really, the organism is sick because of a lack of base nutrition in its body; this stems from the unaffordability of private care. More than half of South Africa’s healthcare GDP is being spent on the private sector. But when it comes to patients, it’s a different story: 86% of the population rely on public healthcare, which is marked by limited resources and poor returns on their health investment. The organism is further deprived by poor governance through asymmetrical power dynamics being taken advantage of. Those governing battle for money in its representation of power and recognition, creating a fragmented system that breeds circumstantial chaos such as corruption. The ways in which politics has manifested in South African healthcare lends itself to interconnectedness between political leadership getting involved with public organizations for their benefit. There is, hence, inadequacy in governance, disconnect between policy and implementation and lacking regulation/enforcement and cohesiveness between sectors/individuals, leading to a burdened healthcare system with conflicts of interest, nepotism and fraud/collision. For example, in 2015, evidence found that a Gauteng Department of Mental Health director sent 1200 mentally ill patients to falsely certified healthcare facilities (with whom he allegedly had financial ties), resulting in 143 deaths in 9 months from neglect and mismanagement. Corruption doesn’t only exist in the abstract but has tangible consequences upstream, including on people’s ability to live.
The Future: Healing
With healing comes change for a strong governance base to ensure the organism functions well. Corruption remains under-addressed in healthcare, potentially because it’s difficult to track, hard to admit and requires confronting major, powerful actors (who may not listen). In a perfect world and (hopefully) as a long-term goal, those in power would shift perspectives to stray away from the normalized (accepted corruption) and towards the normative (minimal, frowned upon corruption). In the short term, however, what is feasible are ‘baby’ steps towards realizing healthcare access and quality as a human right through a more bottom-up approach of transparency, trust-building and community engagement to form informed governance. Since civil society is often neglected within anti-corruption policies in the health sector, communities must participate as partners in processes for intentional and impactful change. This can include education (i.e. workshops, campaigns) for corruption awareness and prevention, co-design with policymakers/governments, interviews/focus groups, and iterative feedback. Ultimately, healing requires treating not only one body part (healthcare), but the whole organism (governance reform across all sectors) to address the systemic roots of corruption.
We must stray away from the normalized and towards the normative
Painting Description
The painting is a representation of the past, present and future of the systemic illness of corruption in South Africa.
The Past: The color blue represents colonialism, with it being desired by Europeans throughout history. It represents the economic pillars in colonies and the expansion of empires due to uniform colors throughout history as well. The paint splatters highlight the injustices that resulted in the passing of lives due to “Global North” domination. I employed large geometric shapes to demonstrate the monopolization of power by certain entities. The rigid structures demonstrate the social hierarchies, political systems and perpetuation of inequities and the rigidity of the injustices performed historically such as the mistreatment of non-white South Africans during the apartheid period. The overpowering top-down approaches as seen through colonialism and apartheid measures are displayed through the top of the page having paint coming downwards in scraping lines, feeding into the “present”, as colonial practices remain evident today.
The Present: The multi-colored display represents the chaos in corruption today. This includes the fragmentation of responsibility to multiple parties, the lack of accountability and enforcement of anti-corruption. The multiple circles colliding, overlapping and darkening with each layer represent the multiple actors taking part in corruption and “fighting” for power and recognition. This feeds into the “the past”, marking similar notions throughout history. The background color of purple was chosen to represent power associated with royalty and luxury, along with a multi-colored display to demonstrate chaos and fragmentation.
The Future: The future marks a stark contrast that is distinct and quite separate from the rest of the painting. Rather than a more cohesive picture between the “past” and the “present”, the “future” depicts disjointedness to represent the need for a perspective shift, as well as a flip from top-down to bottom-up approaches in health system governance; the scraping lines coming from the bottom up, show this idea. The lines represent smooth cohesion and harmony, allowing for community perspectives and policy to connect, while staying separate in their paths in other ways. The color green is representative of healing, combined with bright colors of yellow and orange to represent positivity and hope.