Extortion hindering expectant mothers’ rights in government facilities

When Margaret Najjingo felt the labour pains of her fifth child, she walked to Mukono General Hospital, a government health facility, to give birth. The doctor on duty recommended a scan. 

According to him, the results showed that Najjingo’s uterus was blocked and she could not have a virginal birth.
She was scheduled to have a caesarean section delivery. There was only one glitch, though. She did not have enough money on her.

“I had Shs150,000 on me but the doctor I interacted with demanded for Shs400,000. I pleaded with him to perform the c-section while a friend rushed home to try and mobilize more money. He refused,” she says.

Najjingo sat on the verandah of the facility, hoping for a miracle. No health worker attended to her that day. When she phoned her husband the next morning to inform him of her predicament, he informed her that he had failed to get the balance of the money needed.

“He told me he planned to go and make an announcement on the community radio, urging people to contribute to the bill. By evening, he had not yet raised the Shs350,000. I lost hope. I thought I was going to die,” Najjingo adds.
She is a resident of Ntawo village in Mukono Municipality. It was only latein the night of the second day that her
husband came to the hospital with the entire amount and paid the doctor.
“Since the doctor had other mothers waiting for c-sections that night, he wrote down my name on a list. I had to wait for him to first work on them before I was operated on,”she says.
Her husband, Joseph Kasirye, had to acquire a loan in order to afford his wife’s hospital bill.

“My wife used to attend the antenatal clinic in that hospital but we were not informed of any complications she might have developed. I was shocked when the doctor told me if I wanted to save my wife’s life, I had to stop joking around and find the money quickly,” he recalls.

After paying the money, Kasirye says the doctor wrote down a list of requirements his wife would need during the operation.
“I bought everything in the facility’s pharmacy. It was only then that the doctor took my wife to the theatre. After the c-section was performed, I was called to pick my patient from the theatre. I did not know how to handle her. I had just seen a woman falling off the operating table because her caretaker did not know how to handle her. The doctor directed me to push her bed to the private wing,” he laments.

Kasirye and his wife had not budgeted on delivering their child in the private wing of the hospital. He was told to pay Shs70,000 per day for three days. He ended up spending Shs900,000 on the delivery.
“I spent most of it on food and medicine that I was instructed to buy. Luckily, my boss, who had loaned me the money, said I would work for it during the course of the coming months,” he says.

Amos Ssekibunga, a resident of Ntawo village, is in charge of mobilising funds for the expectant mothers who cannot afford their hospital bills. He says, so far, fundraising campaigns have been held for ten mothers.

“This initiative was started five years ago because the conditions in our government facilities are not favourable,
especially for the poor. Caretakers approach us after medical officials refuse to operate on their patients, demanding money for services that are meant to be provided free-of-charge,”he says.

Ssekibunga uses a loudspeaker as he walks around the village, soliciting for support from the residents. Villagers contribute as little as Shs500 or Shs1,000.
“Usually, the doctors charge between Shs300,000 to Shs500,000. Some caretakers approach us when they do not have a single coin, while others already have some money and are only seeking a top-up. There are times when we fail to raise money in time and the patients will never be worked on until the whole amount is handed to the doctor,” he adds.

Ssekibunga adds that five years ago, the story was different. The village would contribute money for mothers who had been detained at the hospital after they had been attended to.
“They would detain them until we completed the fee for surgery. These days, though, things have changed. They cannot touch you unless you pay the full amount,” he says.

Hospital response

Najjingo’s experience is not isolated. Anita Mutesi, a resident of Nkokonjeru village in the same district, recalls the day when she went to deliver her baby at Mukono General Hospital and was
told the baby was too big.
“Previously, I had had two normal deliveries, but now I was told I needed a c-section delivery. I was asked to pay Shs350,000 and buy the items to be used during the surgery. As I stood in line, waiting to enter the theatre, I gave birth - alone - with no midwife attending to me,” she says.
Mutesi says part of the money she had spent was refunded. Other mothers say they were referred to other hospitals after they failed to pay the money for a c-section.

“A health worker here will never attend to an expectant mother without payment. Instead, those who cannot pay are referred to Mulago Hospital. Women who have normal deliveries pay Shs100,000 before being attended to. However, there is no standard fee for those who have been recommended for surgery. One is charged according to her appearance,” says Caroline Nabukenya, a former client of the hospital.

However, Dr. Kenneth Kigonya, a gynaecologist at the facility, says all services are free to all, except for those in the private wing who pay a ‘modest fee.’
“This issue has been raised a number of times but it can be attributed to a drug stockout. When this is the case, we request patients to buy medicine. Unfortunately, they consider this to be extortion. We already have mechanisms in place to ensure that patients do not pay for any services,” he explains.

On referring poor patients to other health facilities, Dr Kigonya says this is done due to lack of space and resources at the facility, but not because of the narrowness of the patient’s pockets.

“We receive expectant mothers from Wakiso, Kayunga, and Buikwe districts. On average, the facility registers 8,000 deliveries per month and 30 babies are delivered per day. At least ten mothers deliver by c-section every day. Our staffing levels are inadequate to cater to the demands of these overwhelming numbers,” he adds.

What government is doing

In March 2023, the Inspector General of Government, IGG Beti Kamya Turwomwe ordered an investigation into allegations of extortion at Mukono General Hospital. Sheila Apolot, who heads the IGG’s Mukono Regional Office, handled the matter. However, patients still complain to-date.

“That issue was handled administratively and the doctor who had been extorting money from patients agreed to refund whoever had complained. There is a need to permanently remove such doctors from the system. If extortion is still going on, then we need to do a follow-up investigation,” she says.

Labila Sumayah Musoke, a health rights activist and lawyer, and a programme officer at Initiative for Social and Economic Rights (ISER), says every patient has a right to medical care and denying them access to health services is denying them their right.
“It is also unethical. When patients' rights are disrespected, they tend to suffer from psychological and emotional torture. The government should invest in its hospitals by improving staffing levels and ensuring that there are no drug stock outs,”she says.

Musoke adds that the service delivery gaps in government facilities have led to private facilities hiking the cost of their services, and this has led to the phenomenon of patient detention.
Henry Mulindwa, the Mukono district health officer, and the chief administrative officer of the district, refused to be interviewed for this article.

PROBE
March 2023, the Inspector General of Government, IGG Betti Kamya Turwomwe ordered an investigation into allegations of extortion at Mukono General Hospital.
Sheila Apolot, who heads the IGG’s Mukono Regional Office, handled the matter. However, patients still complain to date.
“That issue was handled administra tively and the doctor who had been extorting money from patients agreed to refund whoever had complained. There is a need to permanently remove such doctors from the system. If extortion is still going on, then we need to do a follow-up investigation,” she says.