Hundreds of women are detained in Kenyan hospitals for failing to pay medical bills, a report published early this month has shown.
Although illegal hospital detentions are not a new phenomenon, the study by the UK-based Chatham House cited the country as one of those in sub-Saharan Africa where the practice is widespread.
Obstetric emergencies such as birth complications were cited as the main factor in the detention of women at hospitals after accruing huge bills.
One such woman, who sought anonymity, lost one of her twins when she gave birth prematurely.
The surviving twin, a three-month- old baby, is currently being held at the Nairobi Women’s Hospital, Adams Arcade, because the mother cannot pay the bill amounting to nearly Sh300,000.
The mother has to commute daily to the hospital to breastfeed her son before leaving him under the care of nurses.
With tears rolling down her cheeks, she told the Nation about the psychological distress of being separated from her son.
Countless women have undergone terrible experiences at Kenyan hospitals, including mistreatment by healthcare workers.
Ms Margaret Anyoso, for instance, was detained at Pumwani Maternity Hospital in Nairobi for some time. It was later discovered that a pair of scissors had accidentally been left inside her body during a caesarean section operation.
At private hospitals, as receipts always show, the patient foots the cost of everything, from syringes to surgeries.
Ms Nereah Ojanga, a midwife at the Kenyatta National Hospital, cited the health risks that come with preterm babies.
“Some swallow meconium, their own poisonous poop, which gets into their lungs and has to be painfully removed by a neonatologist, an expert in the medical care of newborn infants. The babies start life on a rough patch and are usually sickly for most of their life,” she said.
Aware of the dangers involved, the mother of the three-month-old baby was referred to the Nairobi Women’s Hospital, after delivering at Midhill Hospital.
The hospital bill shows that the woman needs to pay for daily incubator charges as well as nursing procedures that include bathing the baby, feeding it and changing its diapers.
She will also have to pay the paediatrician attending to her baby.
When the Nation reached the Nairobi Women’s Hospital for comment, Ms Njoki Njuguna, a manager, referred the paper to the Finance Department.
Hospitals that resort to detentions are usually met with a backlash and harsh criticism.
They lose most of the cases in court. One of them is that of Ms Veronicah Nyangai against Nairobi Hospital, where judge E.C. Mwita ordered the health institution to release her. The judge said the hospital “could have pursued other legal means to get their money”.
However, health economists wonder whether Kenyans perceive the provision of healthcare as an act of altruism, and not a specialised service that needs to be paid for and also controlled by the market forces of demand and supply, just like in any other business.
In an interview with the Nation in May this year, Dr Stephen Ochiel, the chairman of the Private Practice Committee of the Medical Practitioners and Dentists Board, said private hospitals are businesses, just like hotels.
“A cup of tea at Hilton Hotel will not cost the same as the one at your local joint,” he argued.
Dr Ochiel, a gynaecologist who has practised for over 40 years, said a hospital is only as good as the personnel and the equipment therein.
“If you go to a nursing home for some surgery, the risks are much higher than at a hospital because of the equipment, the competence of the medical personnel and the length the facility goes to make its patient comfortable,” said Dr Ochiel.
However, the most common malpractice patients have lodged with the board is overcharging by medical workers.
Dr Ochiel maintained that Kenyans make the mistake of comparing the cost of medical care in India and Kenya yet the latter imports most of its drugs and medical equipment while the Asian country manufactures the medicines.
Healthcare in Kenya has not been spared the spirit of ‘tenderpreneurship’ where brokers charge extra fees for importing drugs and equipment.
These additional costs are borne by the procuring doctor, who, in turn, passes them to the patient.
The private health sector owns and manages almost 47 per cent of Kenya’s health institutions and is also the largest employer of medical professionals in the country.
Nairobi Women’s Hospital falls under the category of private hospitals referred to as “for profit”, according to an analysis conducted by the World Bank and the Ministry of Health in 2005 and 2006.
There is no government regulation on what they can charge patients, with the medical board only issuing guidelines.
Dr Abdi Mohammed, the chairman of the Kenya Association of Private Hospitals, said patients have a right to seek recourse with the medical board, particularly on doctors’ fees if they feel exploited.
He also spoke to the Sunday Nation in May over the issue.
“Some medical procedures are complicated. Others are simple and there cannot be a standard fee per day for a medic or a procedure,” he said.
He further said it is entirely up to the hospital to decide the bed charges because some institutions make an extra effort to provide more than the basic bed.
Dr Mohammed said he had observed that many patients do not understand these transactional dynamics at hospitals and, therefore, do not make enquiries to gauge whether they will afford the care offered at the institutions they go to.
“If you seek clarification and realise that you cannot afford care at a hospital, it will most likely allow you to move your patient to a cheaper one after the patient has been stabilised and out of danger. No institution wants to be entangled in a brawl over money,” he said.
Universal healthcare coverage, where resources are pooled to provide services to all, has been touted by the World Health Organisation (WHO) as one of the solutions to this matter.
WHO director general Tedros Adhanom Ghebreyesus urged countries to strengthen their systems for providing healthcare to all.
This requires insurance, which Kenya is pursuing through the National Hospital Insurance Fund (NHIF).
NHIF’s least contribution is Sh500 every month and the maximum is Sh1,7000.
NHIF chief executive officer Geoffrey Mwangi decried the apathy among the people regarding insurance.
“People think they will never get sick, so they do not take insurance. They wait until they are in hospital and they sign up,” said Mr Mwangi.
The mother of the three-month-old baby detained at Nairobi Women’s Hospital, who describes herself as a small-scale businesswoman, did not have insurance, just like more than 40 million Kenyans.
According to the Economics Survey 2017, there were 6.1 million subscribers to NHIF, most of whom are from the formal sector.
The number is less for those under private insurance.