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Ripping off the Patient

The president of the Zambia Medical Association Dr Munjajati recently revealed that the current health delivery system in the country cannot protect patients seeking private medical attention from flagrant overcharging. His remarks tend to highlight the fact that Zambia has a two-tier health system within public hospitals. Fee-paying hospital wards were introduced in 1980 by the UNIP government of Dr Kaunda. Those with enough money could be hospitalized in fee-paying wards in order to receive proper medical treatment .

The reluctance of the current Patriotic Front government to boldly check and regulate the operations of privately-owned hospitals and clinics is because to do so would be against the government’s policy of economic liberalization. Private health care is encouraged in the belief that an increased role for entrepreneurs and competition in the delivery of healthcare will result in a more efficient and effective healthcare system. Thus the search for financial gain determines the quality of healthcare systems. But the values of free enterprises and the economic benefits that may flow from a more efficient healthcare system can only be achieved at the cost of other and more important values – including a concern for fairness, the dignity of people and community-centred ethics that places people before profits.

Caring or looking after the sick is a calling of special dignity and importance. The striking nurses were dismissed by the Labour Minister in 2013 on the allegation that they had failed to uphold the oath of allegiance they swore when they graduated from Health College – to serve others out of compassion. To go on strike for reasons of salary increments was anathema to the values that guide governments and their civil servants. This is the oath to serve the people out of love and compassion, without regard to the standard of prevailing salaries and poor conditions of service. In that case, by the same standard, it would be the task of every government to make access to healthcare as free as possible. But they don’t.

There are relatively small amounts of legislation regulating the operations of health facilities compared to laws governing health personnel. The existing legislation regulating the operations of both private and public health hospitals was introduced by President Michael Sata when he was minister of health. In 2002 the MMD government went on to introduce consultation and medical fees in both public hospitals and clinics. Economic liberalisation entailed the acceptance of the lurid fact that free health care and education was a cost to the government. Hospitals, schools and colleges were de-centralised under health and education boards.

Under the system of private healthcare, the opportunities for ripping off patients seems endless. There is nothing in place to regulate the prices that are charged by service providers and hence the price differences in goods and services from one private health provider to another. Grading of private health facilities does not exist on the ground due to the salient professional ethic surrounding medicine. Due to the prevalence of HIV/AIDS and the mystery surrounding the disease and its causes, Zambia has seen a proliferation of traditional herbal therapies and traditional healers. It is not illegal in Zambia today to sell and advertise traditional herbal medicines that have not even undergone a laboratory scrutiny.

The introduction of free male circumcision in public hospitals emphasises that lack of a regulatory framework. The public health system exists in a state of corruption. Private surgeries are stocked with medicines siphoned from public hospitals. There is no treatment protocol and this results in over-servicing; a private doctor will prescribe ten supplementary drugs for the sake of advertising his business. Most private hospitals are under the control of lay managers whose primary interest is to make a profit. Thus under the system of private health care doctors promote profit-producing drugs, surgeries and tests. Medical treatments and counselling that lack profit potential are discouraged. The commercialization of private healthcare has led to the abandonment of human virtues that are essential for a community - caring for old people, compassion and charity, especially for the less privileged members of the community.

The zeal and altruism that is displayed by doctors and nurses in their primary concern for the alleviation of pain and sickness has been hijacked by the profit motive. Indeed the prevailing ideology says that political states or governments have a duty to protect the interests of the citizenry, through providing them with law, security and healthcare. But the provision of healthcare under capitalism is hamstrung by the principle of free enterprise with its competition and profit. The income and wealth disparities between the working and capitalist classes translate themselves into standardized economic, political and social programmes. The vision of free healthcare, and other services cannot obtain under a capitalist state. It is only in socialist society that health care will be characterized by its capacity to serve the good of every member of society. The sense of responsibility by those engaging in providing free medical care will demonstrate the individual and social virtues necessary for the wellbeing of a classless, moneyless and stateless society – socialism.

K. MULENGA