Informal Payments in the Health Sector

In Vietnam, corruption in the health sector has been identified as a crucial issue by the authorities and by the public at large. According to TI’s 2010 Global Corruption Barometer, Vietnamese urban citizens perceive the health sector to be the 3rd most corrupt institution, with 29% of people who had contact with medical services in the past year reporting that they paid a bribe. The Government has since committed to prioritising the health sector in its anti-corruption efforts.

Nonetheless, more evidence – based analysis of the concrete forms and patterns of corruption in the health sector is currently needed to properly inform policy actions.

Towards Transparency has worked with national (the Research and Training Centre for Community Development) and international experts (from Boston University) to undertake a qualitative study of informal payments, including money or gifts exchanged during the process of receiving health care services.

Over 170 doctors, nurses, patients and other health related professionals were interviewed across four geographic provinces in Vietnam: Ha Noi, Son La, Dak Lak and Can Tho.

The research finds that offering cash directly and cash in envelopes are the most common ways of making informal payments in health services. Values of envelope payments vary greatly between lower and higher-level hospitals as well as between rural and urban health facilities, ranging from 50,000 VND (2.50 USD) to 5,000,000 VND (250 USD).

Although most services providers surveyed considered informal payments to be given voluntarily, about half of the interviewed patients said they gave money or in-kind gifts because it is the common behaviour of others and one third of the patients reported that health service providers sometimes extort payments in subtle ways.

Patients report giving informal payments in order to help gain access to care or improve the quality of care; to ensure the availability of supplies or transfer to a higher-level hospital; or just to avoid shame (in front of peers who have paid). For health workers, reasons given for accepting informal payments are overwhelmingly to increase their low official salaries, and in some cases to expand social relationships or simply to avoid embarrassment for patients.

Informal payments were found to erode the patient’s belief, respect and trust in the health system and creating internal conflicts within a health facility.

Recommendations from the research include:

•     Strengthening the capacity of primary healthcare facilities to reduce overload
•     Improving independent supervision and sanctions for health workers who accept informal payments
•     Increasing financial and non-financial remuneration for health workers
•     Establishing an independent system to supervise the quality of health services
•     Improving patient awareness of their rights and knowledge of official fees

The research aims to understand perceptions, forms, patterns and the impact of informal payments in Vietnam and to identify approaches to limit such practice in the country’s health services.

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