Giving and receiving envelopes has become a common phenomenon in Vietnam's health services, as well as in other areas of life such as land resource management, construction, transport and education. RTCCD conducted a new study in 2010-2011 on this issue with the technical and financial support from International Transparency and Toward Transparency, in collaboration with the Boston School of Public Health, United States. The research aimed to identify the origins, roles and impacts of informal envelope payments on health services. The results of the research showed that envelope payments occur commonly when people use public health care services such that the higher level of facility, the more common the situation. The study also indicated that not only do envelope payments fail to improve the quality of treatment (which is, of course the goal of offering an envelope), but it diminished the overall respect that the public has for doctor. When people’s belief in the health sector falls, people use envelope offerings to compete against each other for treatment and of course, the poor become be the most disadvantaged. However, both the public and health workers expect the intervention of the state in this issue, lacking a belief that their own changes in thought and action will have an impact.
Responding to the call for Vietnam Anti-Corruption Initiatives (VACI 2011 program), RTCCD brings the initiative "Say NO to envelope payments in health services." The idea is to promote people's participation in creating an environment that does not tolerate informal costs in health services. A “clean” environment could be created through increasing awareness to people about the issued health policies laws, the rights and obligations of the parties involved in health activities, the role of envelope payments and their impact on health care quality, as well as on the society. Next steps towards an envelope-free environment may include guiding and encouraging people to shift from awareness to a change in behavior of not giving envelopes, as well as recording and condemning health workers’ harassment behaviors.
The proposal P51 uses means that are capable of transferring knowledge and messages to the entire Vietnamese population, such as screening on public television channels and the printed and online newspapers around the country. RTCCD will collaborate with the VTV broadcasting agency to perform two talks and five reports on the subject of envelope in the health service, in order to disseminate knowledge to the public. In the two talks, participants will be policy makers, social activists, hospital managers, health staff and people using health services. Their view points and comments will help to answer people’s questions about the impact of envelope payments on health service quality. Five reports aim call people across the country to make recordings of voices and videos of incidences of harassment that they experience when they are using health services, and sending to a VTV address and live broadcast them all over the country. The contents of the 2 talks and 5 reports will be copied onto VCD, attached with a discussion guidance book, will be delivered to communes and villages in Ha Nam province through the Ha Nam Province Women’s Union. The women’s union will host the video and audio presentations and group discussions to women in the community in order to guide them and their families to manage harassment situations. These discussions also aim to provide information about policies so that the people know their rights and raise their voice to protect them.
The advantage of this public education approach through the mass media is to bring real images over large coverage and large audience reach, continuous broadcasting frequency, and storage ability for future reference.
The implementation period of P51 is one year, beginning in Sep 2011. We all hope that the proposal will attract the people’s attention and action, with a community consensus to rebuild a transparent and quality health care system for Vietnam.