Illustration by Matt Haney, GPJ
KAMPALA, UGANDA — In early June, Evat Butuguta’s sister, Margaret Bomugisha, was diagnosed with COVID-19 and admitted to Kampala Hospital, a private hospital in Uganda’s capital. As her health declined, the hospital bills grew larger and larger. She died 12 days later.
The hospital demanded a deposit of 40 million Ugandan shillings when Bomugisha was first admitted, then another 47 million shillings the night before she died, and an additional 40 million shillings before the hospital would release her body — a total of 127 million shillings (about $36,000), Butuguta says. According to the hospital, the charges were for Bomugisha’s treatment, oxygen and consultations with two specialist doctors who checked on her the night before she died.
To her family, it’s a prime example of how Uganda’s private hospitals have been overcharging patients during the coronavirus pandemic.
The country is experiencing a second wave of infections, overwhelming Uganda’s public health facilities and forcing hundreds of people to seek medical care from private hospitals, which have more space and resources. Yet the cost of treatment at private institutions is far beyond the reach of most Ugandans. The median monthly income for salaried workers in the country is 176,000 shillings ($49), according to 2017 data from the national statistics agency, the last time an official household survey was conducted.
Many patients and human rights advocates say private hospitals are taking advantage of desperate patients by charging exorbitant fees for medical care. Some hospitals have refused to release patients until they have paid. Families have been forced to offer up land and vehicle titles in order to cover the costs of medical care, they say.
“If we have a pandemic in the country, all health workers should work in interest of saving lives,” says Flavia Zalwango, programs director of research and advocacy at the nonprofit Human Rights Awareness and Promotion Forum. “By the time you ask for a land title, it means they have nothing else to offer.”
Mephi Nampa, credit controller at Kampala Hospital, says the hospital charges more to treat COVID-19 patients because the risk of infection to medical staff is high, and the hospital must source personal protective equipment and other supplies.
“There are risks associated with admitting a COVID-19 patient,” he says. “A doctor who has been charging 200,000 shillings for review will charge 500,000 shillings. The nurse will also increase charges. The cleaner or person taking food to the COVID-19 patient will end up charging more.”
Patients may be asked to make a deposit to ensure they can pay for their care, Nampa says, particularly if the cost of treatment is expected to be high, given the patient’s condition. The hospital may use the deposit to purchase medical equipment and supplies required for the patient’s care. Nampa says clients are informed of the cost of treatment upfront and are alerted to any new charges.
“Our bill is standard. Our price list is standard,” Nampa says. “We may tell a client to deposit some money if a client is not insured. We update them on the bill on a daily basis, and if there are any errors, they can be corrected when pointed out.”
But that doesn’t prevent patients from getting saddled with crushing health care costs.
Sarah Ddungu, a resident of the Kampala suburb of Bukoto, says her sister was charged 5.5 million shillings ($1,560) after she spent two days being treated for COVID-19 at the Case Medical Centre. That amount was far beyond what Ddungu and her sister could afford, so they frantically called friends and relatives to ask for help.
“We were lucky that she was healed, so we raised about 3 million shillings from family and friends and got the extra 2.5 million from a money lender,” Ddungu says.
A spokesperson for the Case Medical Centre declined to comment.
Zalwango, at the human rights nonprofit, criticizes the Ugandan government for leaving critical health care services to the private sector. “We are taking capitalism too high as a country,” she says. “Health service provision is a very essential service that the government has to provide.”
Ugandans don’t have public health insurance, and there’s no law regulating how much private hospitals can charge patients.
To address these issues, the Ugandan Parliament recently passed a national health insurance bill that would limit the amount Ugandans are charged for medical treatment at both public and private facilities. Individuals in formal employment would contribute 4% of their salaries toward health insurance, while employers would contribute 1% of employee salaries. Those working in the informal sector would be able to pay an annual fee of 100,000 shillings ($28) to opt in to the health insurance system. The president has not yet signed the bill into law.
The Center for Health, Human Rights and Development, a nonprofit that advocates for the health rights of vulnerable communities, recently sued the Ugandan government for failing to protect Ugandans from the excessive fees for COVID-19 treatment charged by private hospitals. In July, the High Court ordered the government and the Uganda Medical and Dental Practitioners Council to craft regulations limiting how much private hospitals can charge for coronavirus treatment.
The court didn’t specify a timeline for drafting or implementing these regulations.
Emmanuel Ainebyoona, senior public relations officer at the Ministry of Health, says the government is investigating the issue of private hospitals overcharging patients and is working with health care providers to determine what fees are reasonable. Health Minister Jane Ruth Aceng announced in July that the government also is exploring the possibility of providing free oxygen to private facilities, to help reduce the cost of treatment.
For now, though, patients are left to fend for themselves.
After Butuguta received the final bill for his sister’s treatment, his family couldn’t imagine how they would pay the full amount. But they managed to scrape together enough to cover the bill, so that the hospital would release Bomugisha’s body for burial.
“We consulted a lawyer, a specialist doctor and banker to negotiate with the hospital, and the bill was reduced to 60 million shillings,” Butuguta says.
Combined with their initial deposit of 40 million shillings, the final bill paid was 100 million shillings (about $28,000).
Apophia Agiresaasi is a Global Press Journal reporter based in Kampala, Uganda. She specializes in reporting on health and politics.