Tashkent, Uzbekistan (UzDaily.com) — The "Yuksalish" movement conducted a study aimed at identifying factors contributing to corruption in the primary healthcare system. A total of 4,821 individuals participated in the survey, including 1,968 citizens and 2,853 healthcare workers.

The goal of the study was to determine existing corruption risks within the primary healthcare system and develop proposals for their elimination.

Corruption in the healthcare sector remains one of the most pressing challenges, eroding public trust in government and creating serious barriers to social progress. Its presence in a system responsible for ensuring the fundamental right to health is particularly alarming. For Uzbekistan, tackling corruption at the primary care level is a high priority.

Public Survey Findings

Of the surveyed citizens, 49% lived in urban areas and 51% in rural regions. Women accounted for 57% of respondents, and men for 43%. The largest age group represented was between 31 and 45 years (41%), followed by those aged 18–30 (27%), 46–55 (21%), 56–64 (9%), and over 65 (2%).

A majority — 65% — stated they had not resorted to informal payments or gifts when receiving services at clinics or family health centers. However, 15% admitted to such actions, 14% were unsure, and 6% did not respond.

Among those who acknowledged giving money or gifts, 152 said they did so voluntarily, 93 cited subtle hints from healthcare staff, and 49 reported mutual agreement.

Perceptions of the prevalence of informal practices varied: 39% believed such cases occurred occasionally, 23% thought they were rare, 20% denied them entirely, and 17% believed they were systematic.

The most common form of corruption identified was “gratitude” payments for free services (37%). Another 26% pointed to covert payments for specific procedures, 5% mentioned other forms, while 30% believed there was no corruption at all. Notable examples of informal practices included cash gifts in maternity wards, prescriptions favoring certain pharmaceutical companies, and corruption-linked surgeries.

Asked how they would respond to demands for illegal payments, 37% said they would report the incident immediately, 34% said they might report it, 16% were unsure, and 13% said they would not inform anyone.

As for perceived causes of corruption, 45% cited low salaries for medical staff, 36% blamed patient behavior, 23% mentioned weak anti-corruption messaging, and 22% pointed to a lack of digitalization.

Suggestions from citizens included reducing paperwork, enhancing public awareness efforts, introducing digital systems, implementing health insurance, ensuring transparency around free services and medications, and training healthcare staff in ethics and communication.

Healthcare Worker Survey Findings

Among the 2,853 surveyed healthcare workers, women made up 75%. The largest group — 66% — were nurses, followed by doctors (16%), junior staff (8%), and administrative or other specialists (10%). Most were employed in family clinics (57%), with 22% working in family health centers and 21% in other institutions.

Only 36% of medical workers were fully satisfied with their working conditions, 40% were partially satisfied, 15% were entirely dissatisfied, and 9% were unable to evaluate.

When asked about corruption in their field, 56% said it did not exist, 29% gave no definite answer, and 12% acknowledged its presence.

The most common corruption scenarios reported were in hiring (13%), audits by higher authorities (8%), issuing sick leave certificates (6%), conducting medical checkups (5%), and providing referrals for inpatient care (5%).

Regarding “informal gratitude” from patients, 58% of healthcare workers said they had never encountered it, 18% said it was rare, 17% said it happened occasionally, and 5% said it was frequent. The reasons cited included low salaries (38%), the entrenched belief among citizens that gratitude is expected (36%), and patients’ hopes for better treatment (17%).

When asked about coercive payments initiated by management, half of the respondents said such practices did not occur, 18% had heard of them but had no personal experience, 13% confirmed their existence, and 19% were unsure.

Proposed solutions included increasing salaries (48%), raising legal awareness among both citizens and doctors (21%), digitalizing doctor-patient interactions (14%), and strengthening oversight and penalties (7%).

Healthcare workers also emphasized the need to improve working conditions, ensure adequate staffing, eliminate infrastructure shortages, and develop facilities.

Conclusions and Recommendations

The survey confirmed the existence of corruption within the primary healthcare system. However, perceptions of its scale differ: while 15% of citizens reported encountering informal payments, most healthcare workers denied such occurrences. This suggests the problem is being concealed and that the system lacks transparency.

Key issues include the prevalence of unofficial gratitude payments, low medical staff income, societal norms that normalize bribery, bureaucratic hurdles, incomplete digitalization, and poor legal awareness among the population.

To address these challenges, the following measures are recommended:

• Increase salaries for medical personnel to reduce reliance on informal income
• Introduce digital tools such as electronic queues, health cards, and prescriptions
• Expand informational and educational campaigns for both the public and medical professionals
• Launch a mandatory health insurance system
• Ensure transparency in the list of free services and medications
• Train doctors in ethics and effective patient interaction
• Guarantee inevitable punishment for corrupt practices.