Covid treatment: Hospitals defend Shs5m per day bill

Health workers attend to a Covid-19  patient in  the intensive care unit at Mulago Hospital in Kampala recently. Several variants of the viral disease have been confirmed by WHO following its outbreak in 2019. PHOTO/ PROMISE TWINAMUKYE

What you need to know:

  • Many families of Covid-19 patients end up in private facilities after failing to get admission in public health facilities due to lack of space.  
  • However, charges for Covid-19 treatment range from Shs2 million to Shs5 million which is largely unbearable to many Ugandans, given the per capita income of $777 (Shs2.7m).

Private health facilities in Kampala have defended the high charges for Covid-19 treatment, attributing the amounts to increasing costs of medicines, payment of specialists and purchasing oxygen, among others. 
This follows complaints by members of the public over  “exorbitant daily charges” to treat a critically ill patient which go as high as Shs5 million.

Many families of Covid-19 patients end up in private facilities after failing to get admission in public health facilities due to lack of space.  
However, charges for Covid-19 treatment range from Shs2 million to Shs5 million which is largely unbearable to many Ugandans, given the per capita income of $777 (Shs2.7m).

Dr Edrin Jjuuko, the head of medical services at UMC Victoria Hospital, said their charges are reasonable. 
He added that many manufacturers have increased the prices of essential drugs that are used in the Intensive Care Unit (ICU) to treat Covid-19 and other conditions but did not specify the medicines.

 “Charges for ICU care are high because of the increase in prices of medicines and other supplies used. Expenses on care providers such as nurses and doctors have also gone up. There are lots of risk allowances that are paid,” he said in an interview with Daily Monitor yesterday.

He added: “When a critically ill Covid-19 patient is admitted to ICU, there are many medicines that are used because of different conditions they present with. Some of them have complications like kidney failure and or need plasma forensic which can increase the charges to about Shs7 million a day.” 

He added that each patient is allocated two nurses. The nurses work in a 12-hour shift and they are paid Shs100,000 each. 
He added that before the pandemic, a nurse was paid Shs50,000 to work in the ICU.

Dr Jjuuko said a doctors in their ICU work for about four hours. 
The hospital was reportedly demanding Shs10 million to be paid upfront to get admission in their Covid-19 ICU and that their daily charges were at Shs5 million.

However, Dr Jjuuko said the charges for managing a Covid-19 patient at the hospital varies from Shs500,000 per day to Shs3.5 million, but admitted that the charges are high. 
Apart from Covid-19, many patients with common conditions that require critical care include heart problems, kidney failure, brain trauma, serious injuries, blood infections (sepsis) are treated in ICU.
Dr Jjuuko said there are more than 40 Covid patients admitted at the hospital currently. 

The country has a total of 1,099 Covid-19 patients admitted in hospitals across the country, according to Ministry of Health statistics.
Dr Samuel Opio, the secretary of Pharmaceutical Society of Uganda, said a one-week dose of Covid-19 medicine (Remdesivir) costs around Shs2.5 million. This is Shs357,000 per day for the medicine which is imported. 
The Uganda Medical Association president, Dr Richard Idro, confirmed that doctors working in the ICU private facilities are paid around Shs150,000. 

This means the hospital spends around Shs900,000 for the six doctors they need to provide 24-hour care. 
Ms Grace Ssali Kiwanuka, the executive director of the Uganda Healthcare Federation (UHF), said each Covid-9 patient is provided one nurse to care for them.  

“Hospitals are paying Shs400,000 to obtain 10 [big] cylinders of oxygen that a Covid-19 patient needs for life support on daily basis, excluding the transport charges,” Ms Kiwanuka said.

The cost of refilling the big cylinders ranges from Shs35,000 to Shs40,000. A critically ill Covid-19 patient needs about 70 litres of oxygen per minute, according to Dr Byarugaba Baterana, the Mulago Hospital director. 
This reporter couldn’t determine how many litres of oxygen are in a cylinder.
Ms Kiwanuka said private sector is simply stepping in to bridge the gaps in patient care, especially limited capacity of public hospitals.

“The government should come to cushion private hospitals from the high costs they are meeting so that they are not transferred to patients. The government can provide PPEs or support the patients in clearing the bills instead of lamenting that the private sector is conning people,” she said. 
“The government should be talking about giving Shs20 million to support private facilities for treating Covid-19 patient,” she said.
The government spends around Shs22m to treat a Covid-19 patient in a public facility. 

What others say

Dennis Bwanika, public relations officer Mengo Hospital
‘‘Mengo Hospital is  missionary founded, private not for profit and our rates are affordable. You cannot compare our prices to those of private hospitals where patients cannot pay the bill at once, we engage the family for them to give us their payment plan.’’

Dr Peter Katumba, Norvik Hospital
 ‘‘We met Ministry of Health and the Uganda Healthcare Federation on Saturday from 11am to 2pm. We also met Dr Charles Olaro [the director of Clinical Services at the Ministry of Health] about the same issue. They have the information you are looking for so they are the best institutions to give you the information you are looking for.’’

Jaliira, Receptionist Case Hospital
‘‘The best people to give you that information are the medical director and the head of finance but they are not in office.’’

Dr Richard Lukandwa, Medical director Medipal International Hospital
Before you start writing your story about the cost of treating a Ugandan in an Intensive Care Unit (ICU) bed, compare how much it is to treat a person in an ICU bed in USA and United Kingdom. Uganda is a poor country, your hospitals lack oxygen right now I have two doctors struggling for their lives in the ICU due to lack of oxygen. When you find out, you come back and we shall give you information.’’

Peter Mulindwa, PRO IHK
‘‘I am not in position to tell you how much it costs because I need to look at all the details of an ICU bed.’’

Grace Kiwanuka, executive director of Uganda Healthcare Federation
‘‘Yesterday, we met the private healthcare providers and they said treating a Covid-19 patient takes 10 to 20 days. Each day a patient requires 10 cylinders of oxygen which costs Shs400,000 a day. You need 10 sets of Personal Protective Equipment (PPEs) for the doctors a day which costs Shs750,000 each. There are also allowances for the health workers and costs for medicine required.’’

Additional reporting by Stephen Otage