Patients: If TB treatment is free, why are we paying for it?

The war against tuberculosis in the country might be hard to win if patients admitted at the isolation ward set up at the Kenyatta National Referral Hospital continue paying a fee of Sh4,500 per day.

According to the investigation done by Healthy Nation, the high cost is due to a push and pull between the government and the hospital management on who should manage the ward.

Ideally, the government should manage the ward that houses patients with drug-resistant tuberculosis, through the National TB Programme, but given that the isolation ward was built on KNH land, but away from the hospital’s main complex, the hospital has taken to determining what patients should pay, even though the government provides tuberculosis treatment for free.

Patients with normal TB infection who have defaulted on treatment and have therefore become a public health risk, are also hosted in the isolation ward.

The patients are isolated for between three to six months before being discharged. Only authorised health workers and a close relative are allowed access to the patients and they wear protective gear (gloves, gown and mask) every time they visit the ward.

Kenya has been listed as a multi-drug-resistance tuberculosis (MDR-TB) high-burden country, together with eight other nations grappling with the deadly disease globally. Kenya features in all three high-burden country lists under the categories of tuberculosis, multi-drug resistant TB and TB/HIV.

MDR-TB is caused by bacteria that are resistant to at least one first-line anti-TB drug. Treatment takes longer than treatment for normal TB. MDR-TB occurs when patients develop resistance to Rifampicin and Isoniazid, the two most powerful anti-TB drugs.

The World Health Organisation requires that MDR-TB patients be supervised directly in order to increase adherence to medication. Many patients fail to complete their drug courses because they take medication for longer and it has many more side effects.

WAR AGAINST TB

To win the war against TB, experts are calling on the government to make admission to the isolation ward at KNH free, to increase access to patients who need it. There are only two other isolation wards – one at the Moi Teaching and Referral Hospital in Eldoret, and one at Homa Bay Hospital – and they do not charge patients for treatment.

Treatment for tuberculosis is usually offered free in public hospitals, and patients with MDR-TB receive a Sh6,000 monthly stipend for food and treatment.

“TB treatment is free. Why is a referral hospital that should be giving the services free be charging more than a private hospital? Patients should not suffer any catastrophic cost,” said Evelyn Kibuchi, the national coordinator of Stop TB Partnership - Kenya.

Last year, Stop TB Partnership – Kenya wrote a letter to the government asking for the ward fees to be dropped, but no action has been taken so far.

One patient in the KNH TB isolation ward who spoke to Healthy Nation on phone on condition of anonymity, said that though he wanted to be cured, he was struggling to raise money to pay for the cost of treatment.

“I have been taking medication for close to two years now. I do not want to default or spread the infection. But if drugs are free, why are we being charged Sh4,500?” he posed.

A full dose of drugs used for second-line tuberculosis treatment costs the government Sh1.3 million per patient. The patients receive drugs and an injection every day at the facility and the treatment goes on for 18 months, with extensions for the harder-to-cure cases.

Last year, a survey released by the National Tuberculosis, Leprosy and Lung Disease Programme revealed that patients with drug-resistant tuberculosis spend an average of Sh145,000 while seeking treatment for the infectious disease over a 20-month period. These costs include direct medical costs (consultation fees and diagnostic fees), non-medical costs (transport, accommodation and food) and indirect costs (productivity hours lost). The high costs plunge many into poverty.

While releasing the report, the Cabinet Secretary for Health Sicily Kariuki noted that these costs make tuberculosis patients less likely to present for treatment, complete TB testing and initiate and adhere to treatment.

“They place an economic burden on households, worsening poverty and increasing deaths due to the disease,” she said.