Poor patients attending a busy public hospital in Nairobi have told of discrimination if not being treated for diseases covered by donors.
For example, 50-year-old Grace of Kibera with multiple diseases gets first class free care for HIV at Mbagathi District Hospital, Nairobi.
However, at the same facility she gets substandard or no treatment at all if she cannot pay for her diabetes, high blood pressure and heart condition.
“I can’t always afford the treatment for diabetes, blood pressure or heart condition so I only go for the free HIV care and place the rest in God’s hands,” says Grace.
Grace says she feels like two people; one well treated at the highly resourced HIV clinic at Mbagathi while discriminated at the shabby and unfriendly diabetes unit of the same hospital.
This kind of ‘medical discrimination,’ researchers say is an increasing problem in Kenya’s public hospitals. Some poor patients may only be turning up for donor supported illnesses but going untreated for other conditions.
A study in the Medical Anthropology Quarterly by among others the Kenya Medical Research Institute suggests the prioritization of HIV by donors has distorted provision of health care in the country.
“The priorities of donor agencies that emphasize HIV care over other disease in Kenya has created sub-citizens—people who are essentially denied citizenship rights because of their disease,” says he study.
Led by Edna Bosire and Emily Mendenhall of the University of the Witwatersrand, South Africa and Georgetown University, US, respectively it says the discrimination is evident in public facilities.
The study involving100 patients at Mbagathi hospital tell of how well organized and clean the HIV clinic is. “It has enough space for patients to comfortably seat, and adequate supplies and friendly staff.”
In contrast, patients, including Grace, observed that TB and diabetes clinics were situated in an old, small building with rude and overworked health workers and no drugs.
“I have seen patients with diabetes getting infected with TB in this hospital due to mixing of patients and sharing of common waiting rooms,” said a health care provider at the diabetes clinic.
The patients said while at the HIV clinic health workers are helpful and friendly at the diabetes clinic they are rude and always almost hurried.
Similar findings, the study says have been reported from elsewhere in Kenya with better buildings and more resources reserved for HIV at the expense of other disease and patients.
The bigger problem they say, even those on National Hospital Insurance Fund (NHIF) are sent to buy diabetic drugs they can hardly afford at private pharmacies.
More than three quarters of people with diabetes reported that the cost of medication was unaffordable.
In addition, the report says due to frequent stock outs of diabetic drugs at the public hospitals, patients were forced to buy costly drugs from chemists or private hospitals with most skipping treatment.
“I was asked to go to the lab for blood tests and X-ray scans but due to lack of money, I have not done anything and this is stressful,” said a 66-year old woman at Mbagathi.
Patients said they can’t understand how the same government will bring free HIV testing and treatment to their homes but not be treated for high blood pressure even when they take themselves to the hospital.
A senior official at Mbagathi, said such discrimination is an unfortunate outcome of a government policy which is affecting the whole health public sector.
“The answer would be for donors to help strengthen the whole health systems and not individual diseases, but then donors have their own priorities,” said the official.
Uncharacteristic for Kemri, the study largely blames the Global Fund and the US President’s Emergency Plan for AIDS Relief (PEPFAR) the main donors to HIV for this turn of events.
But this is not the first time government agencies are blaming the donor rich HIV, malaria and tuberculosis for the distortion of the disease map in Kenya.
Last year the Ministry of Health published a national survey on the diagnostic capacity of Kenyan laboratories which had malaria, TB and HIV with highest detection rates.
But the study, involving the National Public Health Laboratory said the data was misleading because the three were not the leading cause of illness in most of the participating hospitals.
This, the study said came about because through donors, laboratories have been given extensive capacity for testing the three diseases but which lacked for other illnesses.
By Gatonye Gathura