The organization Towards Transparency, Transparency International’s national contact in Vietnam, has released a report about informal payments in the health sector in the country. The study investigates the causes, perceptions and impact of such payments on health services, and raises potential solutions to the problem.
According to the report, these payments are very common in Vietnam and occur not only in the form of bribes, but also as tokens of gratitude for medical treatment. Informal payments are also strongly influenced by a culture where citizens feel that such payments are necessary to guarantee them adequate health care, even if medical personnel does not openly ask for extra fees.
From the perspective of health care professionals, these payments are perceived as opportunities to improve their meager income, as salaries in the health sector are commonly very low in the country. Testimonies by doctors reveal that they feel compelled to accept informal payments due to financial needs.
The report was presented in June at a workshop at the Research and Training Centre for Community Development (RTCCD), where health managers, medical staff, and representatives of civil society and government discussed the findings of the study. Their conclusions corresponded to the key drivers of informal payments pointed out in the report: low salaries, over-crowding of public hospitals, pressure on hospitals to have financial autonomy as a result of the introduction of market-based management mechanisms in hospital management, inconsistent professional ethics of medical staff and managers, and low levels of awareness of patients about the legitimacy of fees and available complaints mechanisms.
During the workshop, possible solutions to the problems were also discussed among participants. Participants stressed that solutions to this issue will have to address the multiple causes of the problem in order to be effective. Some of the suggested policies raised were measures to improve patients’ awareness about their rights and official fee rates, increase accessibility and effectiveness of complaints mechanism, introduce and enforce codes of ethics, improve oversight by elected bodies and independent monitoring mechanisms, and develop pilot “no-envelope” programs in selected hospitals.
For more details, read the article “Vietnam: Who pays the doctor?” on blog.transparency.org. The picture shown above is also featured in the article. A summary in English of the report “Towards a Transparent and Quality Healthcare System” is available online.