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)

[Wah Wah Lwin]

-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.

[Wirichada Pan-ngum]

Good points Wah Wah has brought up here. Do others have additional comments regarding Myanmar health system and corruptions?

[Soe Wai Yan]

Let me provide my opinion based on Myanmar health system issues:
I agree that defining corruption in health system is difficult because many practices are socially accepted and rarely labelled as corruption, experiencing in Myanmar. Informal payments, favouritism, and absenteeism are often seen as normal responses to a weak system rather than unethical behaviour. However, even when definitions are unclear, I agree with the article that public health professionals should still assess practices based on their impact on equity, patient safety, and trust.
I partly agree the second point that some practices that appear corrupt help keep Myanmar’s fragile health system functioning. Due to low salaries, shortages of medicines, and ongoing political instability, health workers may rely on informal payments or private practice to survive. However, I do not agree that these practices should be tolerated, as they increase inequality and limit access to care for poor and displaced populations.
I agree that conducting research on corruption in Myanmar is extremely challenging. Fear of punishment, lack of transparency, and political sensitivity discourage honest reporting from both health workers and patients. Despite these difficulties, I agree that research is still necessary, as without evidence it is impossible to design effective and context-appropriate anti-corruption strategies.
I partly agree with the concern that studying corruption in Myanmar may be seen as ignoring larger structural problems such as conflict, weak governance, and underfunding of the health sector. However, I do not agree that corruption should be avoided. Corruption worsens these structural problems and directly harms patients, so it must be studied alongside broader political and health system reforms.
In addition to the above points, strengthening transparency in health financing and procurement could help reduce corruption in Myanmar. Limited oversight of medicine supply chains and procurement processes increases the risk of diversion and misuse of resources. Introducing clearer reporting systems (such as real time digital reporting system) and independent monitoring, even at a basic level, could reduce opportunities for corruption and improve access to essential medicines.
Furthermore, supporting decentralised and non-governmental health service delivery may help limit corruption in Myanmar’s current context. Where public systems are weak or disrupted, partnerships with community-based organizations and international agencies can provide alternative accountability structures. This can reduce dependence on informal practices while maintaining access to care for vulnerable populations.

[Nang Phyoe Thiri]

The article discusses the main reasons and the possible solutions regarding corruption in health systems.
Overall, I agree with all four interventive measures. However, these measures should be undertaken according to specific context and should be complemented by system-level considerations and approaches.

1. I totally agree with the first view, that is to convene all key stakeholders, including policy makers, health professionals and senior managers and seek consensus on the scale and nature of corruption. Corruption is usually normalized, hidden or mis-labeled. Therefore, having shared understanding of the meaning and what constitutes corruption is the critical and foremost steps, to find actionable solutions.
By doing this, it will create a mutual and common language of corruption among various stakeholders, including frontline workers. It will also reduce denial and misunderstandings.

2. Once we get consensus on the problem, the second view is to prioritize action using impact and feasibility matrix.
I only partially agree with this view.
The benefits of this approach are that – it helps focus on high impact issue and prevent wasting resources on low impact cases. It also increases chances of success, that is, high return on investment.
The drawbacks are-
Serious problems may be ignored merely because the case is difficult to address and not quite feasible.
Feasibility may not be shaped by the true health burden or public health concern, but by political will and power relations.
It may focus mainly on small and easily fixable bribery and avoid deeper corruption.
The approach may favor quick wins instead of harder but more sustainable long-term reforms.
Subjectivity in defining impact and feasibility – that is assessments can be biased.

3. I totally agree with the third view. Corruption in health system needs holistic and multi-disciplinary approaches; as it is not just a technical issue, it is shaped by social norms, economic pressures, weak governance, weak infrastructure and system dysfunction.
The benefits of this approach are that- it addresses the root causes leading to corruption (for example, low salaries, poor systems) and prevents negative consequences (for example, just punishing coping behaviors without fixing system failures)

4. I also agree with this view. Because corruption is complex, well-designed research using new tools and data sources will help analyze the root causes of the problem and finally lead to actionable and practical anti-corruptive strategies.
The described four research paths- individuals, organizations & industries, different countries, different cultural contexts – will contribute a different but complementary perspective.

In addition to the four ways, I believe the following strategies can be utilized in some situations.
1. Community feedback & response mechanisms (CFRM)
The system encourages anonymity, accessibility, transparency, safeguarding and accountability of health system.
2. Digitalized system (HMIS, LMIS, HRIS)
Digital tracking systems (like attendance, procurement, stock management) will reduce the opportunities for fraud.
3. Internal controls and audits
Clear SOPs & policy, routine internal & external audit will help reduce corruption.
4. Addressing the system dysfunctionality
For example, fair salaries for health workers and adequate funding for facilities should be provided.

In fragile or low-resource settings, combining the described principles with digital tools, community accountability, and protection mechanisms would offer a more practical and sustainable pathway to reducing corruption.

[Kevin Zam]

My personal view on the four actions to fight corruption is as below.

1. Convene stakeholders and talk openly about corruption
Agree. Corruption cannot be reduced if it is not acknowledged. In Myanmar, open discussion is difficult, so health workers, especially junior staff, need support and protection to speak safely.

2. Prioritize actions with high impact and feasible solutions
Agree. Public health professionals should focus on corrupt practices that harm vulnerable groups most, such as informal payments and drug diversion, and where solutions are realistic.

3. Take a holistic and multi-disciplinary approach
Agree. Corruption is not only a health problem. In Myanmar, involving communities, civil society, and other sectors helps to understand causes and find practical solutions.

4. Clarify the role of research
Agree. Simple, practical research such as audits, community feedback mechanism, and basic data report, is more useful than complex studies in the Myanmar context.

Additional suggestions for Myanmar might include
Promoting community engagement and accountability
Improving transparency in recruitment and procurement
Improving health worker pay and working conditions
Using simple digital tools for reporting and stock management

In conclusion, the four actions might be appropriate for Myanmar if they are applied carefully, using practical, and community-based approaches.

[Tee Tar]

I generally agree with the four recommended actions; however, their effectiveness depends on how well they are adapted to local political, social, and security contexts, such as those in ethnic areas of Myanmar.
First, open discussion on corruption is essential, as the problem cannot be addressed if it is ignored. However, in fragile and conflict-affected settings, fear and power imbalances often prevent health workers from speaking openly. Therefore, discussions on corruption must take place in safe, confidential, and non-punitive environments, with protection for those who raise concerns.
Second, prioritizing high-impact and feasible actions is crucial. In fragile settings, it is unrealistic to address all forms of corruption at once. Public health professionals should focus on practices that most directly harm vulnerable populations, such as informal payments, unfair access to services, and misuse of medical supplies, as addressing these issues can lead to visible improvements and increased trust.
Third, a holistic and multi-disciplinary approach is necessary. Corruption is closely linked to broader governance, social, and economic factors. Engaging communities, civil society, and local leaders helps identify root causes and develop realistic solutions, with public health professionals playing a coordinating and facilitative role.
Fourth, research and monitoring should be practical and context-appropriate. Simple approaches such as routine reviews, basic audits, community feedback, and transparent reporting can help identify risks and improve accountability without overburdening health workers or relying on complex systems.

In addition to the four recommended actions, while I agree with many points raised by others, I would like to reflect on several additional measures that, in my experience, may work better in ethnic and conflict-affected settings.

1. From my perspective, strengthening community engagement and accountability is essential, as empowering communities to safely monitor health services and raise concerns can improve transparency, trust, and local ownership.
2. I believe building local capacity and knowledge to develop context-specific policies and to apply community-level rules is critical for sustainable system strengthening and effective governance. Establishing strong human resource and organizational policies at all levels to set clear standards and serve as role models.

Furthermore, NGOs and INGOs should prioritize health system strengthening rather than fragmented, single-issue interventions. Programs should be designed with an understanding of how they influence the overall system and long-term sustainability. Implementing agencies and funders must demonstrate strong awareness of local context and work closely with local actors, providing not only technical assistance but also ethical leadership. Donors should focus on long-term, system-wide investments instead of short-term, output-driven funding. Transparency and fairness across all processes are essential to building trust and gradually reducing corruption.

In conclusion, I agree that the four recommended actions provide a strong foundation for public health professionals to fight corruption. However, in ethnic and conflict-affected settings like Myanmar, these actions must be applied in a context-sensitive, community-based, and system-oriented manner. Without trust, fairness, long-term commitment, and strong local capacity, anti-corruption efforts are unlikely to be effective or sustainable.

[Than Htike Aung]

I would like to provide my opinion with Myanmar current context. I agree with the first point. One of the most important steps that public health professionals can take in fighting corruption is to build a shared understanding of what corruption looks like within their health system. Corruption is often difficult to define because it takes many forms, ranging from bribery and procurement fraud to absenteeism and informal payments. Without consensus, these practices may be normalized or dismissed as “just the way things are.” By convening policymakers, health workers, patients, and civil society groups, professionals can create a common language and framework for identifying corruption. This process not only clarifies the boundaries between acceptable and unacceptable practices but also helps reduce denial and silence around the issue. In contexts like Myanmar, where corruption is deeply embedded in everyday health transactions, such consensus is crucial to ensure that reform efforts are grounded in reality and widely accepted.

For the second point, I mostly agree with some exceptions. Not all corrupt practices have the same impact on health outcomes, and some may even serve as coping mechanisms in fragile systems. For example, while small tokens of gratitude may not significantly harm patients, the diversion of medicines from public facilities to private markets can have devastating effects on vulnerable populations. Public health professionals must weigh both the severity of the harm and the feasibility of tackling each issue. In Myanmar, where resources are limited and political sensitivities are high, focusing on high-impact areas such as drug procurement and staff accountability could yield the greatest benefits. This pragmatic approach ensures that reforms do not destabilize the system further but instead strengthen its ability to serve those most in need.

I totally agree with the third point. Corruption in health systems cannot be understood or addressed in isolation it is deeply intertwined with political, economic, and cultural structures. Public health professionals must therefore adopt a holistic approach that draws on multiple disciplines, including economics, sociology, law, and information technology. This broader perspective allows for solutions that go beyond the health sector, tackling root causes such as weak governance, poor accountability mechanisms, and cultural norms that tolerate informal payments. In Myanmar, corruption in healthcare is linked to broader governance challenges, meaning that reforms must be coordinated with wider anti-corruption initiatives across government institutions. By collaborating with experts from different fields and engaging communities, public health professionals can design systemic reforms that address both the symptoms and the underlying drivers of corruption.

Finally, public health professionals must contribute to building a robust research agenda that examines corruption at multiple levels ranging from individual, organizational to national level. Research is essential for understanding how corruption operates, who benefits, and what interventions are most effective. However, studying corruption is politically sensitive, especially in countries like Myanmar, where exposing malpractice can put researchers and whistleblowers at risk. To overcome these challenges, professionals should adopt safe, anonymized, and community-driven research methods, while also partnering with international organizations that can provide protection and credibility. By generating evidence, they can inform policies that are context-specific and effective, avoiding one-size-fits-all solutions that may fail or even worsen the situation. A strong research base also ensures that anti-corruption strategies are continuously evaluated and refined, making them more resilient and impactful over time.

In additional to these four points, I believe that these approaches can reduce the corruption in Myanmar context.
Digitalization and Transparency: Introducing digital systems for procurement, budgeting, and patient records can greatly reduce opportunities for corruption. Tools like e-procurement and blockchain-based medicine tracking would make transactions traceable and harder to manipulate, helping Myanmar modernize its health system while increasing accountability.

Community Monitoring and Patient Voice: Empowering communities to monitor healthcare delivery ensures corruption is addressed where it directly affects patients. Local groups can report absenteeism or informal payments, building trust and accountability from the ground up, especially in rural areas where oversight is weakest.

Whistleblower Protection: Protecting those who expose corruption is vital. Secure, anonymous reporting platforms supported by NGOs can allow health workers and patients to speak out without fear of retaliation. In Myanmar’s sensitive environment, this safeguard is essential to uncover hidden malpractice.

Incentive-Based Accountability: Rewarding hospitals and staff who demonstrate transparency can shift the culture toward ethical practice. Performance-based financing or recognition programs would motivate health workers to resist corrupt practices, turning accountability into a source of pride rather than punishment.
Leveraging International Partnerships: Aligning reforms with global frameworks like the SDGs and donor requirements can strengthen Myanmar’s anti-corruption efforts. International collaboration brings technical expertise, funding, and credibility, helping sustain reforms in a fragile governance context.

[Salin Sirinam]

I agree with all 4 main recommendations in the article. To solve any problem, the first step is acknowledging that the problem exists. In order to reach a consensus among different stakeholders, we must clearly define the specific issues we are trying to solve, which in this context is corruption.

However, I believe one reason it is so difficult to acknowledge corruption is that healthcare professionals often hold themselves to high standards of ethics and morality. This can lead to a misconception where they believe they are acting in the best interest of the patient or the system while ignoring or defending practices that are actually part of a corrupt cycle. Therefore, I strongly agree that to effectively tackle corruption, we must move beyond individual morality or victim blaming and focus instead on strengthening the larger system, which I believe can create a larger impact and be more sustainable than focusing on individuals’ cheating. We must create an environment where all stakeholders can talk openly about these issues without feeling defensive about their professional ethics or personal morality. And solving this effectively requires more than just clinical health practices. It must include a multidisciplinary approach to address the root causes of the problem.

In addition, the role of research is also important, especially, as I gathered from our peer discussions, when combined with digitalization and the transparency of open data, it can make an impact to help fight corruption in the system.

[Jenny Bituin]

Here is my view on the four recommended points that public health professionals can do to fight corruption.
1. Convene key stakeholders in the health system
I agree with the authors that this is such a formidable task, similar to what is happening in the Philippines today, in relation to the investigations on the alleged corruption of flood control projects worth billions of pesos. Some former officials of the department involved (Department of Public Works and Highways) who previously gave statements to the Senate were rumored to have recanted their statements. Another former official who was said to be a key figure in the investigation was found dead, likely of suicide according to reports.

2. Prioritize action
I agree that prioritizing action is important. Aside from addressing the causes of corruptions, people might also be more encouraged to report/expose corruption practices if they can see that actions are being done.

3. Take a holistic view
Although looking at the problem in a holistic view is important, I think looking for the root cause of corruption at the smallest unit of the organization must also be emphasized.

4. Research community sets out what it can offer
Aside for conducting research on health corruption, I think it is also important for the findings of these researches to be disseminated to the general public, policy makers, and legislators, preferably in a language that common/average people will understand.

To add from the points mentioned above, another way of fighting corruption in my opinion is recognizing the efforts of people who dedicate their work fighting corruption, and sharing all about them to others, especially the youth. Like in the Philippines, we have a popular mayor who is a well-known anti-corruption champion. He sets a good example to others, showing how more prosperous and comfortable a city can be without corruption. He is a good role model, especially to youths who will be the future leaders of our country. Because of his popularity, some mayors even copied some of their city’s practices to fight corruption. He also inspires other people to fight against corruption and push for change, because they know that they are not alone in the fight.

[Yin Moe Khaing]

The article suggests four main actions for public health professionals to fight corruption: talking openly about corruption, clearly defining and measuring it, prioritizing actions that are feasible, and using a holistic, multidisciplinary approach.

I generally agree with these points. First, openly discussing corruption is very important because ignoring it allows the problem to continue. When public health professionals talk about corruption honestly, it helps us see it as a system problem, not just individual wrongdoing. Second, defining and measuring corruption is necessary for action, but it should be done carefully because some practices exist due to weak health systems. Third, prioritizing actions based on impact and feasibility is practical, especially in low-resource settings where everything cannot be fixed at once. Finally, a multidisciplinary approach is essential since corruption is influenced by political, social, and economic factors.

In my setting, these actions would work better if there were stronger protection for health workers, better working conditions, and more involvement from communities to improve accountability.

[Hteik Htar Tin]

For the first recommended point, it must be initiated to fight corruption in the health system. Advocating among healthcare workers is an essential and pragmatic starting point for addressing corruption within health systems. Not only manger level but also basic level staff must aware about this to prevent relapse and redo of corruptive behavior consciously or unconsciously. Seeking agreement on both the scale and nature of corruption is particularly important, as it establishes a shared understanding and common baseline from which credible reforms can emerge. This can build trust among the healthcare professionals and reduce misinformation about the process. I agree for this point as this is one of the foundational steps toward transparency and accountability in the health sector.
Second recommended point presents a thoughtful approach to prioritizing anti-corruption actions within health systems, particularly by linking decision-making to impact on vulnerable populations and the feasibility of remedies. The acknowledgment that not all corrupt practices have equal consequences is a strength, as it helps avoid a one-size-fits-all response. Recognizing that some practices may be rational responses to systemic dysfunction also reflects a realistic understanding of operational constraints within health systems. But we need to sustain the action as long term plan, should consider to add a subject or topic to learn in pre-service trainings.
Third, holistic review can be assumed as academic perspective to be studied in health-related databases. In my opinion, routine practice to do journal reading and discussion during workshops can get reviews from various stakeholders and learning can lead to research practice.
In health, research is essential for continued medical practices, so we should foster the research community in addressing complex policy and system-level challenges to fight corruption. By setting out what it can offer, the research community will help manage expectations and ensure that evidence generated is relevant and usable for decision-makers. This clarity can strengthen trust between researchers, policy makers, and practitioners, and reduce the risk of research being perceived as disconnected from real-world problems and fear of discrimination from powerful corruptors.

[Myo Thiha]

I agree with the first recommendation that key stakeholders should seek agreement on the scale and nature of corruption in each health system. To address the corruption should begin with creating space for open discussion. However, there are some challenges because less empowered people may be afraid to speak openly. They might need strong support and protection.

I will stay neutral on the second recommendation. Although we need to prioritize action based on the impact of the health system and the existence of a potential remedy that has some feasibility of success, we need to take action against all forms of corruption to prevent the severe threats.

I agree with the third recommendation. The corruption response mechanism in the health system need multi-disciplinary approach. Many countries with high levels of corruption do not have strong multi-disciplinary response and have limited research because studying corruption can be politically sensitive and even risky. Understandably, researchers choose less controversial topics.

I agree with the fourth recommendation. The researchers need to be clear about how they can contribute to the study of corruption. In addition, this timing is especially great due to big data and modern analytical tools like social network analysis, which can help researchers study corruption in a more detailed and innovative way.

[Wirichada Pan-ngum]

Thank you all for sharing your view on corruption in different settings. For Thailand, we also have a long way to improve this. Educate individuals from young age would help our society in the long term with the hope that the young generation will do a better job of taking care of the country. As a teacher, I am doing my role as good as it can get 😊

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