Self-medication is a product of dysfunctionality in public hospitals

Woman reads label on an over-the-counter medication. [Courtesy/GettyImages] In May this year, Public Health Principal Secretary Mary Muthoni warned Kenyans against self-diagnosis and use of over-the-counter (OTC) medications, especially antibiotics. The warning, though well-intentioned, disregarded the real issue; dysfunctionality in public health services provision. Our public health system has evolved from being a service provider to becoming a highly lucrative business, completely detached from ideals of the Hippocratic Oath for medical practice, an oath that has guided the medical profession for centuries by laying emphasis on beneficence and non-malfeasance. Public hospitals are a nightmare for many; from long sluggish queues, indifferent staff, exasperating demands and lack of medicines. There have been reports of patients dying in queues in hospitals. Women have given birth in hospital queues with no medical staff in sight to offer help. The most depressing thing is that after enduring hours in the queue to be attended to by, mostly, clinical officers, patients encounter empty shelves in hospital pharmacies and are forced to buy drugs from private chemists conveniently situated next to public hospitals. Most times, getting to see a doctor in a public hospital is the most difficult thing because they are hardly available. A doctor only has to report, don the white coat, hang on the stethoscope and visit one ward. He can then remove these accoutrements and disappear while the assumption remains that he or she is doing ward rounds. Most patients who go to public hospitals with a fever will most likely end up being asked to conduct every imaginable test; malaria, pneumonia, stool, urine, blood, kidney, lungs, echo and scan, all in private laboratories and clinics where patients in government hospitals are routinely referred to. These private clinics and laboratories charge an arm and a leg for their services. Patients in need of tests in public hospitals are often told diagnostic machines are dysfunctional or, on a lucky day, one is told that the waiting list is too long, which is a polite way of asking for a bribe to facilitate the tests. Loose control mechanisms and cases of conflict of interest have made it possible for some hospital staff, especially lab technicians, clinical officers and doctors to extort money from patients directly or through referrals to private hospitals and clinics. The latter have pushed healthcare out of reach of those seeking medical services and made it a money minting venture. An injection for which a patient would be charged, say Sh200 in a pharmacy will cost upward of Sh3,000 in a private hospital. How much choice does that leave a poor patient? This explains why most patients would rather not waste hours in public hospitals only to be referred, or asked to buy medication from a dispensing chemist. Why not save time and money by going for OTC medication? In reality, this type of treatment plays a vital role in healthcare by providing not just accessible, but also affordable treatment for common ailments without the need for a prescription. OTC drugs serve as the first line of defence against illnesses due to limited access to formal and competent healthcare facilities. Underwhelming public hospital services push patients to private hospitals, but the cost factor there becomes an impediment. That has allowed pharmacies to step in and fill the gap with OTC medication. To dissuade people from OTCs, the government must stock hospitals with drugs. While county governments purchase drugs from Kenya Medical Supplies Authority (Kemsa), most end up being diverted to private clinics and pharmacies. Kemsa should set up stores in all public hospitals to stop drugs from disappearing mysteriously. The current model where drugs are sent to the counties is a conduit for corruption. Conflict of interest ensures these drugs are diverted before reaching target hospitals, hence the referrals to specific private pharmacies and clinics. Notably, some private hospitals have taken advantage of SHA dysfunctionality. They treat out-patients but book them as admission cases and falsify documents, submitting much higher claims to the SHA. The government must work hard to restore public trust in our hospitals.

Self-medication is a product of dysfunctionality in public hospitals

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