1. Edition 1, Volume 2  1 For more information contact Vlastimir Milosavljevic t +381 63 490094 or Vlastimir.Milosavljevic@globalatlantisllc.com
February 29, 2016 www.globalatlantisllc.comM
Government Corruption: The trickle down
effect
“High and rising corruption increases income inequality, and
poverty by reducing economic growth, the progressivity of the tax
system, the level and effectiveness of social spending, the
formation of human capital, and by perpetuating an unequal
distribution of asset ownership and unequal access to education.
These findings hold for countries with different growth
experiences, at different stages of development, and using
various indices of corruption.”
Corruption can destroy
Laws, rules, regulations, and procedures derived from patterns of
corruption within a government or society is destined to breed a
culture of non-compliance.
Haider al-Abadi, Prime Minister of Iraq, came to power on August
11, 2014, with promises of “change for the better.” His
predecessor, Nouri al-Maliki, was known to be corrupt to the core.
He is also known for his allegiance to Iran and accused of
“following Iran’s orders” possibly against the best interest of his
country. Al-Abadi’s performance has been poor according to
many of his countrymen and Transparency International. “Iraq is
the 161 least corrupt nation out of 175 countries [that are
ranked], according to 2015 Corruption Perceptions Index reported
by Transparency International. Corruption Rank in Iraq averaged
160.92 from 2003 until 2015, reaching an all-time high of 178 in
2007 and a record low of 113 in 2003.”
On February 26th, 2015, hundreds of thousands of Iraqi Shiites
held a protest against corruption in a Bagdad’s Tahrir Square rally
called by influential cleric Muqtada al-Sadr. In January, al-Sadr
gave al-Abadi an ultimatum saying he must immediately carry out
corruption reforms he had previously promised. “Abadi must
carry out grassroots reform. Raise your voice and shout so the
corrupt get scared of you."
Muqtada al-Sadr told the crowd. “No, no, to corruption,” and
“The people are all with you, Sayed Muqtada,” the crowd chanted
waving flags as al-Sadr gave his speech. Just how bad is the
corruption in Iraq? “After five years of trying to get a job as a
public school teacher, Saleh Ali paid a bribe of $4,300 to an official
in Iraq’s Education Ministry to secure one. He says it was the only
way.”
Iraq needs a corruption make-over and a governance
commitment
Iraq has put off any reforms in the government since al-Abadi
began making promises of reform. Accordingly, to jumpstart the
process now he will have an almost insurmountable task on his
hands managing conflict and corruption at the same time.
However, in Bagdad where they have managed to hold the
conflict back, Muqtada al-Sadr has brought his people forward
with a strong warning that “corruption must be fixed now.”
Iraq has a lot to consider, as corruption is prevalent throughout
the country. Sectarian issues are a driver, and tribal rivalry is front
and center.
By Kimberly Jones, President, Global Atlantis LLC

2. Edition 1, Volume 2  2 For more information contact Vlastimir Milosavljevic t +381 63 490094 or Vlastimir.Milosavljevic@globalatlantisllc.com
February 29, 2016 www.globalatlantisllc.com
Perception: The downstream effect of
corruption
It has been shown there is a correlation between access to the free
press and the level of widespread corruption in countries.
Is corruption widespread through the government [in countries
with Free Press Countries] or not?” Although some countries do
register very high on the CPI Index, generally there is a greater
number of countries that fall low on the index.
Assessments reveal common trends
Based on the evaluation of many governments, all these countries
have the following typical patterns that contribute to long-term to
corruption:
- Relatively poor salaries and working conditions for public
servants/officials
- Absence of leadership integrity at any level of
governmental levels (macro, sub-macro and micro level)
- Ineffective law enforcement in corruption related cases
- Unequal opportunity structures for any advancement
- Very poor internal control and audit in the primary
institutions of a government
- A political function of patron-client relations applied to
state structures. This varies up and down based on the
Corruption Perception Index (CPI) of the government.
- Long term culture of tolerance of petty corruption and
inadequate measures taken against previous corruption
cases by authorities.
” A staggering 75% of the American public believe corruption is
"widespread" in the U.S. government, said Gallup, not due to
incompetence, but corruption. This jaw-dropping figure may be
shocking to most, but it has held steady since 2010, up from 66% in
2009.” Gallup’s results to public opinion appear remarkably high
and disconcerting. It is important to remember Americans are
“generally free to criticize the US government and over the past
ten years have been more vocal in their criticism as frustrations
have increased.”
Unfortunately, in many countries, citizens do not have the luxury
to criticize their government for fear of sanctions, incarceration or
possibly death. When the stress becomes too much, and the
people speak out “en masse,” rarely is there a neatly negotiated
outcome where everyone wins. Additionally, bribery countries
throughout the world.
In South Africa which many think of as affluent, corruption such as
bribery annoys the rich (at least those who do not themselves
benefit) but makes life miserable for ordinary people. Getting a
place at a good school; getting permission to build on land you
own; starting a business: all can involve paying people off. The
injustice of the rich buying themselves out of criminal convictions
while the poor get harsh treatment is greater still. Most recently,
the people of South Africa have raised their voices in protest going
as far as asking the President of South Africa to step aside.
“Bribes and backroom deals do not just
steal resources from the vulnerable– they
undermine justice and economic
development, and destroy public trust in
government and leaders.”
 Transparency International

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Identifying corruption within an organizational
structure or system
To identify corruption or fraud within an organizational structure
or system, one of the best ways to pin down a problem is through
“good governance” of transactions. In this newsletter, we will be
focusing on the “contracting process” and associated transactions.
The assessment must include:
1. Evaluation of contracting process
2. Analysis of the government payments process to vendors,
contractors, and sub-contractors
To evaluate the methods and processes mentioned above, the
most reliable and recommend methodology is:
AIM = Assess – Improve – Monitor
AIM methodology is used by the “Big Four Consulting Firms” and
focuses on:
Assess phase:
- Review standard contract terms and conditions
- Review the applicable laws, rules and regulations
(including government decrees)
- Perform an interview with the main process owners to
understand contracting and payment processes
- Identify system and non-system supported processes
- Assess contracting and government payments to
contractors (forms and processes)
- Review the compliance of contracts and payments with
present legislation
- Assess government contracting and payments risks
- Identify areas of control weaknesses
Report findings:
- Improve phase:
- Identify issues
- Identify and create potential solutions
- Develop action plans
- Summarize findings and recommendations
- Prepare recommendations to develop a Road Map
Monitor phase:
- Plan monitoring activity for contracting and payment
processes
- Follow up on recommendations and approved Road Map
- Monitor high-risk areas
The main target of the analysis and AIM methodology is to create
efficient, effective, speedy and transparent contracting and
payment to contractors. The key process design principles drive
the assessment of the current state and evolve through
recommendation to the Road Map.
There are no studies that define an ideal structure or practice for
procurement, but rather a generic list of functions that
procurement entities undertake. Despite the existence of a single
unified model and the fact that a public procurement entity needs
strong a legal framework, it is recommended that the public
procurement entity be established at a very high central level
within a government.
The majority of countries forming a central procurement body
(authority) during economic transition have the body reporting to
the Office of the Prime Minister. Forming the public procurement
entity, focused must be placed on creating a strong procurement
function, Therefore, it is recommended that the Cabinet play a key
stakeholder role the in governance process.
The Cabinet role begins with the Assessment follow-up process
from its’ initiation phase (Current state), approving Assessment
recommendations for each sector, ministry or stakeholder, or
authority, then adopting a Roadmap of the whole process at all
government levels. On an on-going basis, the Cabinet will receive a
progress report on achieved results. Obtained results should be
compared at the accountability or Central level against KPIs for
each phase of the processes. The Cabinet holds the Government
accountable for their performance and has the capability to
demand improvement if performance wanes. They also have
accountability to provide strict oversight to ensure that corruption
stops and the activities of the government are carried out in a
“clean and fair” manner.
By Vlastimir Milosavljevic, Vice President International Development and
Kimberly Jones, President, Global Atlantis LLC

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February 29, 2016 www.globalatlantisllc.com
Is the Emergency Department your worst
emergency?
In the United States, the use of the Emergency Department has
increased exponentially since the year 2000. In 2003, the
Emergency Medical Journal warned, “Emergency department (ED)
overcrowding is widespread in US cities and has reportedly reached
crisis proportions.” Chris Van Gorder, CEO of San Diego's Scripps
said, “The number of emergency room visits for non-emergencies
ballooned by 160 percent from 2014 to 2015.” The result is not a
mere inconvenience for the patient. It is a disintegration of the
entire hospital experience -- the quality of care suffers, patients’
safety is endangered, staff morale is impaired, and the cost of care
increases.
The global problem of Emergency Department overcrowding is
well-known. The International Journal of Emergency Medicine
states the adverse negative effects include patients, physicians, and
the hospital. Most important is patient safety, with decreased
quality of care and an increase in medical errors in overcrowded
Emergency Departments.
The reason people are pushed to use the Emergency Department
over a Primary Care Physician is complex. A fair share of the
answer lies in the increased cost of medicine, the continuing rise in
hospital care and rising costs of health insurance despite private
insurers reporting profits for commercial lines of business. Health
care has become out of reach for the unemployed, unemployable,
underemployed and those with chronic illnesses globally which
are a form of corruption.
Emergency Department overcrowding not just a single focus issue
As has been documented in many journals, it is impossible to
resolve the issue of ED overcrowding by expecting a magic fix in just
one hospital department. In a hospital, the Emergency Department
is part of a greater system intrinsically connected. When people
arrive at the ED in the US, they will receive treatment regardless of
ability to pay.
A bottleneck or failure at one point in a process will cause
additional failures or slowdowns in an interdependent system.
In the US and other countries, Emergency Departments are triaging
patients upon arrival in many hospital settings. If the hospital has a
step-down Urgent Care facility, the triage staff redirect the patient
who has a non-emergent illness or injury to the hospital-based 24
hours Urgent Care Center. However, Urgent Care Centers are not
the answer to Emergency Department overcrowding.
Patients with adequate health coverage, or who live in countries
where health coverage is free, may choose to go to the Emergency
Department for care. Some people cannot afford to miss work
during the day, or delay care until after office hours rather than
miss work. In many communities, physicians are not available.
When people require care, they not only need to visit the
Emergency Department due to unavailable primary care, but they
must travel a distance to get there.
In Saudi Arabia, factors that have contributed to increased use of
the Emergency Department for non-urgent care include
convenience, limited access to primary health care, limited
availability of social support, and similar patterns of health care
seeking by familial caregivers. In an “Assessment of Non-
emergency Cases Attending Emergency Department at King Fahad
General Hospital, Jeddah” a direct correlation to increased
overcrowding in the Emergency Department was found.
In Malaysia, a study found that the prevalence of adverse drug
event (ADE)-related emergency department (ED) visits was high.
“The 2015 study reported that more than one-half of the events
were considered preventable, and one-third should be classed as
severe. As such, preventive measures will minimize future
occurrences and increase patient safety.” A total of 93 patients
(69.9 %) were admitted to the ED for observation, 25 (18.8 %) were
discharged immediately after triage, and 15 (11.3 %) were admitted
to the hospital through the ED. A high number of occurences
related to drugs antibiotics, and other common medications.
Drug seekers often use Emergency Departments as a source of
opiates and other drugs. In New York and other states, Emergency
Departments are required to have an e-prescribing system in place
that will manage medication prescribing. With an interconnected
State-wide e-prescribing system, e-prescribers can identify opiate
overuse, drug-seekers, and other abuse at the point of prescription
ordering. It will also reduce drug errors, fraudulent prescribing,
and the expense of writing prescriptions on paper. With the
successful implementation of e-prescribing, fewer addicts will find
their way to the ED looking for their next drug deal.
At the other end of the Emergency Department overcrowding story
is the problem of inpatient overcrowding. A few top reasons
hospitals face inpatient overrowding include:
 not enough beds,
 staffing ratios and training may not be appropriate,
 longer than the average length of stay,
 readmission rates higher than expected,
 inadequate control of preventable conditions,
 readmission rates (less than 30 days) are higher than
anticipated,
 lack of “Home and Community Based Care” models for
seriously physically and behaviorally ill

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Getting arms around the elephant – “hospital performance.”
Many opportunities can be taken depending on the need to
improve Emergency Department overcrowding. However, it is
critical to recognize that success will not come from just knocking
on one door. The following are recommendations that can help:
 Understanding demographics and establishing services to
meet community needs
 Implementing a standard coding system that enables
accurate reporting of medical services, then using the
reporting to evaluate accurately where policy, training and
other administrative changes may not only provide
opportunities to improve overcrowding in the Emergency
Department but hospital inpatient and other areas of the
hospital as well.
 Tracking preventable conditions and implementing
decisive measures to prevent reoccurrence including
training, technical and environmental changes reduce long
hospital stays and recurrent stays.
 Advanced disease management programs, implementing
care management programs and reminder tools to
improve patient compliance help maintain patient-
centered services in the community rather than in the
hospital.
 Developing a better partnership with the community, rural
and remote-based clinics or small facilities; implementing
telehealth from central hospitals to extending services and
expertise.
 Implement telemedicine to connect central hospitals with
community nursing homes assisted living centers and even
group homes. Telemedicine can extend the services and
expertise of a central hospital to local and remote area
community-based services, particularly for triage services.
 Similar to the US Veterans Administration, implement
traveling rural clinics improving both outreach and rural
health care particularly for people with disabilities, the
elderly, and school-age health care. This approach will
improve routine Primary Care access to people who would
otherwise not have the same access.
 In countries where there is a Universal Health System,
implementation of a broadly connected EMR with e-
prescribing can provide benefits beyond internal business
analytics; the system can offer point-of-service health and
drug management. E-prescribing has the potential to
decrease drug seeking, opiate misuse, prescription fraud,
and overall health care savings
 Improve patient satisfaction through both Health System
and Community Education
Overall, many of these solutions contribute directly or indirectly to
the prevention of corruption, fraud, waste or abuse in the health
care system.
How are you solutioning Emergency Department aproblems? What
solutions are you interested in implementing?
By Kimberly Jones, President, Global Atlantis LLC
Up Next:
If fraud, waste and abuse, and other potential corruption are
preventing the best use of government health care spend, what
next?
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About Us
Global Atlantis LLC is a strategic consulting and merchandising firm. We offer a broad spectrum of consulting services addressing the needs of
national, state, and municipal governments both in the United States and Internationally. We have internationally-sought out talent providing
expertise in areas such as Anticorruption, Procurement Management & Governance, Value Chain Assessments, Organizational Development,
Leadership Development, Job Coaching (In-House or Web-based), Local Economic Development, and Multicultural Sensitivity Training.
We also provide a full array of services providing business leaders trusted advisors at any level of the organization including C-Level. Our services
include strategic and business development, business planning, business process realignment, financial planning, letter of credit assistance, and in
some cases, we can assist with loan acquisition.
Under a new agreement with a US partner, we can facilitate the offering of US certified Special Forces military training; counterterrorism training;
border, police and security training; high-value asset, diplomat or executive personal protection; and UN human rights training. Our partner is duly
licensed by the US State Department to train in foreign countries (with certain non-ally exceptions).
Global Atlantis has designed services specifically for delivery in the Middle East and North Africa regions, including Central Africa. We prioritize our
efforts on projects that improve outcomes for individuals or groups of people through strategic projects. I offer you the broad expertise of my
team and our partners, contributing to solutions that directly impact stability, water security, food security, gender inclusion and poverty
eradication in areas of the Middle East, North Africa, and Central Africa.