Employment, conflict of interest, undue influence, insufficient transparency and unregulated handling of gifts remain among the key weaknesses of the public sector, according to the annual report of the Agency for the Prevention of Corruption (APC) on integrity plans for 2025.
The institution warns that human resource management and healthcare are particularly problematic areas, where risks related to the work of doctors, waiting lists, treatment of patients, and possible influence of pharmaceutical companies have been identified.
Data is leaking from the healthcare system
Risks identified in the healthcare sector include employment, public procurement, data protection, conflict of interest, additional work of healthcare workers, treatment of patients, waiting lists and the possible influence of pharmaceutical companies.
The integrity plans of healthcare institutions identified 1.240 risks, of which 42 are of high intensity. The largest number of them are in the area of personnel policy, ethical and professional behavior of employees - 398.
The most common risks in healthcare, according to ASK, are the violation of the integrity of the institution, information leakage, unauthorized lobbying or other non-public influence, conflict of interest, abuse of public office or official position, and violation of transparency.
Among the high risks are those that directly relate to patients and the work of healthcare workers - unethical and inadequate behavior towards patients, disrespect for the personality and integrity of patients, as well as leaving the workplace before the arrival of a replacement, which undermines the safety of healthcare provision.
The agency also identified the relationship between healthcare workers and pharmaceutical companies as a particularly high risk.
"Abuse of paid leave of absence of doctors and other medical workers to participate in congresses, seminars and other scientific meetings organized by pharmaceutical companies. Conflict of interest, namely the prescription and dispensing of medicines and other pharmaceutical products from companies that financed the attendance of doctors and other health workers at various scientific meetings," the ASK report states.
Health institutions, the document states, reported 2.575 risk reduction measures. Of these, 2.114 were implemented, 276 were partially implemented, and 185 were not implemented. The best results were achieved by health centers, with 86,2 percent of implemented measures, while hospitals had the lowest percentage - 74 percent.
"As in previous years, the level of implementation of measures differs significantly among subsystems within this system. The highest level of implementation of measures was achieved in health centers - 86,2 percent, while 80,1 percent was implemented in other health institutions. When it comes to the hospital subsystem, the lowest number of implemented measures was achieved there - 74 percent, and 10,4 percent of non-implemented measures were recorded," the report states.
ASK warns that the internal control system in healthcare is insufficiently developed, that risks for sensitive social groups are rarely recognized, and that most institutions do not have fully regulated internal employment documents.
Health institutions were given 717 recommendations, and the Agency, among other things, is requesting strengthening internal audit, regulating employment and non-employment contracts, better records of additional work by health workers, strengthening the role of patient rights advocates, clearer rules on conflicts of interest when prescribing medications, and participation in events organized by pharmaceutical companies.
Risk of employee competence and recruitment process
Human resources policy remains the weakest point of the public sector, and institutions still fail to sufficiently eliminate risks in employment, performance evaluation, rewarding, sanctioning, and professional behavior of employees, ASK estimates.
According to the Agency's data, the most problems were recorded in the area of personnel policy, ethical and professional behavior of employees.
"As in previous years, the most demanding and risky area in integrity plans was personnel policy, ethical and professional behavior of employees, with the largest number of high risks and unrealized measures," the ASK report states.
In this area, 75,4 percent of measures were implemented, which is less than in the areas of financial planning and management, leadership and administration, as well as data and document storage and security. At the same time, it was in the area of personnel policy that the largest number of unrealized measures remained - 943.
KAS therefore requests that institutions, in the next cycle of integrity plans, more seriously address risks related to employment, employee expertise, performance monitoring, and the accountability system.
"In the next cycle of adopting or updating integrity plans, it is necessary for authorities to pay special attention to the development of risks related to aspects of human resource management, such as employee expertise, employment planning, the employment process, performance appraisal and monitoring, as well as rewarding and sanctioning, in order to ensure legality and transparency in that process," the ASK recommendations state.
The agency also points out that authorities must more clearly determine why certain legal obligations are not being implemented - whether it is due to a lack of staff, poor work organization, insufficient expertise or low employee motivation.
Municipalities worst for fourth year
According to the report, local government units had the lowest percentage of implemented measures for the fourth year in a row. Municipalities implemented 72,1 percent of measures.
The best result was recorded in the judiciary, where 86,3 percent of measures were implemented, and in education, with 86 percent implementation.
Among the most common risks that recur in integrity plans are the violation of the integrity of the institution, conflict of interest, abuse of public office or official position, unauthorized lobbying or other non-public influence, violation of transparency, and making illegal decisions.
Integrity plans also included risks related to asset declarations, sponsorships, donations and gifts. According to ASK data, 754 basic risks relate to receiving unauthorized gifts or other unauthorized benefits, 596 to failure to report corruption and other illegal acts, and 125 to discrimination, restriction or denial of the rights of an employee who reports suspicions of corruption or other integrity violations.
The agency also warns about the unregulated handling of gifts. The report states that 754 basic risks relate to receiving unauthorized gifts or other benefits, while 57 relate to failure to declare gifts and lack of records.
"It is necessary for authorities to adopt or amend internal acts on gift management, by defining in more detail an appropriate gift, situations in which appropriate gifts may be accepted, and the procedure for disposing of received gifts by all employees. It is necessary to specifically regulate the handling of received gifts by public officials," the Agency's recommendations state.
Specify jobs and earnings for contractors
In its recommendations, ASK requests that institutions more clearly regulate employment, service contracts, temporary and occasional jobs, additional work, gift management, and conflicts of interest.
The report states that it is necessary to specify who can be hired without establishing an employment relationship, for which jobs, how they are selected, how much they are paid, and how their work is monitored. ASK also recommends that contracts without establishing an employment relationship be concluded only for jobs that are not systematized and that are not within the core competence of the authority.
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