VZCZCXRO4095
RR RUEHIK
DE RUEHAH #0160 0331249
ZNR UUUUU ZZH
R 021249Z FEB 10
FM AMEMBASSY ASHGABAT
TO RUEHC/SECSTATE WASHDC 4180
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUCNCIS/CIS COLLECTIVE
RUCNMEM/EU MEMBER STATES COLLECTIVE
RUEHAK/AMEMBASSY ANKARA 6209
RUEHBJ/AMEMBASSY BEIJING 3888
RUEHKO/AMEMBASSY TOKYO 3747
RUEHIT/AMCONSUL ISTANBUL 4453
RUCNDT/USMISSION USUN NEW YORK 1460
RHMCSUU/CDR USCENTCOM MACDILL AFB FL
RUEHVEN/USMISSION USOSCE 4363
RUEAIIA/CIA WASHDC
RHEFDIA/DIA WASHDC
RHEHNSC/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RUEKJCS/JOINT STAFF WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHDC

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.