Medical detention of patients

December 10, 2017

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In parts of Africa and Asia, patients who cannot pay their medical bills are detained and abused by healthcare staff, a new research paper from Chatham House in the UK states. The report lists evidence of “medical detention” of patients, particularly women and babies, in countries  like Nigeria, Kenya, Ghana,  Zimbabwe, Liberia, Uganda, Cameroon and the Democratic Republic of Congo.

Some examples highlighted in the paper:

  • Patients at Kenyatta National Hospital in Nairobi, Kenya, claimed in 2015 that they had been pressured into having sex with hospital staff in exchange for cash to help pay their bills.
  • Two women said baby-trafficking had been taking place at Kenya’s public Pumwani Maternity Hospital, with nurses offering single mothers money in exchange for their babies.
  • In South Africa, the detention of undocumented foreign women from Zimbabwe and elsewhere has been reported, despite the fact that South African law protects their right to free maternity services in state-owned facilities.

Summary

  • In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills.
  • Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way.
  • The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year, in several sub-Saharan African countries and parts of Asia. Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities.
  • Victims of medical detention tend to be the poorest members of society who have been admitted to hospital for emergency treatment, and detention can push them and their families further into poverty. They may also be subject to verbal and/or physical abuse while being detained in health facilities.
  • The practice of detaining people in hospital for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care.
  • At the root of this problem are the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients.
  • Universal health coverage (UHC) cannot be achieved while people are experiencing financial hardship through their inability to pay for healthcare, so by definition any country that allows medical detention is failing to achieve UHC.
  • Health financing systems should be reformed by moving towards publicly financed UHC, based on compulsory progressive pre-payment mechanisms. This would enable hospitals to become financially sustainable without the need to charge significant user fees.

Access the report Hospital Detentions for Non-payment of Fees: A Denial of Rights and Dignity. Robert Yates, Tom Brookes & Eloise Whitaker. Chatham House/Centre on Global Health Security, December 2017

Source of the examples: Report: From Cameroon to Kenya, hospitals violate patient rights over bills. Laureen Fagan, Africa Times, 10 December 2017