Health

How Sh50 clinic fee threatens to cripple Aids treatment at one of Kenya’s leading hospitals

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Introduction of the charge at Kisumu’s Jaramogi Oginga Odinga Teaching and Referral Hospital has seen the number of patients seeking ARV drugs dwindle. GRAPHIC | CHRISPUS BARGORETT

A few months ago patients living with HIV/Aids would be seen queuing at the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu every Thursday morning awaiting to collect antiretroviral (ARV) drugs.

But now only a handful stroll in, and they do not have to wake up early — there is no queue to beat. What changed is that the clinic introduced a Sh50 fee per patient before they are given ‘‘free’’ ARV drugs.

When Jane Atieno, a mother living with HIV/Aids, went to pick her ARVs from the hospital one Thursday last year, she was told to pay Sh50.

“We were told to either pay or miss the drugs,” she said.

Ms Atieno and her four-year-old son had been collecting free ARVs from the hospital for years. The mother of two said that at times she goes without food due to lack of money and raising Sh100 every month, plus fare, to go pick the dose is a tall order.

“I struggle to fend for my two children, why is it that I have to do the same to get drugs that are given free in other hospitals?” she asked.

Ms Atieno is not alone. Some patients complained that nurses at the hospital produce their medical files only after payment has been made. However, the patients are not given receipts.

Elizabeth Akinyi, a young breast-feeding mother living with HIV, said that since the introduction of the charge she has not been taking her ARVs regularly.

“I know it’s dangerous to default once you have started treatment, but what do I do if I don’t have the money?”

Her biggest worry is her breast-feeding son. The use of antiretroviral therapy (ART) by pregnant and breast-feeding women markedly reduces the transmission of HIV from mother to child.

“I know I am putting my son at risk of getting the disease, but what can I do?” After failing to collect drugs for some months, Ms Akinyi went back with Sh50 and was detained in a corner.

“There is a corner nicknamed Ocampo where patients who fail to go for medicine are detained for hours despite the fact that they do not have money to consistently pay for the drugs,” she said.

Kenya has made great strides in enhancing patients’ access to ARVs, especially in public health institutions where the medicines are available for free.

The country has made huge investments in response to HIV, which have seen the infection rate drop by half in a decade and ART scaled up to 800,000 patients. The government plans to put 600,000 more patients on ARVs, especially children and teenagers.

Virus transmission

Kenya has 1.6 million people living with HIV. Following the World Health Organisation’s October guidelines, which expanded the use of ARVs after research showed that early use of the drugs keeps patients healthier and reduces the risk of virus transmission, more Kenyans are expected to be put on the drugs.

Despite the progress made, HIV continues to account for the highest mortality rate in the country, burdening households and straining health facilities.

The country, with the support of donors, has injected billions of shillings in the campaign to reduce Aids deaths and new infections.

Only last month, Kenya received Sh21.9 billion funding from donors with President Uhuru Kenyatta pledging Sh2.6 billion this financial year towards fighting tuberculosis, malaria and HIV/Aids. The money will also support programmes that help prevent mother-to-child transmission of HIV, expanding coverage from 66 per cent to 90 per cent of patients.

Manageable disorder

According to the Health ministry, the use of ARVs has transformed HIV from a debilitating and fatal disease to a manageable disorder.

Since 2006 when the government started supplying free ARVs, deaths from Aids have been reduced remarkably while those affected remain productive. Sustained provision of the drugs has also seen cases of opportunistic infections among patients decrease and reduced hospitalisation.

The Health ministry said the number of HIV patients suffering from diseases like tuberculosis, candidiasis, pneumonia and herpes simplex, among others, have dropped drastically due to sustained use of ARV drugs.

Regina Ombam, head of strategy development at the National Aids Control Council, said Kenya had made great gains in the fight against HIV/Aids, adding that charges on drugs would hold back the progress made.

“Kisumu is one of the counties with the highest HIV prevalence and new infections, leaders should look for ways of enticing the sick to take drugs rather than pushing them away,” she said.

According to the National HIV and Aids Estimates Report 2014; Homa Bay, Siaya, Kisumu, Migori and Kisii have the highest prevalence rate of between 10 and 28 per cent. The Kenya Aids Strategic Framework of 2014-2018 shows that Homa Bay has 159,970 people living with HIV and 15,003 are infected with the virus every year.

In Kisumu, 134,826 people live with HIV/Aids with 12,645 new infections every year.

Ms Ombam said that the high rate of ‘‘drug defaulters’’ would lead to more opportunistic infections.

“ARV treatment should be taken for life, paying money before picking drugs is a worrying trend,” she said.

Failure to take drugs is a serious affair. It leads to patients being placed on more expensive medicine than normal ARVs.

“I get disturbed when so many people default on ARV treatment, it means that the country will look for another alternative treatment which will be costly,” said Ms Ombam, adding that once patients default the virus reproduces and develops resistance hence increasing new infections and the cost of treatment.

Charles Otieno whose partner is HIV negative is a worried man.

“Once my viral load goes down it is very easy to infect my partner, I do not have the money to pick my drugs. I need financial support,” he said.

His problem is made worse by the fact that Kenya Medical Research Institute (Kemri) staff is on strike over salary arrears.

“The HIV viral load can only be monitored at Kemri, but since staff downed their tools in September nothing has been going on,’’ said Erick Ondieki, the chairman of the Kenya Union of Clinical Officers, Kisumu Chapter.

Maurine Oora, a Kisumu community health worker, said that some of her patients had stopped collecting drugs from the hospital because they cannot afford the Sh50 fee.

“At times I am forced to give them money for the drugs, but I cannot afford to give everyone. Can someone who has gone for days without food afford to pay for drugs regularly?” she asked. She urged the hospital’s management to waiver the charge to ensure that all Aids patients access drugs.

The National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak) plans to petition the Kisumu county government to do away with the fee.

“We are collecting signatures to show the importance of the matter,” said Nelson Otwoma, the Nephak national coordinator.

He said that detaining patients who fail to collect their drugs is demeaning.

Transporting drugs

However, Dr Ojwang Lusi, the Kisumu chief officer of health, said he was not aware of the Sh50 fee.

Juliana Otieno, the hospital CEO, said she would comment on the issue after consultations with the county director of health.

An official at the hospital, who sought anonymity for fear of losing his job, said the Sh50 fee covers the cost of transporting drugs from the warehouse to the hospital.

Elizabeth Ogaja, the county executive in charge of health, said the fee was unwarranted.

She said that some hospitals in the county are, however, allowed to charge patients for hospital cards. Ms Ogaja said the county had received funds to cater for expenses incurred by hospitals.

“We are following the government’s policy of distributing free ARV drugs. The fee could be for hospital card charges for first time patients, but I have to check out the details,” she said.

Nicholas Muraguri, the Director of Medical Services, said that demanding money from patients before providing them with ARVs is against government policy.

Dr Muraguri said the fee would stop patients from visiting hospitals and lead to resistance hence reversing the country’s efforts to fight HIV/Aids.

“If Kisumu is charging for ARVs then they are doing it against government policy. Over 850,000 Kenyans are on ARVs and inflicting charges on the free drugs will cause huge barriers and default in treatment,” he said.

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Additional reporting by Stellar Murumba