Bribes order of the day at many hospitals

A research undertaken by the Zimbabwe Lawyers for Human Rights on Access to Treatment and Corruption showed that corrupt activities were rife within medical facilities throughout the provinces.

Bribes, incidence, frequency and size

Seventy-three percent (73%) interviewed in the research reported that they had experienced encounters with health personnel where bribes were requested. Usually, the requests were explicit.

Waiting lists at the different hospitals for enrolment are very long, and they drive desperate patients to pay something to access a service, noted the report.

Bribes for enrolment at an identified hospital in Bulawayo can be as high as 700 Rands as reported by one respondent.

Those who pay for enrolment will also have to contend with other bribes in accessing the drugs in future instances of artificial shortages and drug stock-outs. In these circumstances, respondents informed that patients are often told there are no drugs to be dispensed but nurse so and so may be able to assist them if they pay something.

These drugs are often dispensed through nurse aides or other support staff such as security guards. These transactions usually take place in closed offices or in the public toilets of hospitals. In extreme circumstances, patients have to source drugs from private residences of health personnel staff.

Patients were paying bribes ranging between US$1 and US$ 50. It was observed that diagnostic services and enrolment demanded he biggest bribes, usually above USD10.This is because people living with HIV were usually aware of the inhibiting costs of the alternatives in the private sector.

Those who declined to pay bribes may have done so as a matter of principle or because they did not have money on that particular day. This means that those who cant afford to pay are left to die at home with no alternative.

In most cases patients queued from 6 am for drugs but the hospitals started to serve at 11.00 am.

By this time, they will be hungry and eager to go home. For them to jump the queue or to be served, they will have to pay a bribe, the report noted.

Dispensing drugs to ghost patients or defaulting patients is suspected to be breeding black market for drugs. These markets thrive because most people who are HIV positive live in fear of stigma and discrimination. As a result, they get backdoor prescriptions, and drugs are dispensed by unqualified people who act on behalf of the hospital personnel.

Drugs dispensed in these instances are fake or have expired, and may be unrelated to the treatment sought. This may also lead to a situation where adherence is compromised and people develop drug resistance.

It is difficult to ascertain whether fees paid by patients are actually deposited and accounted for at the provincial and national level because sometimes patients are asked to pay whatever they have at that time and settle the balance later.

In some cases, if a patient insists that they have no money, they are asked to bring the money later. Receipts are not always issued.

People living with HIV are asked to pay money for services that are supposed to be free for example enrolment on a government programme, but most people in urgent need of treatment are forced to pay a fee to hospital personnel.

Causes

The survey noted that this was among other things due to socio-economic circumstances such as lack of public accountability mechanisms, the vulnerability of people requiring urgent treatment and because the management structures in public hospitals provided the latitude and opportunities for engagement in corrupt activities with impunity.

The cases were going unreported for fear of victimisation or being denied access to treatment and medication.

Corruption devalues investment in health, is responsible for the perpetual collapse of health infrastructure and decreases the uptake of health services and goods by the poor, thereby facilitating underdevelopment.