TURKMEN DOCTORS PAY BRIBES TO AVOID PENALTIES

UNCLAS ASHGABAT 000160 SENSITIVE SIPDIS STATE FOR SCA/CEN E.O. 12958: N/A TAGS: AMED SOCI PGOV TX SUBJECT: TURKMEN DOCTORS PAY BRIBES TO AVOID PENALTIES ¶1. (U) Sensitive but unclassified. Not for Public Internet. ¶2. (SBU) Despite the Turkmen healthcare system's glamorous fagade of gleaming white marble medical facilities, family doctors and nurses struggle to provide services to the local population. In the early 1990s, the Ministry of Healthcare introduced a system in which each family doctor was made responsible for a district with 1,000 people. Initially, this practice was introduced with the purpose of forcing doctors and nurses to visit people's homes and encourage those with serious health conditions, as well as pregnant women, to undergo regular medical check-ups. A local nurse told Pol/Econ Assistant that the family doctors and nurses still do the visits, although the authorities do not provide transportation for them to do so. They cannot, however, make people undergo medical check-ups because many of their patients cannot afford to pay for the services. The contact said that she was penalized for not bringing a pregnant woman for medical check-ups who was later found to have complications because of a chronic health condition. To avoid penalties and reprimands, doctors and nurses sometimes pay for the medical check-ups of their patients with TB, who are often drug-users and whose families do not have the means to pay for the services. ¶3. (SBU) The local nurse described the system of bribery that has developed at the district health care level. According to the contact, family doctors and nurses have to pay a 50-manat ($18) penalty to the deputy head of their polyclinic for every incident of an undocumented health problem that surfaces among the population of the district that they are responsible for. According to the contact, the penalty fees collected from the doctors and nurses are used by the administration of the polyclinic to bribe health inspectors from the city health department to make sure that the inspection report looks good and does not reflect any failures in their work. Laboratory workers of district polyclinics and hospitals also pay bribes to inspectors from the city Sanitary and Epidemiological Department to ensure positive reports about their work. ¶5. (U) Recently, the Ministry of Healthcare established a "hotline" for question and answer sessions over the phone. The hotline announcement, which was placed in the local Neutral Turkmenistan newspaper, said that in addition to asking questions, callers can also request resolution of problems with healthcare officials. However, Embassy local contacts say they are afraid to complain because of the government's practice of shunning those who do so and labeling them troublemakers. ¶7. (SBU) COMMENT: Despite local media coverage of Berdimuhamedov's "reforms" to the local healthcare system, the situation on the ground shows that very little has changed since former President Niyazov's rule. Corruption is system-wide, and persists, in part, because healthcare officials are required by law to fulfill tasks, but are not given the means to do so. Berdimuhamedov could significantly improve the health of his population, which is his publicly stated goal, by investing money in local clinics and providing free services to those who cannot afford to pay, instead of building new specialty hospitals. END COMMENT.