Topic Discussion 2 : Corruption in health system

[Wirichada Pan-ngum]

Please give your view on the four recommended points that public health professionals can do to fight corruption.
Do you agree or disagree, why? Any other suggestion which could work better to fight corruption in your setting? (10 marks)

—————————- Deadline 16 January 2023 Pls reply before ————————————

[Zarni Lynn Kyaw]

First, it is important to convene key stakeholders in the health system in Myanmar, such as policy makers, health professionals, and managers, to seek agreement on the scale and nature of corruption in the country’s health system. This can help to identify specific areas of concern and to build a sense of shared responsibility for addressing corruption. I’m always impress with Thai National Health Assembly and a similar approach in Myanmar is needed.

Second, it is essential to prioritize action based on both the impact of corruption on the health system and the feasibility of potential remedies. For example, corruption that poses a severe threat to health or disproportionately affects vulnerable groups may be a higher priority than practices that have less impact. The previous democratic government formed anti-corruption council and it was working to some extent because even a threat of legal action was proved to be impactful.

Third, a holistic approach is needed to understand the underlying causes of corruption in the health system. This should include a multi-disciplinary approach, drawing on various fields such as anthropology, political economy, and health systems research, to fully grasp the extent and causes of corruption. There is a committee to track the progress of Sustainable Development Goals (SDG) indicators, which was chaired by the state counsellor where a multi-disciplinary approach was adopted but it had stop after the military coup.

Fourth, the research community can play an important role in developing knowledge and understanding of corruption in the health sector in Myanmar. This can include using big data tools, social network analysis and other techniques to gain a deeper understanding of the factors that contribute to corruption and potential ways to combat it. There is an ongoing effort to institutionalize community of practice approach in Myanmar as well.

Moreover, Another key step that can be taken to combat corruption in Myanmar’s health system is to improve transparency and accountability. This could be achieved through measures such as increasing public access to information about health system funding, performance, and decision-making, as well as strengthening the oversight and enforcement of existing laws and regulations. The previous democratic government update the ministry of health website regularly and the public get daily up-to-date information through that channel as well as the official Facebook page of MOH but unfortunately that practice stop after the military coup.

Lastly, building a culture of integrity and ethical conduct within the health sector can also be an effective way to fight corruption. This could involve training health workers and other stakeholders on the importance of integrity and ethical conduct, as well as promoting and rewarding good governance practices. Myanmar medical community is in the process of integrating the ethics training in all of the medical curriculum but it is a slow process.

[Kansiri Apinantanakul]

Thank you for your sharing.
In Thailand, we also try to implement ethics training in the curriculum (some of universities/departments may also implemented for a long time).
I think It’s very good to start telling children/student “what is right or wrong”
However, I personally would like to add “conflict management” and/or “dealing with unethical behavior” to the curriculum also since most of the time I think people know what is the right thing to do. However, they refused to do it because of some reasons.
To make them change their mind, we might need the persuasive and conflict management skill.

[ABDILLAH FARKHAN]

I agreed about all four key recommendations as the strategies to combat corruption in health system. These recommendations highlighted interconnected actions through stakeholder collaboration and holistic research and are in line with SDG 16 in order to promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable, and inclusive institutions at all levels.

1. Needs to convene key stakeholders: stipulating scale and nature of corruption through stakeholder forums can identify potential activities leading to corruption according to the business process of each organization. In my opinion, scope of stakeholders involved in the convention needs to be expanded not only those who are officials, but also community members, independent researchers, independent commission of corruption eradication (if any), and academicians.

2. Prioritize the action: prioritizing action means that institutions (particularly those who is providing public service) are required to implement collective anticorruption intervention in a certain period. In my opinion, in addition to awareness-raising on the impacts of corruption in health system, it is better if the stakeholder convention supports modification of the organizational system, values-based human resource training, and promotes transparency in health system.

3. Holistic approach in corruption research: it is true to mention that research on corruption is a multi-disciplinary and coordinated effort. Corruption in health system is strongly related to economic findings, law and social context, and results on political recommendation. Even in some cases, investigative journalist can play more appropriate to carrying out difficult investigations, collecting court cases data, and disclosing information than social researchers.

4. Four broad paths for research on corruption: corruption in health system can be investigated in a tiered pathway since the individual’s integrity, organizational fair rules and norms, and institutional culture that enables corruption.

In Indonesia, there is a public view that corruption is close to government officials because the term corruption is closely linked to the abuse of power. Anti-corruption education is a mandatory curriculum taught in new government officers orientation training. In addition to that, the anti-corruption core value is the main part of bureaucratic reform agenda which should be actualized by all government entities. As long as I joined with Ministry of Health of Indonesia, the key to reform is change management, including human resources, governance, and performance.

[PREUT ASSAWAWORRARIT]

I agree with all four steps of the recommendation to fight corruption. The details in each step should be modified to meet specific contexts in different organizations. The following are my opinion on such recommendations.

First, we must ensure that we have key stakeholders in the health system before discussing measurement to fight against corruption. A hospital director, policy makers, department heads, and healthcare professionals should be included in a team. A team that lacks key persons from some fields will face difficulty managing corruption in such fields. On the other hand, too many members in the team can lead to diversity of policy direction. During the team meeting, the number of problems addressed is underreported. Some specific problems in some department cannot be recognized by outsiders, so these will not be pointed out.

In the second step, problems must be prioritized with regard to the impact on the health system and the feasibility of eradicating corruption. The problem in the first priority will be discussed in detail to take further action. People who take advantage of corruption, underlying causes, and feasible management should be discussed in details for each problem.

The third step is to establish the solution to combat corruption. The proper solution should be fine-tuned in each problem. Some members, for example, anticorruption specialists, economists, social welfare, should be invited to guide and suggest the best solution.

In the last step, there is little literature on corruption in healthcare published in the main databases, for example, PubMed and Scopus. In addition, there is no evidence-based practice or guideline to prevent corruption. The term ‘corruption’ is often described in other words. Additionally, there is publication bias on this topic.

In my opinion besides the abovementioned steps, we have to create the anti-corruptive culture in our organization. Basic knowledge about starting minor corruption should be given to everyone in the organization. Good culture can prevent minor corruption. However, there must be rules or regulations to prevent major corruption, for example, minimum number and specific requirement of committee for making inspection.

[Siriphak Pongthai]

I agree with you on having anti-corruptive culture in the organization. I believe that by having fundamental training on this issue could have prevented future corruption in organization.

[Tanyawat Saisongcroh]

I strongly agree with the importance of good organization culture and behavior.

[Kawin Wongthamarin]

I partially agree with all four recommendations. If I am an optimist, I think these four steps will lead to success in dealing with corruption. However, since my friends’ opinions are pretty much the same, I’m going to look at it from different angles to add some variation. I’m going to be pessimistic with the assumption that corrupt people are smart, powerful, and have large-scale networking.

I think the first step is not should be convening stakeholders, but to find a way to identify which stakeholders are really honest before planning together to combat corruption. Because if the team leader is a great corruptor then this team will only find small corruption against the leader’s interests. Moreover, there will be no person who dares to report suspected corruption.

In the second step, I agree that prioritization is necessary in order to make the best use of limited resources. I also agree that it will be very important to understand the reasons why
corrupt practices thrive. However, if the priorities were made by corrupt leaders, then the results would certainly not be realistic.

Third, I strongly agree with encouraging research about corruption and disseminating information to everyone, and I also think that there should be courses on anti-corruption methods included in fundamental education in Thailand.

fourth, I think that in Thailand there should be an independent organization that mainly conducts studies on corruption and disseminates this information freely, with the researcher being protected and researchers’ information being concealed from the authorities. (working independently with National Anti-Corruption Commission).

Finally, I sincerely hope that we can overcome all of this corruption.

[Boonyarat Kanjanapongporn]

Thank you for sharing different ideas toward the recommendation. I do agree and understand with your point on the corrupt leaders in some settings who might be empowered until the first and second recommendations couldn’t be effectively performed. It seem like endless problems when thinking about large scale of beneficial networking. 🤔

[Kansiri Apinantanakul]

Thank you for sharing such an interesting view.
I agree that if we truly would like to fight corruption, we need to identify the true problem and the stakeholders who truly could influence in the process (in a good way).
As P’ Kanoon (Boonyarat) mentioned in #39464, we need a good and powerful leader to fight corruption.

[Boonyarat Kanjanapongporn]

I have experienced small private organizations with not over 10 people and big organizations with hundreds of people working together. I agree with the four recommendations to stop corruption because this can be adapted and used in settings where I have experienced. The supported reasons are below.

First, the interest from stakeholders or empowered staff positions toward the corrupt would encourage the witness to confidentiality report corruption and also make it more difficult to perform the misbehavior. The transparency of performance from the top hierarchy position of work would also be the good example for others in the organization. For example, WhistleBlower is the report hotline which companies have educated and encouraged staff to direct report the corruption to the main organization.

Second, Prioritizing problems and analyzing the cause of corruption would help the management team to focus on important problems especially within the large organizations where there could be many people and corruption happening in different ways. For example, the intentional action which harms the organization and people might possibly need urgent management and stronger penalties. Repeated corruption, happening in the same department, should produce analyzed, defined and rigid planning to reduce the recurrence.

The multidiscipline response is also important on corruption controlling. Common groups of people who work together or do the same routine possibly might not see the problem, or even worse, support each other on corruption. Therefore taking recommendation from other point of view might assist the organization to find the problem and reduce the bias from familiarity. Third parties audit especially for financing is the example of getting ideas from others.

Lastly, opening researching in many aspects would support the knowledge on dealing with corruption. Without research and open speaking, every organization probably has to research and develop their own process toward corruption. However with the research evidence, methods on dealing with corruption could be more efficient and quicker to tackle the problem from the previous case studies.

In my experienced settings, First,Second and Third recommendations are always implemented in different ways based on company policy and the leader of units. From my idea, Intentional and transparent leaders are probably the most important in regard to continuously fighting corruption. Without the proper leader, it would not be easy for the lower empowered to stand for the right ,and activities above ,to resist corruption, might not be supported.

[Kansiri Apinantanakul]

Thank you for sharing ka.
I totally agree with you the proper leader who dedicated themself to flight for the right thing and protecting the staff is the important key stakeholder to fight corruption.

[Kansiri Apinantanakul]

I do agree with the steps for fighting the corruption and I’m totally agreeing to begin the first step with the communication
Below is my view on each steps:

First step: Convene the stakeholders
In my opinion, I think the major and the most challenge is to make people speak up. Concerning the complexity of our society, speaking up something not only impact at individual level but it could impact thousands of people in the same organization as I usually call it “butterfly effect”. I agree that the protection of the corruption exposure is crucial regardless of the severity of corruption level. I’m one of the people who always try to speak up and try to flight for ethical conduct. I truly admitted that it’s hard the speak up but it’s harder that thing would change after we speak, and I guess that is why many people decided not to speak up anymore.

Second step: Prioritizing action
As I mentioned earlier, all comments and/or concerns raised may not lead to the prompt corrective/preventive action. I agree that we need to research and plan well before implementing something to fight the corruption due to its sensitivity in nature. However, I think that all policy maker level should response to all cases. Some of them may need only “wait and see” process but the response of acknowledgment and inform the corruption exposure on their plan.

Third step: Take holistic view
I agree with this step that at the last before we execute, we should ensure that we see the “whole picture” of the problem, and we have a plan B when things go unplanned. The solution should be reviewed by multidisciplinary team.

Forth step: Research the community sets out
What we research and investigate the corruption internally is important but the insight from community might also helpful and reflect our own practice. I agree that we should take it in consideration.

Thanks

[SIPPAPAS WANGSRI]

This discussion topic is indeed very interesting! I’ve always known that there surely are corruption in the health care field of work, but defining and tackling them are the whole next level. Just like other professions, corruptions are undeniably everywhere. Think of them as shades of grey, there are so many level of corruption and it depends on how it is defined, and by whom. In the provided paper from IJHPM, they proposed four steps of addressing problems and initiating a debate on corruption in health system.

First, we need to define the responsible stakeholders and talk about them together. I agree. However, it is very hard and, like the author stated, reluctant to speak about “corruption”, let alone the awkwardness. Who would brazenly admit that they are corrupted, right? It’s not even hard to define key stakeholders and beneficiaries behind the corrupted system. The important point is that as long as there are persons — it could even be your co-workers, for instance, who will benefit from the corrupted system, they will only strengthening the corrupted system even more. The only way to fight is that you will need support from people who are negatively affected by the corrupted system to demonstrate the impact of current situation. In our case, it could be our patients, co-workers, or your superiors. If you have enough proof and support — then you can open the discussion more easily.

Second, prioritise action and analyse why these corruptions persisted. Make a good use of your support and proceed to pursue the issue that has a bigger impact for most people first.

Third, making a holistic view. There will always be the reasons behind every action. Power, money — for whom and by whom. It’s like a strategic chess game. An external investigator may be helpful in this case, and also to help look from a different angle.

Lastly, this paper mentioned about research community for insights about corruptions. Making the data publicly available for transparency and provide third-party organisations to routinely interrogate might even help reduce corruptions.

[Siriphak Pongthai]

All the four steps recommended in the articles are good for fighting corruption, but I would like to add and modify something in those four steps. Some of those steps are practical in my organization as well:

– Having key stakeholders: the organization should have reporting system on corruption report. In my setting, employees can send an email or call to the team on what we have heard or have saw that can be misleading to corruption. By blowing the whistle on corruption, I believe people will not be reluctant to speak out what they know.

– Prioritize action: by having this step, we will know which problem or concern should be taking into account and which to develop solution or draw attention to. By having what matter most could make it easy to reach and solve the problem. The key stakeholder then can investigate into the point of report.

– Take a holistic view: this is a good step by seeing the overall picture rather than focusing on one particular spot or department. We should better have a third party come in part of investigation. To make sure that the things that was reported is not come from their own political issue within department/organization.

– Research community sets out: this is good by having outsource or organization conducting research on corruption to reveal what information they have retrieved. This could terrify those who corrupted somehow. In addition, I think this method could prevent future corruption in organizations as well. In my organization, they always have annual organizational survey which we can report on conflict, equity, or ethical behaviors of colleagues, supervisors, and workplace.

[Tanatorn Tilkanont]

I agree with all recommendations provided in the articles. Fighting corruption would improve the health system and reduce health inequality.

For the first recommendation, I think convening key stakeholders would impact the change in policy-level. In this level, anti-corruption could be effectively executed. However, population power also matters. I think if the agreement is publicly open to be verified and partially accepted by the population, this may help anti-corruption become more decentralized and effective.

I also agree on the second step. Focus on the impact and vulnerable group would make the agreement and policy leading the big change to the health system and anti-corruption.

I partially agree with the third recommendation. I believe the earlier steps are impactful to draw attention. It is good to have research on corruption published in a healthcare database, however not many people will read that journal.

Finally, the research community is important. Once we develop the policy or agreement, we can know the feedback using the “big data” from social network analysis. The feedback could represent the room for improvement. Lastly, Thailand needs a good leader and a power of population that leads to an anti-corruption system.

[Tanyawat Saisongcroh]

In this era of information technology, I believe the usage of big data from social network analysis could empower the real issue and lead us to the anti-corruption action plan.

[Tanyawat Saisongcroh]

First of all, thank you for bringing up this challenging topic and encourage us to think about it.

In my opinion, all four recommendation in the article are important.

Convene key stakeholders: Find consensus among the stakeholders. This sensitive issue might be approached in each system differently. The result of agreement could be in form of law for particular critical action, organization policy for rules and punishment or organization culture for routine practice. The support team for the victim and confidential report portal are also essential.

Prioritize action: Since there might be a lot of corrupt practices at a particular time and we probably could not handle all that issues, priority setting is always the key management. I do agree that this should be guided by the impact on health system and feasibility of success. Honestly, the most difficult situation is in the case corruption from executive officer of that organization.

Take a holistic view: Although a multi-disciplinary view is essential, majority response should come from healthcare committee, since they know what is matter the most. However, sometimes third party who had that power might be a real key to initiate the change.

Research community sets out four broad paths on corruption: Various evidence-based report will make this issue more academic than dramatic. It will lead us to the real anti-corruption action plan and can be used in development of new social standards as well.

[Hazem Abouelfetouh]

Convening key stakeholders in the health system to seek agreement on the scale and nature of corruption I agree that collaboration with all parties can aid in developing a common knowledge of the issue and a sense of shared accountability for finding solutions. This strategy can foster collaboration and the exchange of best practices while also facilitating the creation of focused and efficient anti-corruption tactics. Additionally, involving decision-makers can aid in ensuring that corruption-fighting measures are in line with the overall goals and objectives of the health system. Involving the public in the battle against corruption is another idea that might be successful in reducing corruption in the healthcare industry.

It is necessary to prioritize action I agree that prioritizing actions is necessary. The impact on the health system, particularly for vulnerable groups, as well as the viability of potential solutions should guide decisions regarding how to fight corruption. Healthcare professionals and policymakers can ensure that limited resources are utilized effectively by concentrating on the most severe and widespread forms of corruption as well as those that have the greatest impact on vulnerable groups. They can also increase the likelihood of successfully combating corruption by considering the viability of potential solutions.

It is essential to take a holistic view
I agree that taking a holistic view is essential to fight corruption in healthcare. Examining the issue from multiple perspectives, such as anthropology and political economy, can provide a more complete understanding of the root causes and potential solutions to corruption in the health sector.

It is important that the research community sets out what it can offer I agree that research can play an important role in fighting corruption in healthcare. The four broad paths identified by Zyglidopoulos et al – individuals, organizations and industries, different countries, and different cultural contexts – provide a comprehensive framework for understanding the various factors that contribute to corruption in healthcare. Research on individuals can assist in determining the psychological and sociological factors that motivate individuals to engage in corrupt behavior. On the other hand, research on organizations and industries can shed light on the structural and cultural factors that enable corruption to flourish. Corruption in healthcare can be affected in a variety of ways by a country’s economic and political systems, which can be studied in depth.

In my opinion, it will be beneficial to collaborate with international organizations and other countries to share best practices and coordinate efforts to fight corruption. it is important to implement strict laws to prohibit corrupt practices in healthcare and promote transparency and accountability within healthcare organizations with different measures such as financial disclosure for healthcare workers and educating them and all stockholders about the negative impact of corruption on patients and communities to encourage a culture of integrity and ethical behavior.

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