The detention of patients in health facilities for lack of adequate financial resources to settle their medical bills is widespread phenomenon, especially in the developing world (Otremba et al; 2015).
Under such conditions poor patients are held ‘hostage’ for a longer period – hours, days or even months in healthcare facilities and subjected to all forms of abuse and mistreatment by health workers.
This detention creates psychological stress for patients, but more crucially the impact of such action on the economic conditions of their families – since they have to borrow money at unreasonable lending rate to settle those bills.
Being a worldwide problem, Ghana is not exempt from this practice.
As such, several media reports have highlighted how economically disadvantaged Ghanaians have been detained in health facilities across the country.
Recently, some 246 patients were reportedly detained at the Eastern Regional Government Hospital in Koforidua for the inability to settle their medical bills.
The lack of national health insurance cards, part payment of medical bills were identified as some of the reasons for the predicament of the affected persons.
Impugns Human Rights
One of the major reasons why some patients are detained is poverty – a consequence of the state’s failure of its commitment to social and economic rights – which has the transformational capacity in addressing poverty.
Although, it is sometimes reported that some of the affected persons do not subscribe to the national health insurance scheme, the depressing situation would have been avoided if they were not economically disadvantaged.
It is, therefore, not in dispute that the detention of patients in both public and private health facilities is dehumanising and a violation of fundamental human rights and freedoms, particularly the right to health care, liberty and dignity as protected under international human rights treaties and domestic legislation viz, ICESCR and 1992 Constitution.
The commission recognises the fact that health facilities must be supported to continue to run, re-stock their consumables so as to afford others the opportunity to receive healthcare when the need arises.
The challenge, therefore, is striking a fair balance between ensuring that healthcare facilities continue to operate without interruptions from the shortage of essential drugs and consumables and providing health care to the most vulnerable in the society.
This dilemma calls for a serious national conversation on how to address this phenomenon bearing in mind the human rights obligation of the state towards its citizens irrespective of their socio-economic status. The CHRAJ thus recommends the following:
Firstly, working towards a universal health coverage (UHC) for all.
This is where the NHIS and other pre-paid healthcare financing modules come in handy.
The continuous strengthening of the NHIS is crucial in achieving this outcome.
The government must, therefore, strengthen the scheme; and also, ensure the aggressive enrolment of the economically disadvantaged onto the scheme in the light of some recent reports that the subscription rate of the scheme was declining.
Resourcing health facilities is adopting a human rights based approach to implementing universal healthcare coverage requires stakeholders considering access to healthcare services as a matter of right for citizens and a sacred duty by the state.
The right to health goes beyond access to healthcare services when indisposed, but also include the freedom and dignity to be discharged without any conditionality.
Secondly, government’s moratorium on patients’ detention in health facilities across the country can go a long way to safeguard the dignity of economically disadvantaged patients.
This should include enforcing aspect of the Hospital Fees Act, 1971(Act 387) which grants some form of financial amnesty to patients due to poverty.
Thirdly, a Samaritan’s fund – an internal fund created to support persons who have difficulties in paying for their medical bills within health facilities – should be worthy of consideration.
Detention of patients in both public and private health facilities is an age old issue which impugn human rights of affected persons.
The CHRAJ appreciates that finding solutions to this challenge require a multidisciplinary approach since the underlying factors are compounded.
A careful consideration of the above recommendations together with a national conversation on how to address this albatross will contribute significantly towards Ghana’s commitment to human rights and sustainable development goals.