By Ngumbo Njoroge
Hundreds of women are detained in Kenyan hospitals for failing to pay medical fees, an advocacy group has said. Nyasha Chingore, the regional manager for the Center for Reproductive Rights said that her organization had gathered 10 year data on detention in health facilities, urging government to attend to mothers detained in those hospitals despite the introduction of free maternity services.
“There is widespread detention of maternity patients who are unable to meet the high costs of delivery,” Chingore told a forum on detention of women organized by Amnesty International. Margaret Anyoso was detained and abused twice at Pumwani Maternity Hospital while seeking delivery services during different pregnancies.
She said that during her first visit, she was supposed to be discharged five days after her Cesarean section, but was instead detained due to inability to pay her bill in full. For more than a week, she was held at the hospital until her husband was finally able to pool together money to cover her delivery expenses.
Adding to the traumatic experience, she later discovered that a pair of scissors was left in her stomach during her Cesarean section, causing her to contract sepsis in addition to other medical complications. She had to undergo a subsequent surgery in order to remove the scissors and was required to stay an additional two months at the hospital.
During a subsequent pregnancy, Anyoso says she arrived at the hospital bleeding, and although she was seen by a doctor, nurses informed her that they would not allocate a bed until other patients vacated the beds. Still bleeding, she was left sitting on a bench until her condition worsened and was rushed into surgery.
After undergoing a Cesarean section, she was again detained because she was unable to pay her bills in full. During the detention, she said nurses refused to dress her surgery wounds and would not let her go outside. After five days she was released and had to go to a private clinic for treatment for her infected surgical wounds.
In a study by the UK-based Chatham House, the country was cited as one of those in sub-Saharan Africa where illegal hospital detentions are widespread. Obstetric emergencies such as birth complications were cited as the main factor in the detention of women at hospitals after accruing huge bills.
George Morara, a commissioner with the Kenya National Human Rights Commission, said detentions were illegal and a violation of the right to health, adding that the legal framework provides the right to health, including reproductive health. Morara said discrimination of women was done on the basis of socio- economic status.
Hospitals that recourse to detentions are usually met with backlash and criticism. In the case of Ms. Veronicah Nyangai versus Nairobi Hospital, 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”.
“Detained women, like Margaret, tend to be rural or poor and although President Kenyatta issued a directive on free maternal health, the system suffers from ineffective implementation that blocks realisation of this noble program”, Chingore said.
However, Dr Andrew Mulwa, CEC Health Makueni County said 60 per cent of mothers are delivering in health facilities in the county, triple the number in 2013, attributing the rise to successful implementation of the program in the county.
He added that counties are implementing the program despite financial challenges, adding there are inadequate facilities. On detention of women unable to pay medical bills, Dr Mulwa said Makueni County does not detain patients for lack of payment of medical bills.
He said Makueni has a fund to pay for those who are unable to pay and teen mothers who can’t benefit from Linda Mama program. The government created the Linda Mama program for free maternity services under the National Health Insurance Fund. To access services, mothers are supposed to register through short messaging code.
Teenage mothers who lack civil registration cannot benefit. According to Dr. Mulwa, the program has serious challenges and needs to be overhauled. He added that Linda Mama does not reimburse counties when mothers deliver in county hospitals.
“I have a very low opinion of Linda Mama. I expected the government to give women an annual cover which would be an efficient way to move towards universal maternal health,” Mulwa said.
To address the challenges facing the program, Dr. Meshack Ndirangu, Country Director of AMREF Health Africa, said NHIF needs to get more public health facilities accredited, make it easy for women to register through working with community health workers and facilitate faster payment to counties.