Integrity assessment survey of the health care system in Montenegro
Ministry of Health, Montenegro
Results of an integrity assessment survey of the health care system in Montenegro were presented at a joint press conference in Podgorica on 10 March 2011. The research was part of a joint project organized by the Ministry of Health, Montenegro, the WHO Country Office in Montenegro and the United Nations Development Programme (UNDP) Montenegro to support the implementation of a national action plan to fight corruption and organized crime.
The purpose of the integrity assessment was to provide data on the functioning of the health care system as well as citizens' satisfaction with the up to date health reform results. There was a particular focus on one type of corruption (informal payments) and barriers to equitable access to quality health care. The survey data will serve as evidence for defining future policy measures in Montenegro.
The survey comprised 3000 hospital patients, 1159 primary health care patients and 301 health workers. Almost 80% of the primary health care respondents considered the reform to be successful or partially successful. Also, a large majority of the respondents believe that quality of health care has been improved as a result of reform interventions. According to the survey results, 49.4% of hospital patients made an informal payment (gave money or a gift). The average value of informal payments amounted to 60€, contributing to 12.5% of the average net salary during 2010. Most frequently informal payments take place following provision of health service (68%), whereas in 32% of cases of informal payment preceded delivery of health care. The majority of cases (71.5%) delivery was the reason motivating a patient to make an informal payment.
Reminding that corruption in health systems is a reflection of broader governance issues at the country level and that it exists in all types of health care systems, Ms Mina Brajovic, Head of the WHO Country Office in Montenegro, underlined that “corruption is a great and complex challenge which has a direct impact on people’s capacity to satisfy health needs and affects health policy and spending priorities”. She explained that informal payments in health systems must be addressed as a matter of priority, as they take place in the moment of service delivery, constituting a barrier to equal, effective access to health care. This affects everyone - in particular vulnerable groups - increasing the polarization gap between poor and rich people. Ms Brajovic emphasized that corruption in the health sector must be addressed in a systemic manner which presupposes strengthening links between anti-corruption initiatives and activities aimed at strengthening good governance. Also, it is indispensable that measures to address corruption are integrated in the strategy for hospital reform. According to Ms Brajovic “one of the key prerequisites for addressing corruption is citizens’ participation in decision making and awareness raising so that citizens understand that the “gratitude payment” concept is nothing more than a convenient myth that has been used to make an unacceptable phenomenon acceptable. Only systemic realization of policy interventions and measures promoting payment based on performance and quality control strengthening will result in regaining the citizens’ lost trust in health institutions”.
This joint project was a genuine demonstration of the United Nations (UN) delivering as One approach, where all UN agencies come together to support the development goals of Montenegro with enhanced synergy, common purpose and dedication.
The purpose of the integrity assessment was to provide data on the functioning of the health care system as well as citizens' satisfaction with the up to date health reform results. There was a particular focus on one type of corruption (informal payments) and barriers to equitable access to quality health care. The survey data will serve as evidence for defining future policy measures in Montenegro.
The survey comprised 3000 hospital patients, 1159 primary health care patients and 301 health workers. Almost 80% of the primary health care respondents considered the reform to be successful or partially successful. Also, a large majority of the respondents believe that quality of health care has been improved as a result of reform interventions. According to the survey results, 49.4% of hospital patients made an informal payment (gave money or a gift). The average value of informal payments amounted to 60€, contributing to 12.5% of the average net salary during 2010. Most frequently informal payments take place following provision of health service (68%), whereas in 32% of cases of informal payment preceded delivery of health care. The majority of cases (71.5%) delivery was the reason motivating a patient to make an informal payment.
Reminding that corruption in health systems is a reflection of broader governance issues at the country level and that it exists in all types of health care systems, Ms Mina Brajovic, Head of the WHO Country Office in Montenegro, underlined that “corruption is a great and complex challenge which has a direct impact on people’s capacity to satisfy health needs and affects health policy and spending priorities”. She explained that informal payments in health systems must be addressed as a matter of priority, as they take place in the moment of service delivery, constituting a barrier to equal, effective access to health care. This affects everyone - in particular vulnerable groups - increasing the polarization gap between poor and rich people. Ms Brajovic emphasized that corruption in the health sector must be addressed in a systemic manner which presupposes strengthening links between anti-corruption initiatives and activities aimed at strengthening good governance. Also, it is indispensable that measures to address corruption are integrated in the strategy for hospital reform. According to Ms Brajovic “one of the key prerequisites for addressing corruption is citizens’ participation in decision making and awareness raising so that citizens understand that the “gratitude payment” concept is nothing more than a convenient myth that has been used to make an unacceptable phenomenon acceptable. Only systemic realization of policy interventions and measures promoting payment based on performance and quality control strengthening will result in regaining the citizens’ lost trust in health institutions”.
This joint project was a genuine demonstration of the United Nations (UN) delivering as One approach, where all UN agencies come together to support the development goals of Montenegro with enhanced synergy, common purpose and dedication.
