Shock as medical registration fees up by 600pc

Patients here will now pay six times more in charges at mid-level public hospitals as the authorities move to decongest Muhimbili National Hospital, which serves more than 1,000 people every day.

Mwananyamala hospital, in Kinondoni district, has hiked the registration fee from Sh1,000 to Sh6,000 for out-patients beginning December 1.

The Citizen on Sunday has learnt that Temeke and Amana hospitals will also announce new fees soon as the government seeks to turn them into regional referral hospitals. The move has caught many city dwellers unawares and concerns have been raised over the state of affairs at health centres and dispensaries, which face acute shortage of medicine and personnel.

Many of the over four million city residents who are poor will struggle to raise the new fees at the designated referral facilities. They are expected to throng the lower facilities that still maintain their registration fees at Sh1,000.

In a spot check at Mwananyamala, The Citizen on Sunday met patients protesting the rise in the fees. They lamented that the new charge was way too much for a government hospital. A notice pinned at the hospital announced the new fees and change in status. Patients with referral letters from public health centres will pay Sh3,000 in registration fees.

Those without such documents will pay double the amount, according to the notice. On Wednesday, brothers Mohammed and Abdalah Mwinjuma from Makumbusho left without treatment when confronted with the changes. They claimed they had neither the information nor the money demanded. The brothers have over the years relied on Mwananyamala as it is the health centre nearest to their home. “My brother (Abdalah) is ill and I have brought him straight here,” said Mohammed as they walked out. “Now I am told I have to pay Sh6,000 because we don’t have a referral letter. We have not been attended to.”

Lucy Charles had a referral, though, and had been cleared to see a doctor after paying Sh3,000. But she still complained that the amount was too much: “We used to pay Sh1,000, which is affordable for the common mwananchi like me, but what is the difference with the private hospitals? We don’t see any improvement in services, just the pricing.”

But an official at Mwananyamala defended the new fees, saying they were within the official cost-sharing policy. Mr Edwin Bisakala, the Health Secretary, said the earlier payment of Sh1,000 was only for registration while the current amount covers a medical card, consultations and initials lab tests. “Formerly, the patients were either bringing an exercise book that we used to keep their medical records but the new A4 card remains in the patient’s file at the hospital and the patient is given a card number for reference. On top of that, the patient will get consultation and some initial tests.”

He added: “We are just implementing the national cost-sharing policy that says we should raise the fees by 50 per cent if the cost of operation has risen.  Secondly, it is now a regional referral hospital requiring that the people make use of the health centres in their wards.”

The new charge is expected to help raise internal hospital revenue so that even when the national medical subsidy is delayed or insufficient, they can still maintain required operational levels without disrupting services. “The hospital therapeutic committee proposed the new price and sent the proposal to the hospital board which is the representative of the citizens, who approved it,” he said.

The new charge at Mwananyamala hospital and impending ones at Temeke and Amana means that ward public dispensaries will now receive more patients. But inquiries at the health centres and dispensaries indicate that the current situation in terms of medical supplies and staffing will likely remain the same.

A tour of several of these health centres and dispensaries established that little has changed and staff have not been made aware of their new role. Sources at Makuburi dispensary, who spoke on condition of anonymity, said they were taken by surprise at the sudden surge in patients. The source added: “We were taken aback at first as Mwananyamala did not involve or inform us of the consequences of their move. We now attend to about 200 patients, up from an average of 100 every day.”  An officer at Sinza health centre said they did not know if help would come, and in what form, if they were to handle the new challenges. “We were not informed of the changes but the patients have increased. We have not been given additional funding or more staff and medicine. “

At Makuburi, the facility has only two doctors while the third is on leave. “The government or the administration of Mwananyamala hospital should have first considered the situation in these centres because now we will have a big burden using the same inadequate resources,” said one worker.  Ministry of health officials were unavailable for comment.