A third of citizens have given bribes to medical personnel for health services that are free, and about 60 percent of them say that they have given bribes to the Clinical Center of Montenegro (KCCG). These are the results of the questionnaire Center for Investigative Journalism of Montenegro (CIN-CG), conducted during April.
However, in the last ten years, there has not been a single verdict for giving or receiving a bribe, in which a member of the medical staff was accused.
According to data obtained through free access to information, no judgment refers to corruption in the health care system of Montenegro.
Bribery in the provision of health services is only one form of corruption in the health system, but certainly the most visible to citizens. However, it seems that this phenomenon is practically invisible to institutions and the judiciary.
The lack of judgments for accepting and giving bribes in the health system of Montenegro is worrying, and especially if the absence of such judgments is systematic, then it indicates the tacit approval of such practice, they point out for CIN-CG from the Center for Monitoring and Research (CEMI).
According to CIN-CG's research, there are no criminal proceedings for accepting and giving bribes, and the suspects or defendants are doctors or members of the medical staff.
The Higher State Prosecutor's Office (VDT) in Podgorica told CIN-CG that a case was opened against a doctor for the criminal offense of bribery, which was transferred to the Basic State Prosecutor's Office (ODT) in that city in October last year. The ODT says that the criminal complaint was dismissed.
The Higher State Prosecutor's Office in Bijelo Polje said that they had no such cases in their work.
The Criminal Code (CC) stipulates a prison sentence of 2 to 15 years for a person who receives a bribe, and for a person who gives a bribe from one to eight years, with the fact that a person who reports that he gave a bribe, before which the authorities discover.
The report of the European Commission (EC) for 2023 notes that Montenegro must have a deterrent and effective policy of sanctioning corruption, in order to avoid the perception of impunity.
"Efforts in this area should primarily be focused on those sectors that are most vulnerable to corruption, which requires a solid risk assessment and dedicated action," the EC report says.
Head of the Public Policy Research Department at CEMI Nemanja Stankov emphasizes that data from public opinion surveys for years indicate that the health sector is the most corrupt sector in the country.
"This situation is, to say the least, worrisome, because corrupt practices can completely collapse the health system, contribute to the uneven distribution of health resources, and ultimately prevent access to health care for those who need it the most," Stankov assesses.
Two doctors refused to take a bribe
According to the data from the CIN-CG questionnaire conducted through an electronic survey of 662 respondents, the most money was given for operations, to specialists, who, according to the latest data from the Ministry of Finance, have the highest earnings in our country - from 3.000 to 4.000 euros.
"It is so widespread, that doctors call bribery common law among themselves", "We give them gifts, they give us an appointment for operations, that's how it goes", "No one asks directly, but that's why they take it directly", "When payment can be made through order"...
These are just some of the hundreds of comments from the respondents explaining why Montenegrin citizens give money or gifts for health services, which should not be paid for.
Of the citizens who responded to the CIN-CG questionnaire from April 9 to 17 this year, a third, or more precisely 220 of them, answered that they had given money or an expensive gift, or both.
"No one asked me, the money is taken for granted, otherwise they will treat you like trash," claims one respondent.
"During both births, I gave money to the doctors and midwives, because everyone told me it had to be that way," says one response.
Only two respondents said that the doctor refused to take money or a gift.
However, according to the questionnaire conducted by CIN-CG, only one percent of the surveyed citizens reported that someone asked them for a bribe, and all of them said that nothing happened after the report.
Stankov states that part of the problem of corruption in healthcare is the patients themselves. He adds that the CeMI survey from March 2023 shows that 19,1 percent of citizens would be ready to offer a bribe if it would enable them to get better health care.
"For this reason, it is necessary to carry out a continuous and intensive media campaign on the fight against corrupt practices and patients' rights," Stankov points out.
These CEMI data also coincide with the CIN-CG questionnaire, in which also around 19 percent of citizens think it is okay to give money or an expensive gift for a health service that is not paid for.
However, the majority are those who think they are forced to do so. Only about 10 percent of those who gave money or a gift think it's okay to do so.
"It's not right, because they are paid for it, but the people are aware that if they don't bring money or a gift, they can die next to them", is one of the citizens' comments.
Almost 30 percent of those who think it's wrong to give money or an expensive gift, did it anyway: "Some doctors schedule an operation for a certain date, and if you don't bring money, they postpone the operation until you give money."
It is interesting that there are many who think that if they give money after the health service is completed, it is not a bribe. One of the participants of the survey, who gave the money in a private clinic, says that it is only privately that you can get a timely service that is otherwise not paid for:
"Of course with the same doctor who works at KCCG, but there are no appointments there for six months! It is legalized corruption".
Strategic documents do not recognize corruption in healthcare
In the Health Development Strategy from 2023 to 2027, which has 105 pages, corruption is mentioned in only one sentence, namely that it is necessary to "address the problem of corruption in the health sector through the introduction of a higher level of transparency in work and the implementation of anti-corruption measures." .
In the Draft Strategy for the fight against corruption 2024 to 2028, it is pointed out that healthcare is one of the areas with a special risk for the emergence of corruption, however, there are almost no concrete solutions to fight this honor in the healthcare system. It is also noted that public opinion perception surveys show that healthcare is at the top when we talk about the areas where corruption is most prevalent.
There is not a word in these documents about the dangers of bribing medical personnel. The only goal mentioned in the draft strategy regarding the fight against corruption in the health system is the establishment of a digital system that unifies the business processes of the health system, with the plan that by 2028 only half of the work will be completed.
In CEMI, they point out that significant progress has not been made due to frequent changes in management positions in the Ministry of Health and the Clinical Center of Montenegro, and from the strategic documents that should address this problem, one gets the impression that corruption in health care has been relegated to the background. .
Stankov also states that this shows the unwillingness of state institutions to deal with the problem of corruption in healthcare in a serious and systematic way.
"If the health sector is identified as one of the most vulnerable, then it is completely incomprehensible that the implementation of a solution for this burning problem in Montenegro is not planned within a four-year period," says the head of the Public Policy Research Department at CEMI.
Stankov adds that the only thing that can be concluded is that corruption in healthcare is not a big problem for Montenegrin institutions or that they do not have a clear vision of how to limit and then eradicate such practices:
"Both conclusions are disastrous for the future of the health system of Montenegro."
The Ministry of Health told CIN-CG that in the last few years there have been no reports of suspected corruption in healthcare.
As they say, they are aware of the reluctance to report corruption to the competent authorities, and the lack of trust in those who should act on the report.
The Ministry adds that it will work to raise awareness about patients' rights, and about the harm that events such as corruption cause to the functioning of the entire system and the state:
"Especially on educating and raising the awareness of citizens about the harmfulness of giving and receiving bribes, potential legal consequences, the need to identify and report to the competent authorities".
The Ministry claims that by realizing all the goals of the Health Development Strategy, the conditions for the possibility of corruption will be reduced to the smallest possible extent. What has been identified as the first priority, they add, are waiting lists "because providing an accessible health service is one of the main ways to minimize the potential suspicion of corruption".
They are also planning different campaigns in which they will advocate for zero tolerance of corruption in health care, but they will also consider, they say, the creation of a special Strategy for the fight against corruption in health care.
In the Assessment of the risk of corruption in the health system of Montenegro for the period from 2020 to 2022, prepared by CEMI, they say that a prerequisite for the fight against corruption at all levels of the health sector is a strong political will, as well as a more systematic and serious approach of the health authorities in identifying problems of corruption and defining and implementing anti-corruption measures in this area.
And public opinion surveys, say CEMI, have shown that over the years there has been an increase in the perception of corruption in healthcare.
"The fact that 86 percent of the respondents stated that they or their family members paid for the service, most often they gave money to surgeons, gynecologists, midwives, nurses and technicians, laboratory technicians, radiologists, anesthesiologists or fellow students and health institutions, as well as to the selected doctor ", the CEMI study points out.
Stankov concludes that some of the key recommendations are the introduction of mechanisms for regular evaluation of the quality of provided health services, which could serve to identify corrupt phenomena in the health sector. It is also necessary, he says, to establish a system of periodic reporting on the implementation of anti-corruption measures in healthcare:
"In the normative sense, it is necessary to refine the legal regulations, and create a legal basis for precise and systematic handling of patient complaints".
Stankov adds that on the application www.zazdravijezdravstvo.me citizens can be informed about the rights of patients, but also report irregularities to this non-governmental organization.
Doctors practically untouchable
That doctors and medical staff in Montenegro are untouchable is also evidenced by the fact that in the last ten years, there have been only a few final verdicts for negligent treatment of patients. Only three final judgments can be found on the courts' website - one conditional, one acquittal and one rejection. The only conviction, and a suspended one, was confirmed in 2019, when a nurse was convicted of changing babies in KCCG. She was tried for negligent work in the service, which is punishable by a fine or imprisonment of up to three years.
The trial has been going on for almost ten years due to the infection of the babies from 2014, one of whom died. Former doctors of the hospital in Bijelo Polje were accused. The trial of the doctors for the death has been going on for more than a decade Ivan Šoć 2011. years.
Corruption in healthcare is collapsing the system, which is already vulnerable due to numerous challenges. Institutions from the Government to the judiciary are obviously silent on the mass abuses that affect all citizens, but mostly those who are the most vulnerable, the old and the poor, who sometimes wait for months just to see a doctor. That is why the authorities should finally start working on the eradication of this "ordinary right".
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