Gender and corruption in Viet Nam's health sector

The intersection of corruption and gender inequality in Viet Nam's health sector

Overview

Corruption and gender inequality are mutually reinforcing: corruption can exacerbate women’s marginalisation, while gendered power imbalances can undermine anti-corruption efforts. Anti-corruption policies should therefore take gender dimensions into account.cf841d283b3f

Viet Nam’s legal framework for anti-corruption and gender equality has improved significantly. The 2018 Law on Anti-Corruption, the 2015 Penal Code, the 2006 Law on Gender Equality, and the 2023 Law on Medical Examination and Treatment provide the main legal bases. The Anti-Corruption Law and the National Strategy on Prevention and Combating Corruption and Negativity until 2030 have established a legal foundation for preventing, detecting, and handling corrupt acts in both state and non-state sectors.

At the international level, Viet Nam is a party to the United Nations Convention against Corruption (UNCAC) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), both of which require measures that link integrity with gender equality. Article 10 of UNCAC stresses transparency and accountability in public administration, while Articles 13 and 33 emphasise civil society participation and whistleblower protection. CEDAW obliges states to ensure equal access to health services, especially maternal and reproductive health. These frameworks create a solid foundation for national gender-responsive anti-corruption policies.

Based on this policy and legal framework, Viet Nam has made some progress in addressing corruption over the past decade.afe5a1075df2 Notably, an anti-corruption campaign – often referred to as the ‘blazing furnace’ – has resulted in the sentencing or removal of several senior state officials.ab323e9186db In 2024, Vietnam scored 40 out of 100 on Transparency International’s Corruption Perceptions Index (CPI), ranking 88th out of 180 countries and territories, and showed gradual improvement in the CPI compared to the pre-2020 years.

Viet Nam has also made significant progress in promoting gender equality. On the basis of the Gender Equality Law, gender equality has been promoted in areas such as political life, the economy, labour and employment, and health and education. The National Strategy on Gender Equality (2021–2030) demonstrates the state’s commitment to closing gender gaps. Women’s literacy rates are high, maternal mortality has fallen, and women’s participation in the labour force and politics has expanded. In 2023, women’s labour force participation was nearly 63%; women also held approximately 30% of seats in the 15th National Assembly for the 2021–2026 term.3fc08639c6ae

Despite these achievements, corruption remains a persistent challenge in Viet Nam, undermining good governance, equity and citizens’ trust.77185cd1a354 In the health sector, common forms include bribery, nepotism and misuse of public funds. Health procurement, recruitment, and patient services are particularly vulnerable because procedures are opaque and oversight is limited.c80e6a18ddb7 There are also documented cases of doctors and nurses accepting informal payments to diagnose foetal sex through ultrasound and disclose the results, a practice prohibited under the Ordinance on Population.734b5e3402f2 This contributes to sex-selective abortions that favour sons and is considered one cause of Viet Nam’s gender imbalance, with a sex ratio at birth of more than 110 boys per 100 girls in 2023.caaa98e15b28

Corruption directly affects access to quality services, transparency, and accountability – all essential to upholding the right to health.bd8d60337d14 The gendered impacts of corruption have not yet been fully addressed in Viet Nam. Policy frameworks have not consistently examined how men and women experience or respond to corruption differently, or how gender norms affect access to justice and accountability mechanisms. In particular, there are no gender-disaggregated data in the annual anti-corruption reports submitted by the Government to the National Assembly. As presented later in this report, when corruption shapes how health resources are allocated or how care is delivered, it disproportionately affects women and marginalised groups, who often have less power, fewer resources, and limited means to challenge unfair practices.

Women, especially those in low-income, mountainous and rural communities, are vulnerable to corruption. They often shoulder unpaid care responsibilities and depend on public health services for maternity and reproductive care.8bf2060d2e06 Informal payments, favouritism, and lack of transparency in medical examination and treatment processes can translate into delayed treatment, unsafe births, or exclusion from essential services.b982e1dffd91 Women also comprise the majority of the healthcare workforce, with many holding positions that can be heavily affected by corruption.

In terms of gender inequalities, women remain underrepresented in leadership and decision-making roles, particularly in local governance and institutional management. Gender norms continue to shape expectations around family and work, limiting women’s mobility and opportunities. In the economy, women are concentrated in informal or lower-paying jobs, with fewer opportunities for advancement.2b2a40799335 Access to sexual and reproductive health services, especially in rural or ethnic minority communities, is uneven and often affected by corruption, informal fees, or discrimination.c3db01f961c6 These inequalities heighten women’s vulnerability to corruption in the health system and reduce their ability to seek redress.

Against this backdrop, addressing the intersection of corruption and gender is crucial for inclusive, effective governance and for realising Viet Nam’s commitments under the Sustainable Development Goals (SDGs), particularly SDG 5 (gender equality) and SDG 16 (peace, justice and strong institutions).

Analysis of gendered corruption in Viet Nam’s health sector

Typology and manifestations of health-sector gendered corruption

Corruption in Viet Nam’s health sector is multifaceted, ranging from petty informal exchanges to large-scale collusion in procurement and appointments.34ccf7c5eed2 Evidence triangulated from interviews, secondary data and literature highlights four principal forms of corruption – informal payments, health product procurement corruption, human-resource manipulation, and sexual corruption – each revealing distinct gender and intersectional dimensions. Across the data, several common gendered patterns of corruption in the health sector emerge.

Common gendered manifestations of corruption

Research has examined whether there are differences in how men and women engage in corrupt practices. Some studies state that women may be less likely than men to accept bribes when there is a risk of detection or control.e12dfeaad335 Other studies, however, show that women may engage in corruption as much as men if they have the opportunity to do so.a62d0cedeb3d Based on interviewees’ views, secondary data analysis, and corruption cases in Viet Nam’s health sector, several inferences can be made.

Both men and women can commit acts of corruption: As noted by respondents, the ability to engage in corrupt practices depends mainly on one’s position, authority, level of exposure to public financial resources, and decision-making power over procurement, human resource management and patients’ medical examination and treatment. Interviewees believed that both men and women can engage in these practices if they have decision-making and resource-distribution power, access to resources and a motivation to gain personal benefits.142367bc8a70 Corruption cases in the health sector, such as the Viet A Covid-19 test kit case,24e668844494 the Food Safety Authority caseee018fd9e3b9 and the Son Lam case,3947086cda2d involved both men and women, including female directors, department heads, doctors, and nurses.

Men appear more numerous in corruption cases of greater value: Interviewees commented that men tend to participate in higher-value corruption because they dominate decision-making positions in procurement, human resource management, and lucrative specialties such as surgery and oncology, where procurement and commissions are concentrated. Women cluster in caregiving roles with lower access to resources but higher exposure to direct patient interactions and small-scale bribery. The sources suggest that corruption is an exercise of professional leverage rather than a reflection of gendered ethics. Because the healthcare system disproportionately places men in high-authority roles, such as hospital directors and lead surgeons, they command high-value corrupt transactions. Meanwhile, women, concentrated in frontline care roles, tend to be involved in smaller-scale informal exchanges while facing higher levels of social scrutiny and professional vulnerability. Gendered power hierarchies therefore transform the general practice of corruption into distinctly gendered outcomes.

Perceptions of corruption: Some female respondents had relatively positive assessments of informal payments, stating that they had decreased in recent years.15960f0e1ed7 However, the majority of both male and female respondents expressed the view that corruption in the health sector – especially bidding collusion, illegal bidding, kickbacks in bidding, and bribery in recruitment and personnel appointments – was common. Data from the Viet Nam Provincial Governance and Public Administration Performance Index (PAPI) 2024 show that female respondents rated government performance in ‘control of corruption’ and ‘public service delivery’ lower than male respondents, implying a more critical attitude among women towards corruption.ccdc0c6586f4

Informal payments

Scope of informal payments

Informal payments – often referred to as the ‘envelope culture’ (van hoa phong bi in Viet Namese) – remain the most visible expression of petty corruption.874b4b3dfc06 Some respondents noted that the practice of receiving envelopes has decreased somewhat in recent years because of ‘no envelope’ policies and restrictions. In some hospitals, according to doctors, patients, and experts in public health and law enforcement, the practice is now minimal. Some patients stated that doctors who had treated them over a long period never asked for envelopes. These declines could be attributed to transparent internal hospital rules, efforts to maintain a good image and attract patients, determined leadership by hospital heads who enforce integrity principles, good income sources for hospital staff, and pressure from the media and anti-corruption campaigns.

However, informal payments remain widespread in the health sector and are still perceived in Viet Nam as a norm rather than an anomaly. Patients routinely prepare envelopes to ensure attentive care or to show gratitude after treatment. Interviewees confirmed that, in some hospitals, this act has become almost routine, with most patients preparing envelopes to thank doctors.

2024 PAPI data reinforce the pattern of informal payments described above: 25.5% of respondents nationwide reported paying additional money to obtain better treatment at district hospitals. This is a gradual decline from 32.8% in 2015, but the pattern varies widely. In northern mountainous provinces such as Son La, Lang Son, Phu Tho, and Ha Giang, over 60% of respondents reported giving envelopes, while the rate in southern provinces averaged below 30%.cccc6d5026b4 Similarly, some doctors in this study who had moved from the North to work in southern localities stated that envelope payments were more common in health facilities in northern provinces than in southern provinces.c3c517d5e809 As they explained, these disparities reflect differences in hospital monitoring capacity, institutional culture, and patients’ perceptions of medical treatment and ‘envelopes’ in the two regions.

On the other hand, as the majority of interviewees noted, receiving gifts from patients should not always be considered corrupt. It should be treated as corruption only where there is an exchange for priority in medical examination and treatment. Small gifts of gratitude after treatment that do not affect professional work should not be considered corruption, but they need to be managed transparently to avoid misunderstanding or abuse.

Gendered dynamics of informal payments

Although there are no specific publicly available figures disaggregated by gender in Viet Nam, the information compiled in this study suggests that giving and receiving envelopes and gifts in the health sector differ between men and women, both among givers – patients and family members – and among health workers (see table below).47c4802fa8fe

Women are both the most frequent payers and the most visible facilitators of these exchanges. As caregivers, they accompany relatives, negotiate with nurses and bear the emotional responsibility of ‘making things work’. Male relatives often leave these negotiations to women, reinforcing a pattern in which women internalise the expectation to offer bribes as part of caring.

Among health workers, women are also on the receiving end, but in smaller amounts. Female nurses and midwives have direct contact with patients and are sometimes expected to ‘collect for the team’. Yet they occupy low-status positions and share proceeds with supervisors who control schedules and performance evaluations. Consequently, women bear higher reputational risk but receive limited benefit.

Informal payments in maternity services

Obstetrics is considered an area where patients face higher risks of giving envelopes. Respondents nevertheless commended several obstetrics hospitals and departments for a noticeable decline in the solicitation of envelope payments. Specifically, interviewees said that, in cases of giving birth under a prepaid service package,fc215ac7a815 they did not have to give envelopes and did not see the practice as common, because all costs were included in the package.127d89429fcc

However, respondents also said that they had experienced or knew of cases where informal payments were made to secure good maternity care, see the baby after birth, choose a doctor, or have a caesarean section on a ‘lucky day’ considered favourable for the baby’s and mother’s health. These informal payments can prevent low-income mothers from receiving quality services, negatively affect their health, or endanger their lives. As one obstetrician shared, there have been cases where the health of the mother and newborn was put at risk because the team was forced to perform a ‘lucky day’ early caesarean section at the request of the mother or family.

As indicated by interviews, while informal payments harm all citizens, their effects on women and vulnerable groups are more severe because women are main caregivers and service users, and they are disadvantaged in many other respects. This kind of corruption, along with procurement manipulation, directly restricts women’s access to healthcare, especially in rural and mountainous regions. Maternal and child health suffers when misallocated resources, substandard supplies, and unqualified staff degrade care quality.72175fb558f8

Informal payments, as well as procurement corruption, make services more expensive. Women experiencing poverty are forced to pay bribes to access maternal and reproductive health services, sometimes borrowing money or selling assets. Meanwhile, one study found poor availability of essential medicines across all levels of primary healthcare in Viet Nam.d2e4273803bf Corruption skews priorities towards expensive purchases that yield kickbacks rather than basic healthcare needs, including maternal care.

From the users’ side, corruption reduces the ability to make informed choices, especially for groups with limited access to information, such as women, ethnic minorities and people experiencing poverty. If health information is not provided transparently, or is distorted because of corruption, for example information about drugs or health programmes, women will have difficulty choosing options to protect their health and rights. Informal payments create a two-tier system in which quality care depends on the ability to pay. Women, minorities, and low-income households are systematically disadvantaged.

Corruption in medical procurement

As interviews and secondary data reveal, procurement corruption involves collusion between hospital managers, bidding committees, and suppliers of medicines or medical devices.5bbe8fd19743 These activities represent the costliest losses to the state because they involve large amounts of money. Interviews revealed persistent manipulation, including arranged tenders, abuse of direct contracting, and kickbacks or commissions. Officials or department heads decide procurement lists and receive ‘percentages’ from preferred contractors.

The study revealed some gender dynamics regarding procurement corruption. As stated by interviewees, and as shown in reports, research documents and newspapers, men often have more power than women in decisions on bidding for drugs and medical equipment. They also commit more acts of corruption in procurement for medical equipment, supplies and drugs.e3dcdec69d2b This is because men make up the majority of leadership and senior management positions in hospitals, health departments, and procurement-related agencies. These positions have the final say on bidding plans, document approvals, contractor selection, and implementation supervision. At the same time, the healthcare bidding process requires the participation of professional councils, hospital boards of directors, and related departments, where men often play key roles. Because women tend to hold different positions and roles in these councils, they often have less access to information and a less decisive voice than men, especially in highly specialised and powerful bidding councils.

In addition, as a health manager said, the legal framework on public procurement does not contain specific provisions on gender perspectives in the bidding process for drugs, equipment, and medical supplies.a22a734ef683 This assessment also coincides with studies showing that public bidding processes globally and in Viet Nam still lack gender-sensitive elements.59fd60e69854

Kickbacks and inflated procurement contracts divert resources from essential services, particularly those benefiting women and rural communities. Funds lost to corruption reduce investment in preventive care and gender-focused programmes.

Corruption in human-resource management

Some respondents observed that transparency in the recruitment and promotion of healthcare workers, such as nurses and doctors, has improved in Viet Nam’s health sector. As one obstetrician shared, she was promoted to deputy head on the basis of performance, without any additional payment or relationship. In an online forum of doctors, some participants also stated that they knew of cases where job candidates had been selected through merit-based procedures rather than personal relationships or money.

However, in other cases, recruitment and career development remain largely formalistic. Although formal examinations exist in the health sector, informal influence – money or relationships – often determines hiring and promotion outcomes. This highlights particular concerns about the prevalence of nepotism in public-sector recruitment practices. Respondents in this study confirmed that, in many cases, job candidates had to pay unofficial fees to be hired or promoted. In an online forum, participants discussed ‘standard rates’ varying by hospital and specialty. For technical posts in surgery or obstetrics, the cost can be hundreds of millions of VND, equivalent to several years of a doctor’s salary. More broadly, between 56% and 61% of Viet Namese citizens surveyed in PAPI considered personal connections necessary for applying for civil service positions.7852638db532

The study surfaced some gender differences in human resource management corruption. One respondent noted that recruitment and promotion for nursing and midwifery – roles predominantly held by women – are heavily influenced by nepotism and bribery. Because these professions are often undervalued as ‘manual labour’ requiring minimal expertise, and because the number of candidates is large, merit is frequently sidelined in favour of ‘relationships and money’. This dynamic suggests that women in healthcare are disproportionately vulnerable to corrupt management practices, often remaining trapped in lower-tier positions despite high levels of education.

For highly specialised positions, the corrupt cost of admission or appointment at a public hospital is the same regardless of whether the candidate is male or female. However, as some respondents noted, even when laws guarantee equal eligibility for the same positions, informal networks tend to favour men. Women may be professionally qualified but excluded from promotion.

Corruption in recruitment and promotion reduces fair opportunities for competent women. As a consequence, gender inequalities in human resource management can lead to the appointment of unqualified people to professional positions, directly affecting patients and even endangering their lives during surgery. In addition, some respondents said that because medical staff have to pay money to obtain work, they may then seek ways to recover that money from patients, negatively affecting patients. When unqualified staff are hired through bribery, service quality declines.

Corruption in human resource management, as well as procurement, limits women’s participation in health decision-making at departmental, hospital, provincial, and national levels.5fea98b5e4e2 Corruption undermines transparency and accountability in health management agencies. This can hinder women’s meaningful participation in the design, delivery, and monitoring of health services, as their voices may be ignored when decisions are based on vested interests or bribery. As analysed above, women face more difficulties in reporting corrupt practices that impede access to reproductive health services, in resolving cases of gender-based violence, and in recruitment and promotion.

Sexual corruption

Sexual corruption occurs when a person abuses entrusted authority to obtain a sexual favour in exchange for services or benefits, such as employment, promotion, or medical services, connected to that authority.765d89be0000 It sits at the intersection of gender-based violence and corruption, yet remains largely invisible in official discourse.

Within the scope of this report, only a few respondents mentioned sexual corruption in the health sector. They referred specifically to relationships between superiors and subordinates in health facilities, between male doctors and nurses, and between medical staff and female patients or family members during medical examination and treatment, or to sexual corruption as a potential risk. One participant in an online forum of doctors described a situation where a male department head ‘flirts with staff’ and ‘texts to invite them to go out drinking with the guys’ in exchange for likely benefits at work, causing fatigue and mental pressure on subordinates. In addition, some interviewees said they had heard of this corrupt act in the health sector but did not know of any specific cases. In general, respondents considered sexual corruption uncommon in Viet Nam’s health sector.

Interviewees who mentioned sexual corruption referred to women as actual or potential victims. In particular, respondents noted that female patients may be at risk of exploitation by medical staff who demand sexual relations in exchange for medical examination or treatment priority. Female healthcare workers are also at risk of being pressured or asked to ‘exchange feelings’ to keep their jobs, obtain promotion, or avoid being bullied in the work environment.785604ed1930

As respondents stated, victims of sexual corruption may not dare to speak up, or may be reluctant to do so, because of fear of retaliation, victim-blaming, social stigma, cultural taboos, and barriers to evidence collection, all of which prevent incidents from being punished. They pointed out that sexual corruption can have serious psychological, physical, economic and social consequences for survivors, such as pregnancy, unsafe abortion, sexually transmitted diseases, mental health problems, loss of reputation in the community, and leaving jobs or public services to avoid further abuse.

Looking at the broader landscape, data on sexual corruption in Viet Nam are limited primarily because the legal framework does not recognise it as a type of corruption. Although the 2015 Penal Code treats ‘non-material benefits’ as bribery, it stops short of defining them specifically as corrupt acts. As a legal expert noted, before the 2015 Penal Code took effect, bribery was defined strictly by ‘material benefits’ such as money or property, meaning sexual favours exchanged for influence were legally invisible and not recorded in corruption statistics.b088d369d776 Even with the penal code’s inclusion of ‘non-material benefits’, the lack of historical data creates a significant vacuum. Furthermore, the procedural difficulty of proving a ‘transaction’ that leaves no financial trail means few cases successfully enter official records or prosecution data. As of the end of 2025, there appears to be only one recorded instance of sexual corruption in Viet Nam being prosecuted and resulting in the imprisonment of a judge (see box below).

Beyond legal hurdles, deep-rooted social stigma and structural gaps further obscure the true scale of the issue. Victims face a ‘double stigma’ – the shame associated with sexual violence combined with the admission of participating in corruption – which drives extreme under-reporting. Furthermore, because anti-corruption reporting mechanisms are typically designed for financial whistleblowing rather than sensitive gender-based issues, many instances are likely to be misclassified as harassment rather than corruption, or not reported at all because safe, confidential channels are lacking.

Marginalised groups’ experiences of corruption

As revealed by interview and secondary data, corruption intersects with ethnicity, disability, socioeconomic status, and sexual orientation to produce layered disadvantages.7b8269762d24

Ethnic minority women: Corruption, specifically the practice of accepting ‘envelopes’, is one barrier to accessing maternal health and family planning services for ethnic minority communities in Viet Nam. Ethnic minority women participating in a UNFPA study described discrimination at district hospitals, accompanied by demands for cash bribes in exchange for better services or care.b9aed776452d In addition, access to health services by ethnic minority women in Viet Nam is limited by many factors, including social, cultural and economic barriers on the demand side (related to the women themselves and the community) and capacity, language, and process barriers on the supply side (related to the health system and service providers).6449084962f8 In rural and ethnic minority areas, the primary healthcare system often lacks funding, human resources, and equipment, forcing people to seek higher-level or private health facilities, where informal costs are likely to arise. Women in this group, because of their role in family healthcare and reproductive health needs, have to bear more expenses. For these reasons, ethnic minority women are often more exposed to corruption risks, alongside increased costs and time to access services.

People with disabilities

According to a UNDP survey, a majority of people with disabilities positively evaluate the attitude of doctors and nurses in serving patients (89.1%).5018f197dd0f However, nearly 7% of people with disabilities or their families still have to pay bribes for better treatment when going to public hospitals. The rate of people with disabilities having to pay bribes is highest in the Red River Delta region (21.8%), at least 1.9 times higher than in other regions.c87c2e516fb9 Women with disabilities interviewed in this study said that if people with disabilities do not pay this fee, it will be difficult to receive dedicated care from doctors and nurses. Having to pay additional fees outside the regulations becomes a financial burden for people with disabilities, a low-income group in society.

Although stigma and discrimination against people with disabilities in accessing health services are prohibited by law, policies and measures to prevent and handle cases of discrimination have not been issued.fd03520413c4 In addition, current health policies, especially on reproductive and sexual health and rehabilitation, have not met the needs and difficulties faced by people with disabilities.88cce76cd898 Such gaps in policies and laws can increase risks for people with disabilities, including requests for ‘envelopes’ for healthcare services.

LGBTQI+ community

LGBTQI+ people, particularly trans people, face discrimination and bias at healthcare facilities, as well as fear of exposure. According to an online survey by the Ministry of Labour, Invalids and Social Affairs (June 2022), 76.8% of respondents said that awareness and prejudice in society, medical facilities and among medical staff remained limited towards LGBT people; 24.0% considered that the reason was an incomplete system of policies and laws, including a lack of legal basis for transgender and intersex people.fe88a0bc1760 This raises concerns about corruption risks for LGBTQI+ people in healthcare service provision in Viet Nam.

Informal workers

Informal workers accounted for 68.5% of Viet Nam’s employed workforce in 2021, of whom a large proportion were women. Most (97.8% in 2021) did not have compulsory social insurance, and only a few participated in voluntary health insurance or were supported by the state to buy cards.d4d6b178ad90 They have to pay many medical expenses directly, including informal expenses such as ‘envelopes’, bribes, and over-the-counter expenses. This increases the financial burden and the risk of falling into poverty because of high medical expenses. In addition, women in the informal sector had lower average income than men, especially after Covid-19.33d125e7659b This reduces their ability to pay when they are sick or ill, making them vulnerable to medical expenses arising from informal payments.

Drivers of gendered corruption in the health sector

Corruption in general, and gendered corruption in the health sector in particular, is sustained by structural incentives, power hierarchies, social norms and institutional weaknesses. Understanding these drivers is essential for designing reforms that do not inadvertently reproduce inequality.

Systemic incentives and economic pressures

Chronic underfunding and low salaries drive much of the problem of gendered corruption in Viet Nam’s health sector. Official monthly salaries for doctors in public hospitals range from 5 to 15 million VND (approximately EUR 162 to 485), much lower than salaries in private hospitals.12fe7cb96f1e Nurses, midwives and community health workers – mostly women – occupy the lowest-paid ranks. Equipment shortages and overcrowding further enable staff to demand extra payments for access to scarce services.

As respondents noted, public health sector salaries are neither competitive nor performance-based. Experts and patients observed that this situation has led public health workers to seek bribes to supplement their incomes. While the government has attempted to address this issue by increasing public sector salaries in recent years, many respondents still assess salaries as inadequate for the cost of living in Viet Nam.

In addition, economic stress intersects with gender roles. Women in Viet Nam bear a disproportionate burden of unpaid care, which limits their ability to participate in the workforce. In one survey, 97% of women and 94% of men agreed that childcare was inherently a woman’s duty; twelve out of the fourteen domestic tasks included in the survey were carried out by women, including cooking and caring for senior or ill family members.5dc839b631df In that context, women health workers are no exception. They carry dual burdens – professional work and unpaid domestic care – which limit their capacity to engage in additional income-generating activities. Consequently, this situation can contribute to their informal earnings from patients. Economic vulnerability is therefore both a cause and a consequence of gendered corruption: low income drives informal payments, which in turn deepens women’s financial precarity.

Structural inequalities and their effects

The health sector’s hierarchy concentrates authority at the top with director-, department head-, and senior specialists positions predominantly occupied by men. Below them, female nurses, midwives, and administrative staff perform essential but undervalued labour. This vertical structure can create conditions in which integrity risks are harder to manage and less likely to be reported.

As health workers stated, women are often in the minority in leadership and decision-making positions, such as department and hospital leadership. Other sources show that, nationwide, although female health workers make up the majority (over 57% to 63%, according to different sources), they are often concentrated in lower-status positions (nursing – 63%, midwifery – 91%), while men dominate specialist- (83%), doctor- (72%), and leadership positions.a5d7d74fc674

A doctor in an online forum remarked: ‘In some places, the department head is like a king; if he wants something, everyone must obey’. Such asymmetry increases the risk of misconduct and makes it difficult for subordinates to raise concerns, given that promotions, schedules, and training opportunities depend on superiors’ discretion.

Female patients and family members, as service users, are often in less empowered positions in society, making them more vulnerable. As interviewees noted, this includes lack of knowledge about their rights and lack of social or legal support networks. Women, especially those who are living in poverty or single, often have fewer assets and less control over their finances, making it difficult for them to pay informal payments or bribes.23000e8306d8 This puts them at risk of being excluded from essential services or having to accept poor-quality services. Furthermore, women often need specific health services for reproductive health, maternity, and childcare, so they face additional costs because of corruption.

Social norms and organisational culture

Beyond economic and institutional pressures, social norms, including gendered ones, and workplace cultures can condone or normalise certain corrupt practices in the health sector. Interview data and secondary sources show that ‘envelope culture’ is seen as a natural expression of gratitude rather than an ethical violation. Both patients and health staff often rationalise the practice as unavoidable courtesy, reflecting the broader Viet Namese social norm that gifts maintain harmony and respect. This social expectation has been absorbed into medical settings, where ‘voluntary gratitude’ can conceal pressure. As many interviewees commented, ‘people think of it as politeness, not corruption’.

At the same time, many respondents observed that women are often the primary caregivers in the family, including for children and elderly people. Female patients, especially mothers and daughters, are typically the ones delivering envelopes, perceiving this as an act of responsibility, not misconduct. Men, by contrast, are less expected to handle these exchanges, reinforcing gendered exposure to corruption. This results in women bearing the costs of health-related corruption more than men in the family.

Inside health institutions, the stereotype that men are more suited for leadership positions limits women’s access to management roles and decision-making power. A high-level health manager stated that prejudices about women’s caregiving and family responsibilities also restrict women’s opportunities for education, training, and career advancement, making them more susceptible to corruption pressures.

Social expectations that women remain ‘passive’ or avoid confrontation reduce their likelihood of reporting corrupt acts, increasing their vulnerability to such practices. A reluctance to speak out, which tends to be stronger among women, further limits reporting. Doctors and nurses described environments where ‘everyone knows but no one says anything’.620dc201bfb6 This culture, though unofficial, acts as a strong social control mechanism. At the same time, societal attitudes towards corruption are gendered: female health workers face harsher judgement for misconduct, while similar behaviours among men are often viewed more lightly, as one interviewee noted.

According to interviewees, women are often more vulnerable than men when reporting corruption in the health sector, facing greater psychological and social pressure, such as retaliation, isolation, violence or job loss. Men may also face difficulties when reporting, but they often face less personal and societal pressure than women.

Women’s ability to complain about or denounce corruption in healthcare, and to protect themselves, is limited by various socio-cultural factors. Gender stereotypes and social roles make women more likely to be overlooked, isolated or not fully supported when reporting. Women also often have lower positions in organisational structures and less power, making it difficult for them to access official reporting channels or resist the influence of power relationships.4b9e1d4d161e

Gaps in laws, policies, and institutional context

Despite achievements in anti-corruption and gender equality legislation, as presented in the introduction, gaps remain in the intersection between gender and corruption, both in the policy and legal framework itself and in implementation. The Anti-Corruption Law does not yet include explicit provisions on gender. Gender equality objectives have not been integrated into anti-corruption programmes, notably the National Strategy on Anti-Corruption to 2030. In a policy report developed by the Government Inspectorate on the National Anti-Corruption Strategy to 2030, there is no analysis or recommendation on gender issues, the roles of women or the Women’s Union in anti-corruption programmes.b9951203323e Similarly, health-sector anti-corruption strategies or plans do not contain explicit gender targets, and monitoring rarely uses sex-disaggregated indicators. There are no regular assessments connecting corruption control to gender outcomes, making evaluation of gendered impact almost impossible. A typical example is the Ministry of Health’s plan for implementing anti-corruption tasks in 2026, which contains no reference to gender issues.

Women remain underrepresented in decision-making positions in both the health system and anti-corruption agencies. As noted elsewhere in this report, although women constitute the majority of the health workforce, they hold a minority of leadership posts. At provincial and hospital levels, key decisions on procurement, budgeting and personnel appointments are usually made by male directors and department heads. This underrepresentation limits the inclusion of women’s perspectives in integrity reforms.

Informal networks and personal connections can influence promotions and postings in ways that formal procedures do not fully prevent. Women are less likely to benefit from such networks, given constraints on their time and mobility. While legal quotas or guidelines may exist, cultural norms can still favour men for leadership roles.2d4cb3971b82 As a result, gender gaps in authority may persist even where formal criteria appear neutral.

The Law on Denunciation protects whistleblowers and their relatives. However, Article 23 requires individuals making denunciations to give their name and address to government agencies.aeebfaf74b50 Specific protection and confidentiality for women whistleblowers are limited. Cases such as that of pharmacist Tran Thi Kieu Oanh in Binh Phuoc, who faced violence and dismissal after reporting malpractice, illustrate how legal protections require stronger institutional support to be effective.f5593caa7f00

Legal recognition of sexual corruption is not yet explicit. The Anti-Corruption Law and the Penal Code define corruption primarily by reference to monetary gains. The Code refers to ‘other benefits or advantages’ when addressing bribery, but not as a direct manifestation of corruption. So far, only one case appears to have interpreted ‘other benefits or advantages’ to include sexual favours.c49cb1495890 The lack of explicit recognition of ‘sexual benefit as a form of corruption’ leaves survivors without remedy and makes it difficult to implement UNCAC obligations and protect women’s rights. This gap is particularly notable in the context of Resolution 10/10, passed at the UNCAC Conference of the States Parties in December 2023, which includes provisions on sexual corruption.c4f601628ef2

Data and evidence gaps are another barrier to anti-corruption efforts. Official reports by government agencies, including the Government’s annual report on corruption submitted to the National Assembly, do not disaggregate corruption experiences by sex, ethnicity, or disability. Without such data, policymakers cannot identify who pays bribes, who benefits, and who bears the cost, preventing more precise tracking of trends and evaluation of reforms.

The health sector underwent major restructuring in 2025, similar to other parts of the government system. This included merging departments, divisions, or units; abolishing the district level of local government, resulting in a shift of district health facilities to the authority of provincial Health Departments; and strengthening the structure of commune-level health stations. This ongoing restructuring can bring both risks, such as new integrity gaps, potential instability in human resource management and procurement challenges, and opportunities to embed transparency measures, gender-sensitive safeguards and digital reforms.

Addressing the root causes: structural pressures reproduce gendered corruption

Corruption in Viet Nam’s health sector persists because authority, resources, risks, and responsibilities are distributed unevenly. Chronic underfunding, low salaries, equipment shortages, and overcrowding create incentives for informal payments and other misconduct.

Gendered hierarchies shape how these pressures play out: men’s greater representation in senior and procurement-related roles gives them more access to high-value corruption, while women are concentrated in lower-paid frontline positions and bear greater exposure to informal payments and patient pressure.

Social norms reinforce these patterns by normalising envelopes as expressions of gratitude, assigning women responsibility for navigating healthcare on behalf of their families and discouraging reporting. Gaps in laws, whistleblower protection, and gender-disaggregated data, including the limited recognition of sexual corruption, compound these risks. Effective reform must therefore address the structural and gendered drivers of corruption, rather than treating corrupt acts in isolation.

Recommendations

The following recommendations provide a structured, prioritised, and actionable roadmap for systemic change, targeted interventions, and stakeholder-specific actions designed to build a more transparent, accountable, and effective healthcare system for all citizens of Viet Nam.

Strategic recommendations for systemic change

Systemic reforms addressing legal frameworks, institutional practices, data collection and social norms are foundational for sustainable change. They create the essential enabling environment in which targeted anti-corruption interventions can succeed, and a culture of integrity can become institutionalised. Without these broader reforms, specific efforts risk becoming isolated and short-lived.

Strengthening legal and policy frameworks

A robust legal and policy foundation is the bedrock of any effective anti-corruption strategy. By clarifying definitions, mainstreaming gender perspectives, and reforming procurement processes, Viet Nam can close critical legal gaps and demonstrate a strong commitment to gender-responsive governance.

Gender mainstreaming

The National Assembly, through its committees, and the Government, through its ministries, should work closely to incorporate gender perspectives into anti-corruption-related laws and strategies during the 2026–2030 period. In particular, the Anti-Corruption Law and the National Anti-Corruption Strategy should include direct provisions on gender equality and sex-disaggregated data. The Ministry of Health, Government Inspectorate and Ministry of Justice should integrate gender perspectives into all stages of health policy and anti-corruption programme cycles, from design to implementation and evaluation. This will ensure that national health strategies contain clear gender equality goals based on a thorough analysis of how health risks and service utilisation differ by gender.

Legislative reform

Clear definition of sexual corruption

The Government should submit amendments to the Law on Corruption Prevention and Control and the Penal Code to the National Assembly, with unified and clear definitions of sexual corruption and the demanding of non-material bribes. This measure aims to address current legal ambiguity, which creates gaps that make it harder for victims to report and for perpetrators to be held accountable. The December 2025 amendment to the Law on Corruption Prevention and Control did not incorporate gender-specific provisions, which means these critical elements should now be pursued through implementing regulations, secondary legislation, and the next cycle of legislative reform.

Whistleblower protection

These should be strengthened to safeguard individuals, particularly women, who report gender-based misconduct or sexual corruption. Revised laws should ensure protection from retaliation and reputational harm while providing safe, anonymous reporting channels. Reporting channels should be accessible for persons with disabilities, ethnic minorities, LGBTQI+ people, and others who may struggle with access in other ways.

Gender-responsive procurement (GRP)

The government, through the Ministry of Finance, should review and improve public procurement laws to integrate Gender-responsive procurement criteria. This includes officially adding women-owned businesses and gender-responsive enterprises as target groups in the bidding process, to promote women’s economic empowerment and diversify supply chains.072d1d70e7ad

Addressing root causes

The government should address the structural conditions that contribute to integrity risks in the health sector. This includes improving the salaries and working conditions of medical staff to reduce the motivation for informal payments and corrupt acts in procurement and human resource management. Critically, the health sector should tackle the uneven distribution of resources that causes severe overload at central hospitals, which in turn creates pressure for informal payments. The ongoing restructuring of commune-level health stations should be seen as an opportunity to strengthen their capacity to meet citizens’ healthcare needs at first contact, which in turn can reduce overload at central hospitals. At the same time, as women constitute the majority of the workforce at commune health stations, this process should ensure fairness and equality for women in human resource management, procurement, and labour distribution.

Enhancing institutional integrity and governance

Strong institutions with transparent and accountable governance structures are essential for translating policy into practice. This requires a dual strategy: strengthening the role of women as leaders and monitors, while embedding integrity into the core governance models of healthcare facilities.

Strengthening the role of women

In decision-making

State agencies and health facilities must increase women’s participation in leadership and management positions. The Ministry of Health, Provincial Health Departments and the Women’s Union should take coordinated action to promote women’s leadership within the health sector.

This includes setting equitable quotas for appointments and establishing mechanisms to ensure women’s meaningful participation on critical bodies such as bidding and medical ethics councils. A minimum quota of 30% women’s representation should be established in senior decision-making bodies, hospital boards, bidding committees, and ethics councils. Transparent, merit-based recruitment and promotion processes should be adopted, ensuring gender-balanced representation in human resource management.

Women’s leadership and technical capacity should be enhanced through regular training in management, anti-corruption law, and budget oversight. Mentorship programmes should support women health workers aspiring to leadership roles.

As service users

The Ministry of Health must empower female patients by raising awareness of their health rights and actively involving them in the formulation and monitoring of health policies, ensuring that solutions are tailored to their needs.

Women’s Union roles

The government should take further measures to encourage and enhance the Viet Nam Women’s Union role as a core partner in policy review, independent monitoring, and internal control of the health sector. This can be operationalised through the union’s ‘traditional’ policy advocacy and oversight activities, as well as pilot models such as the ‘Women’s Union supervises hospitals without envelopes’ initiative. The National Anti-Corruption Strategy should directly recognise the Women’s Union’s roles and assign it clear tasks in anti-corruption programmes and activities.

Championing accountable governance at the facility level

The Ministry of Health should mandate the adoption of the ‘Patient-Centred Hospital’ model to increase transparency and accountability. Hospitals should seek to strengthen the separation of administrative and clinical decision-making to reduce opportunities for conflicts of interest, while recognising that effective governance of complex healthcare organisations requires both integration and oversight. At the same time, doctors’ and nurses’ opinions and voices should be heard and counted in decision-making in each facility. Independent internal control units should be established to oversee financial integrity and ethical compliance. Ethics and integrity training should be mandatory for all hospital leaders and managers. Independent patient feedback systems, including mobile applications and hotlines, should enable anonymous reporting, and hospitals must publicly document follow-up actions.

Advancing transparency

True accountability is impossible without the visibility that only consistent transparency and granular, gender-disaggregated data can provide. To strengthen transparency, the Ministry of Health, provincial departments, health facilities, and social organisations should ensure that key hospital information, such as licences, staff credentials, service fees, and procurement results, is disclosed on the health sector’s websites and other digital platforms.

Procurement data and standardised prices for medical supplies and drugs should be published on time on the ministry’s website to prevent collusion. Patient-centred transparency tools, including online complaint systems, real-time cost disclosure, and digital fee schedules, should be widely implemented. Expanding e-procurement and digital human resource systems will reduce discretionary decision-making and promote accountability.

Transparency demystifies healthcare processes, reduces opportunities for abuse, and provides the evidence needed for equitable policymaking. Mandating public disclosure and systematic data collection is essential for building an accountable health system.

Health facilities must be required to publicly disclose key information to empower patients and enable public oversight. This includes:

• Hospital operating licences, full service price lists, and the qualifications of medical staff.
• Complete details of procurement processes, including public offers, terms, selection criteria, and final results.
• Standardised and public medical examination and treatment procedures to minimise abuse and clarify patient pathways.

Improving gender-disaggregated data

Interview participants emphasised the need for gender data collection and analysis on corruption in the health sector. The Ministry of Health must issue unified guidelines for the mandatory and systematic collection of gender-disaggregated health data, including intersecting factors such as age, ethnicity, and economic status. Key data points must include:

• Treatment costs, waiting times, and health outcomes, disaggregated by gender.
• Human resources data, showing the separation of men and women by position (doctor, nurse, midwife, leader) and specialty (obstetrics, paediatrics, surgery).
• Data on the differential impact of informal payments on male and female patients and their families.
• This granular data must be actively used to adjust budget allocations, inform equitable human resource policies, and rigorously monitor the progress of gender-responsive anti-corruption efforts.

Education and communication

Strategic communication is essential for building a culture of integrity. To be effective, campaigns must be social norm-sensitive and grounded in local evidence. However, as international practice shows, such campaigns must be carefully designed and implemented to avoid unintended effects.f1468f022b14 Merely highlighting the prevalence of corruption can normalise it and backfire; the focus should therefore be on celebrating integrity, clarifying rights, and showcasing positive models.

Core messaging

Develop clear and consistent communication campaigns centred on patients’ rights, the consequences of corruption, clear definitions of sexual corruption, and examples of integrity from both medical staff and patients. Messages should also aim to change social norms that reinforce gender bias and inequality.

Targeted campaigns

Within the health sector, mandatory ‘gender-related integrity governance’ training should be conducted for managers, along with ethics training for all staff, especially nurses and midwives. Health facilities can use posters and digital screens to promote integrity and publicise feedback channels. At the same time, good practices mentioned by respondents in this study should be disseminated by the health sector itself, through the media, social media, and other communication channels.

In the community, the media and social organisations can launch public campaigns such as ‘Women say no to envelopes in healthcare’, leveraging the extensive grassroots network of the women’s union.

Engaging men as allies

All communication activities must actively attract men’s participation. Changing entrenched norms that fuel corruption is impossible without engaging men as agents of change who challenge outdated gender roles and share family healthcare responsibilities.

These systemic changes create the foundation for addressing the specific, tangible manifestations of corruption that citizens experience daily.

Targeted interventions for specific corrupt practices

While systemic reforms are important, they are most effective when complemented by measures that address the specific, everyday integrity challenges that affect public trust. The following targeted interventions are designed to combat informal payments, sexual corruption, and integrity risks in procurement and human resources, making systemic change tangible for all.

Dealing with informal payments

Informal payments disproportionately burden patients, particularly women in vulnerable situations such as maternity care, where social pressure to give an envelope for a safe delivery is immense. A multi-pronged approach is required to tackle this deeply entrenched practice.

Clarify regulations

The Ministry of Health must develop and enforce strict codes of conduct that clearly distinguish between culturally appropriate ‘thank you gifts’ and coercive bribes, with clear disciplinary consequences for solicitation.

Increase transparency

Mandate the public posting of all official service costs and health insurance co-payments, especially in departments heavily used by women, such as obstetrics, gynaecology, and paediatrics.

Build capacity and awareness

Provide training for medical staff on how to tactfully refuse envelopes. Launch public awareness campaigns, modelled on successful examples such as the ‘Say no to envelopes in health services’ project, to assure patients that quality service is their right and does not require an extra payment.

Ensuring integrity in procurement

Promoting transparency and women’s participation are key countermeasures to prevent corruption risks in procurement and promote gender equality. The Ministry of Health could be a pioneer by increasing women’s participation on bidding committees and appraisal panels, with a recommended minimum quota of 30%, to mitigate corruption risks. The ministry, its provincial departments, and hospitals can invest in capacity-building programmes for female health workers on procurement management and public finance.

Ensuring integrity in human resource management

Hospitals should ensure transparent recruitment and appointment processes by publicising all criteria, procedures and results. The Ministry of Health should require gender-balanced representation on personnel councils and empower the women’s union to participate in monitoring these processes to prevent bias.

Preventing and responding to sexual corruption

Alongside a formal definition of sexual corruption in the national legal framework, a comprehensive strategy is required to define the problem, create safe reporting channels, and foster a culture of zero tolerance.

Develop specific regulations

Hospitals must adopt and enforce workplace codes of conduct prohibiting sexual corruption, ensuring disciplinary action such as dismissal and legal referral for perpetrators.

Establish safe reporting mechanisms

Dedicated and confidential reporting mechanisms, including hotlines and digital platforms managed by independent bodies, should be established to handle cases of sexual corruption. Survivors must be guaranteed anonymity and protection from retaliation. Health facilities must create confidential, anonymous reporting channels, such as hotlines and mobile applications, with clear protocols for victim protection and support, established in coordination with the women’s union.

Comprehensive support services

Support services, including legal aid, psychological counselling, and medical care, should be accessible and sensitive to the needs of women and marginalised groups.

Strengthen women’s role

Empower women to lead cultural change by serving as role models of integrity and leveraging the women’s union to monitor the implementation of anti-sexual corruption regulations and support victims.

Promote culture change

Launch internal campaigns on ‘Saying no to sexual corruption in healthcare’. Mandate training for all staff on identifying and handling sexual corruption and embed this content into the core curriculum of medical schools.

Implementation roadmap: Prioritising for impact

To ensure momentum and the effective use of resources, these recommendations need to be strategically sequenced. This roadmap organises actions into a phased implementation plan. Short-term priorities focus on quick wins that build political will and demonstrate visible action. These foundational steps pave the way for more complex, medium-term institutional reforms, which in turn enable the deeper, long-term legislative changes required for lasting transformation.

Looking ahead: building gender-responsive integrity in the health sector

Viet Nam’s ongoing health-sector reforms create an opportunity to address the structural conditions that sustain gendered corruption. This will require more than responding to individual acts of misconduct. Reforms should reduce the pressures that enable informal payments, strengthen transparency in procurement and recruitment, improve protection for those who report abuse, and recognise sexual corruption more clearly in law and policy. They should also address the unequal distribution of authority within the health system by expanding women’s meaningful participation in leadership and oversight.

Embedding gender analysis and disaggregated data into anti-corruption measures will help ensure that reforms respond to the different ways in which corruption is experienced across the health sector and produce fairer, more accountable healthcare for all.