A woman is losing so much blood right after having a vaginal delivery; there is a medication to save her, the hospital has it, but she will not receive this life-saving medication if her husband doesn’t raise the money to pay for it.
Francisca Enchill takes you undercover to expose the agony of pregnant women in hospitals, a Pay or Die phenomenon at the Korle-Bu Teaching Hospital, Kaneshie Polyclinic and the Ga West Municipal Hospital, popularly known as the Amasaman Hospital.
This is part II of similar findings at the 37 Military Hospital, Maamobi General Hospital and the Mamprobi Hospital.
Victim’s ordeal at Korle-Bu Teaching Hospital
We run into a woman who looked devastated and asked about how things are done at the Maternity Unit, she narrated now she visited the facility with a cash amount of Ghc30 and was charged Ghc15 for some tests, a Ghc5 for covering her antenatal Health Record book and another Ghc5 she did not know what it was meant for. According to her, she realised she didn’t have enough money to take her back home and had to make a call for transportation to be sent to her through Mobile Money to aid her return home.
This is the reality of the financial struggles of the poor referred from the various health facilities to the premier hospital in Ghana. We begin this undercover work at the Korle-Bu Teaching Hospital to capture live, this victim’s ordeal as it unfolds.
Korle-Bu Teaching Hospital
The premier referral hospital averagely records about five Maternal Mortalities and can record up to 20 infant mortalities in a month.
In spite of this, the hospital and its staff have placed barriers in the way of access to Maternal Healthcare. Pregnant women do not enjoy the Free Maternal Healthcare policy in the premier hospital.
Antenatal
Korle-Bu Teaching Hospital’s Antenatal care is given at two different units of the hospital. The Gynae OPD and the Maternity Unit. The Gynae OPD only accepts pregnancies below 12 weeks and the Maternity Unit accepts pregnancies that are 12-weeks and above.
Gynae OPD: It was found during this investigation that NHIS card bearing pregnant women were required to pay GH¢105.20 for a folder at the Gynae OPD to begin antenatal and pay GH¢17.00 on each antenatal visit till after the 12 weeks where they move to the Maternity Unit.
Maternity unit: At the Maternity unit, pregnant women pay some official and unofficial charges.
Official Charge-Maintenance Fee
The unit officially demands payment of some GH¢5.00. You are not told what exactly you are paying for but every single woman attending antenatal is made to pay this amount on each visit.
You are directed to pay at the bank and submit the receipt as prove to the nurse before you can enter the consultation room for your antenatal care. This payment is classified as Antenatal Maintenance Fee on the receipt.
The demand of the payment is emphasised at every point of the antenatal processing.
Unofficial charges
Also captured was the demand for some payments by health workers directly to themselves without issuing receipts. These payments included GH¢5.00 as cost of covering the Maternal Health Record Book with a rubber as well as the demand for the payment of GH¢15.00 at the Counseling room after HIV AIDS, HB and Sugar tests.
Management’s Response
The Chief Nursing Officer of the Department of Obstetrics and Gynecology at the Korle-Bu Teaching Hospital, Mary Andoh Eshun, acknowledged officially charging the antenatal maintenance fee but said it was a management decision.
She, however, denied knowledge of the GH¢5.00 unofficial charge by the nurses and the GH¢15.00 taken in the counseling room. According to her, all tests conducted at the counseling room are fully covered by NHIS. Meanwhile, staff members were found taking money from patients during this investigation.
She also stated that no staff of the unit is allowed to take any payment from any patient. Hence, staff found taking money during this investigation will face punitive action.
Ultrasound scan: At the Korle-Bu Teaching Hospital, a scan costs GH¢70.00.
Response of Korle-Bu Teaching Hospital
In an interview with the Chief Nursing Officer of the hospital, Mary Andoh Eshun, she admitted that the hospital charges for a scan. According to her, management made the decision to charge for scans and this was approved by the Ministry of Health and Parliament.
Laboratory tests: At the Central lab of the Korle-Bu Teaching Hospital, pregnant women covered by the NHIS spend up to GHc142.00 on the first group of laboratory tests.
The following tests are supposed to be free but they are not free at this hospital. G6PD costs GHc49.00, Hep. Bs Antigen(HBsAg) costs GHc31.00 and the Urine routine exams cost GHc27.00.
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At the Korle-Bu Teaching Hospital, Blood Group test is conducted at the Blood Bank, during a visit to that unit, the pregnant woman was charged Ghc35.00. The attendant at the Blood Bank stated categorically that NHIS does not work at the Blood Bank.
NHIS’s response
Mrs Vivian Addo-Cobbiah, Deputy Chief Executive, Operations at National Health Insurance Authority (NHIA), stated that pregnant women should not pay for any of such charges as the hospitals make claims and get paid for rendering those services. According to her, these could be barriers that prevent the poor from accessing antenatal care, defeating the purpose for which the policy was introduced.
Delivery
At the Korle-Bu Teaching Hospital, delivery is not free. It is paid for and it is expensive. The magnitude of unlawful charges for delivery varied depending on how normal or complicated the delivery was which informs what goes into the delivery.
At the Korle-Bu Teaching Hospital, pregnant women with NHIS cover are charged GHc400.00 and above for spontaneous Vaginal Delivery while delivery by CS costs Ghc1,500.00 and above for NHIS holders.
The Premier hospitals appeared to have some similar practices like a strange phenomenon of NHIS not covering any drug in the pharmacy of the Maternity Unit. The difference though is at Korle-Bu Teaching Hospital, important drugs are administered on the pregnant woman when it is needed, and she is then billed to pay for the drugs during discharge. The hospital, however, gives prescriptions to escorts of pregnant women to make some other purchases elsewhere.
Aside the drugs, lab tests and scans are paid for on a cash-and-carry basis.
NICU: This inve