PHA-Exchange> Burundi: Hospital Officials Detain Hundreds of Insolvent Patients

[Claudio]

From: "Kevin Burns" <kdburns at gmail.com>
The full report is at www.hrw.org.

I have just spent two months in Burundi, and very glad to see this
report come out. It is one of the only and most comprehensive
documentation of this type of human rights violation, even though
anecdotally I have heard many people mention similar situations
occurring in different parts of the world.

The role of the world bank/imf/donors comes through in this report. My
thoughts are that the situation is primarily the outcome of cost
recovery/cost effective/efficiency schemes applied to one of the poorest
countries- while it is working to recover from 13 years of civil war,
and a longer history of ethic violence.

The report mentions the implementation of a cost recovery system in 2002
(p.5).

"According to the chef de cabinet, the responsibility for the
non-payment lay not with her Ministry, but with the Crédit de Relance
Economique, a World Bank- financed fund for reconstruction activities"
(p. 48)

Kevin Burns
www.amsa.org/global

*Burundi**: Hospital Officials Detain Hundreds of Insolvent Patients
*
(Bujumbura, September 7, 2006) – Burundian state hospitals routinely
detain patients who are unable to pay their hospital bills, Human Rights
Watch and the Burundian Association for the Protection of Human Rights
and Detained Persons said in a new report released today. The patients
can be detained for weeks or even months in abysmal conditions.

This practice highlights broader problems of the health system in
Burundi, where patients have to pay for their own treatment, the two
organizations said. Both organizations called on the Burundian
government to end the detentions and to make access to health care for
all Burundians a central part of its new Poverty Reduction Strategy Paper.

“Detaining poor patients because they can’t pay a bill punishes the poor
and violates international human rights law,” said Juliane Kippenberg,
NGO Liaison of the Africa division of Human Rights Watch. “It’s an abuse
that the Burundian authorities must end.”

The 75-page report, “A High Price To Pay: The Detention of Poor Patients
in Hospitals,” documents how Burundian hospitals in 2005 detained
hundreds of indigent patients, sometimes in inhumane conditions. Many of
those detained were women giving birth who unexpectedly needed caesarian
deliveries. In some cases, hospital authorities refused further medical
care to those who could not pay their bills and forced them to vacate
their beds for wealthier incoming patients.

Patients who could not pay their bills were kept under guard and
prohibited from leaving the hospital grounds, often for weeks or months,
but in one case for more than a year. Some detainees sold their farm
animals or land to settle accounts in order to leave hospitals. Others
escaped or were rescued by benefactors who paid their bills. Burundi’s
government continues to detain indigent patients and hundreds are
currently in detention in the country’s state hospitals.

In Burundi, one of the world’s poorest nations, patients commonly have
little money to pay medical expenses. The most vulnerable are supposed
to have part of their medical expenses paid by the government, but the
system of assistance does not work in practice. Moreover, the Burundian
health sector is plagued by massive funding shortfalls and by fraud and
corruption.

“With authorities working on poverty-reduction strategies, it is clearly
past time for them to address the basic right of all Burundians to
health care,” said Jean-Baptiste Sahokwasama of APRODH.

On May 1, 2006, the government took a positive step of ordering that
maternal and child health care be provided free of charge. Hospitals
have since allowed mothers and small children to leave hospitals without
paying their bills. However, the measure was ill-prepared for and
resulted in an influx of pregnant women and sick children, severely
straining hospital resources. The measure did not provide relief for
other indigent patients who continue to be detained.

“Donors will soon be making major decisions about debt relief and aid to
Burundi,” said Sahokwasama. “Funds from debt relief and international
assistance should be urgently directed toward health care so hospitals
and doctors can focus on providing health care to all those in need.”