NANNING, Dec. 2 -- The upgrade of China's rural medical system is breeding corruption among heads of medical institutions in the country's remote areas.

Between 2009 and August of this year, the presidents of six rural health centers were prosecuted by the local procuratorate for taking kickbacks in the coastal city of Fangchenggang in south China's Guangxi Zhuang Autonomous Region, making it the biggest commercial bribery case in the city's medical system.

According to procuratorate documents, the suspects received kickbacks from pharmaceutical sales representatives worth 934,800 yuan (152,496 U.S. dollars) when purchasing medical equipment such as Color B ultrasound machines in Fangchenggang, home to ten rural health centers.

The case was just one more in a series of similar cases in a corruption quagmire that has trapped several public officers working for the country's rural medical system.

In 2012, six health center deans in Guangxi's Luocheng County, a poverty-stricken county under the jurisdiction of Hechi City, were busted for accepting commissions while buying expensive medical equipment between 2008 and 2011.

Official documents show that the sales agents provided kickbacks to the centers' heads ranging from 10 percent to a staggering 25 percent in an attempt to increase sales.

A suspect in the case, surnamed Nan, confessed to police that sales agents would come to his workplace repeatedly, persuading him with lavish dinners while promising him great benefits if he chose to buy the equipment they were selling. The suspect said he could not resist the temptation and slipped into the corruption abyss.

A pharmaceutical sales representative usually promotes medical equipment from multiple suppliers to public officers at China's rural health centers, according to Wang Runsheng, deputy director of Hechi's anti-corruption and bribery bureau.

But some representatives offer lucrative kickbacks to officers who promise to buy equipment with public funds rather than procuring the devices through a public bidding process, and the quality of the products cannot be guaranteed, Wang said.

Taking kickbacks has become a de facto rule in China's grassroots health centers, he said.

"One of the suspects told me that if he did not take the money, he would be regarded as weird and thus be alienated among his circles in the health centers," Wang added.

As China strives to upgrade the country's rural medical system, heads of medical centers around the country have reportedly jumped on the kickback bandwagon when replacing old equipment.

Earlier this year, officers with the municipal procuratorate of Liaocheng City in east China's Shandong Province found that 16 rural health centers were involved in such cases, accounting for 88.9 percent of hospital and health center bribery cases in the city.

From 2009 to 2011, six heads of rural health centers in Dayao County in southwest China's Yunnan Province were targeted in a crackdown for taking kickbacks when buying medical equipment.

In a 2011 anti-corruption campaign, four health center heads in Xinshao County in the central province of Hunan were punished for taking commissions when purchasing medical equipment.

HOTBED FOR CORRUPTION

Before the frequent corruption cases emerged in the rural medical system, health centers in China's countryside were struggling with poor material conditions. In 2006, more than 60 percent of such centers reported a lack of basic medical equipment, according to government statistics.

During a survey trip to China's rural areas, Bai Zhipeng, deputy director of the China Association of Medical Equipment, found that almost one-third of the county- and township-level health centers in the less-developed middle and western areas of China owned nothing but stethoscopes, tonometers and refrigerators.

To tackle the problem, the central government initiated a medical system reform in 2009, promising to improve medical conditions in the countryside by providing more funds.

During China's Eleventh Five-Year Plan from 2006 to 2010, the Ministry of Health allocated about 175.4 billion yuan to boost the development of the medical system in China's poverty-stricken areas, with a year-on-year increase of 73 percent. The money was supposed to cover construction expenses for the health centers' facilities as well as equipment renewal.

The system upgrade did work wonders, said Bai, who saw advanced medical machines used to treat patients during his second rural tour in 2011.

But the renewal boom is also becoming a hotbed for rural corruption, as medical device sales agents try to edge each other out to grab a share of the public funds by bribing the heads of rural health centers.

In Luocheng, which is home to more than 30 companies selling medical devices, sales agents use various methods to bribe center chiefs, according to procuratorial personnel in the county.

An agent in Luocheng, who refused to be named, said that heads of rural medical centers easily fall for the bait, as the amount of money spent on equipment is comparatively smaller than in big city hospitals, and these officers tend to be less "on guard" than their peers in big cities.

"If we can get the heads of multiple health centers to buy our equipment, we can reap more benefits than we do with big hospitals," said the agent.

BATTLING BRIBERY

According to Bai Zhipeng, the general public is more concerned about doctors receiving kickbacks for medicine, and largely ignores the fact that hospitals and rural health centers increasingly take commissions from sales agents selling medical equipment.

Bai laid the blame on a lack of open bidding when rural health centers purchase medical equipment.

Although the government requires open bidding before purchases, the grassroots medical institutions, which manage funds on their own, tend to buy equipment without notifying county-level health bureaus, which makes it difficult for the government to supervise, Bai said.

Even when centers hold open bidding, bidding documents can be changed to meet the specific requirements of the medical equipment companies that have secretly offered bribes to those in charge of centers.

Luo Guo'an, an expert from the Guangxi Academy of Social Sciences, said that while China's rural medical institutions are welcoming the boom in medical equipment purchases, supervision is still poor compared with big city hospitals.

"There is an urgent need to ramp up supervision of these health centers to prevent such crimes from happening," Luo said.

Serious corruption in the poor areas of China has drawn the public's attention, and now governments on various levels are considering measures to battle the crimes.

In Luocheng, an accounting center, which is supervised by accounting staff from the county health bureau, has been established to oversee the amount of money used by local health centers.

To prevent public funds from being pocketed by avaricious officers, Bai suggested that a team of experts is needed to oversee the bidding process.

"Health departments at the provincial and municipal levels should join hands in holding open bidding activities to ensure a transparent bidding mechanism," Bai said.