Little accountability
Hospital detentions, some experts argue, can be traced to policies pushed decades ago by the World Bank, the World Health Organization, UNICEF and others who made loans to developing countries on condition that they charge patients for medical services. Without explicit protections in place to protect the poor, they say, the policies gave countries the freedom to extract health care payments however they saw fit — including detaining patients.
The practice appears to be most prevalent in countries with fragile, underfunded health systems where there is little government accountability. But the problem also surfaced in wealthier countries, with patients being detained in hospitals in countries including India, Thailand and China.
In many countries when patients cannot afford to pay for health care, they are usually sent to a public hospital, where treatment is covered by the state, or refused help altogether. In some hospitals in Cameroon and elsewhere, for example, the problem of patient imprisonment was solved by some institutions by simply demanding payment upfront.
Where patients are imprisoned, hospitals acknowledge it is not necessarily profitable. But many say it often leads at least to partial payment and serves as a deterrent.
Unlike many hospitals in developed countries, African hospitals don’t always provide food, clothing or bedding for patients, so holding onto them does not necessarily incur a significant cost. Detained patients typically rely on relatives to bring food while those without obliging family members resort to begging for help.
Dr. Festus Njuguna, a pediatric oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 185 miles northwest of Nairobi, said the institution regularly holds children with cancer who have finished their treatment, but whose parents cannot pay. The children are typically left on the wards for weeks and months at a time, long after treatment has ended.
“It’s not a very good feeling for the doctors and nurses who have treated