-I agree with the first recommendation. Corruption in health systems is difficult to define because it is often hidden in everyday practices and described as “gifts,” “tokens of gratitude,” or “facilitation.” Power differences between health care providers and patients make these behaviors easy to accept and hard to challenge, as patients may fear receiving poor care if they do not pay extra. Public health professionals should recognize that corruption is not only direct bribery. It also includes informal payments, absenteeism, incentives from pharmaceutical companies, and abuse of authority. These practices are often normalized and ignored. I agree with using clear examples instead of one rigid definition, because strict legal terms miss how corruption actually happens in real health systems. In developing countries including Myanmar’s public health system, corruption does not happen at only one level. It can occur from central budgeting and procurement down to facility management and frontline service delivery. The most harmful corruption lies in the “grey zone,” such as paying for faster care or staff being absent from duty. These practices mainly harm poor and vulnerable people. In Myanmar, for example, some patients feel pressured to give money to get quicker attention in public hospitals, while absenteeism in rural health centers (for example) can leave communities without services. Even if staff do not see this as corruption, it denies patients access to care and risks lives.
-I partially agree with the second recommendation because understanding the background of corruption and prioritizing action by public health impact is important, but not enough on its own. Corruption is more than bribery. It includes absenteeism, and favoritism in postings and promotions, all of which reduce efficiency and equity. In Myanmar, for example, low salaries, weak accountability, political instability, and fragile governance allow these practices to persist. However, recognizing these causes does not automatically protect health outcomes. As an example, a high-level official once misused Myanmar’s vaccination budget, yet no effective action followed. This shows that awareness without effective enforcement allows corruption to continue. Some corrupt behaviors also emerge because the health system is weak and under-resourced. In fragile settings, bribing officials to obtain approvals or using informal payments to keep facilities functioning may be seen as survival strategies rather than personal wrongdoing. Frontline workers sometimes face a choice between strictly following rules and meeting urgent patient needs. While these actions may be understandable, they should not become normal. Survival-driven corruption increases inequality, weakens trust, and keeps the system fragile.
-I strongly agree with the third recommendation because fighting corruption needs a holistic and multidisciplinary approach. The article describes that research on corruption is often published in anthropology and political economy journals rather than health literature, which makes it hard for health professionals to access and use. Important knowledge therefore stays outside everyday public health practice. Studying corruption is also difficult because powerful officials/individuals may shift blame to frontline workers, limit access to information, or present themselves as reformers while protecting their own interests. Researchers often have to choose between keeping access and telling the truth. If public health looks only at rules and audits, it misses the human behaviors and power relations that allow corruption to survive. A holistic, multi-disciplinary view helps explain why corruption happens and leads to solutions that are more realistic.
-I agree with the fourth recommendation because fighting corruption needs evidence, not just good intentions or moral arguments. The article points out that we still do not have enough strong evidence on what really works to reduce corruption in health systems. Without evidence, actions against corruption would not be effective. When research clearly shows how corruption affects mortality, access to care, and public trust, it becomes much easier to persuade policymakers and stakeholders to take action. Additionally, the evidence helps turn it into a practical public health problem. Alternatively, studying corruption can help strengthen public institutions, improve services, and build trust. The key issue is how corruption is framed. When seen as a system problem rather than individual moral failure, corruption research supports equity, and better health outcomes.
-In addition to the four recommendations, (1)Digitalization can minimize chances for corruption. Investing in technology that connects the whole public health system with accountability and real-time monitoring such as e-procurement, stock management, and payroll systems can reduce medicine diversion. Today, mobile phone applications make it easier for staff and communities to report problems, track services, and improve transparency. When activities are recorded and traceable, it becomes harder to hide corrupt practices. (2) Independent third-party monitoring/audit: Corruption can be detected by comparing different sources of information, such as service records, drug stocks, and spending reports. When these do not match, it may signal a problem. Independent or third-party monitoring is especially useful in donor-funded humanitarian programs because it reduces conflicts of interest and increases trust in the findings (3) Strengthening community engagement can also be effective. Empowering communities, local CSOs, and ethnic health groups to monitor public health services can help uncover corruption that officials may overlook. Creating safe and simple channels for reporting problems allows communities to participate in protecting health services. When people are involved, corruption becomes more visible.