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The Healthcare system, due to the huge business around it and due to the fact that even in times of crisis is a sector that cannot be underestimated, is the scourge of crime by every kind of criminal. Raffaele Cantone, Chairman of the National Anticorruption Authority, said during the 1^st National Anti-Corruption Day held in Rome in April 2016 and organized under the project “Healthcare Integrity Assessment” by Transparency International Italia and its partners Censis, RiSSC and ISPE Sanità and funded under the Siemens Integrity Initiative (www.curiamolacorruzione.it). Healthcare is a sector particularly exposed to corruption, as evidenced by various analysis and researches published in recent years. This is because on the one hand, the resources in the field are remarkable (more than 115 billion per year committed by the Italian Government), on the other hand it is an essential and non-replaceable service. Whether we talk about millionaire bribes for large deals or small sums covertly paid skip a waiting list, the problem is urgent and there are no areas that can be said to be completely safe from criminal infiltrations. This makes the prevention of and the fight against corruption even more complicated because the offense is so pervasive and widespread at all levels that the “standard measures” are unsuccessful. Healthcare requires further efforts and the implementation of innovative and advanced strategies. It must be said that since November 2012, when the Italian anticorruption law was approved, the system could take advantage of several improvements. First, the law established the figure of the “Anticorruption Manager” in every public body and so in healthcare structures too. The role of the anticorruption manager is focused on the prevention of bribes and other misbehaviors and his or her major tool is the “anticorruption plan” that must be published and reviewed every year. So, basically, since 2012 each hospital or healthcare structure should have a firewall against corruption and a manager in charge of coordinating all the activities in the field. It is true that, on the one hand, people awareness is higher than ever before and healthcare structures capacity for intervention is improving, but on the other, there is still the need to invest in training and fill the gap between territorial areas. These are just some of the data published in the 2017 report “Healthcare Integrity assessment”, developed by the project partners.

In fact, new regulations and the introduction of tools to prevent and fight corruption within the healthcare structures have been able to stem but not completely eradicate corruption, which in the last year involved 25.7% of healthcare structures. The phenomenon is also differently widespread across Italy: the worst performing are the regions in the south, where the structures where at least one corruption episode occurred is 37.3% out of the total. The survey on the perception of Anti-Corruption Managers of 136 healthcare structures also shows that the sectors most at risk of corruption are procurement and supply, waiting lists and staff recruitment. The positive news is that the system is trying to react to this situation: 96.3% of healthcare structures have already put in place whistleblowing procedures and 44.4% of them have done so by using digital platforms. In addition, 79.4% of the structures adopted Integrity Pacts, anticorruption tools to be signed with the companies participating to procurement procedures. Finally, 90.4% undertook training courses for staff on ethics and legality.Much remains to be done, and our organizations will continue to foster the dialogue with healthcare institutions and structures through project activities in order to make everyone citizens, doctors, health and administrative staff, more aware of the actions that can be undertaken to limit the phenomenon of corruption. For these reasons Transparency International Italia and its partners have been working in the framework of the Healthcare Integrity Assessment Project, proactively collaborating with some healthcare structure in Bari, Melegnano, Syracuse, Trento, Ragusa, Catania, Salerno and Catanzaro, to test new corruption-fighting tools and policies.

Innovative trainings on ethics and integrity were organized in four Italian big hospitals, engaging more than 800 attendants during 11 lessons for staff and executives. Beside these training courses the partners organized more specific coaching sessions dedicated to high profile managers and executive and public events targeting a broader audience. One of these events were organized in Sicily, a region in which corruption is widespread, gathering several managers of hospitals in the same room for discussing the phenomena and the best solutions that can be easily and quickly adopted. The result is not only the diffusion of best practices and anticorruption tools, but the establishment of an informal network of managers who share the same problems and the same vision: a healthcare sector free from corruption. One of the most brilliant result came from the adoption by 9 hospitals of a specific whistleblowing online platform, developed by Transparency International Italia and Hermes Center for Transparency and Digital Human Rights: all the employees of the selected hospitals can anonymously report case of corruption they face during their working activities, but despite the possibility to keep the complete anonymity, the software allow the anticorruption manager to chat with the whistleblowing, in order to ask for more detailed information or evidences. In the first year of testing, more than 30 reports have been collected from four different hospitals. Each of these reports has been processed by Transparency International Italia together with the anticorruption manager of the hospital in order to identify the best solution. Another innovative tool developed in the framework of the project and adopted by the participating hospitals is “Chiedi” (“ask” in English): it is an online tool for the civic access to information. Every citizen can access it and easily file a request of information, fully compliant with the Italian freedom of information law requirements to one of the participating hospitals. The request is then automatically saved in a specific online archive and made accessible for everyone. The civic monitoring of public contracts and conflicts of interests is indeed one of the most powerful weapon against bribers and criminals. The project focused also on the public communication: an aware citizenship is the most valuable result that an anticorruption campaign can achieve. For this reason, posters have been designed, printed and attached into the hospitals, aiming at explaining to the staff and to the “users” the negative consequences that bribery and corruption have on their lives.

Finally, the project partners are now working on the development of a new tool for the analysis and the evaluation of risks of corruption. The VAT “Vulnerability Assessment Tool” will be launched in October 2017, presenting interactive guidelines to support anticorruption managers who have to review their anticorruption plans.