Poor women in Kenya are paying up to KES500 in bribes, a small fortune, to be inserted with the family planning coil in public hospitals.
A recent study has finally put a price tag on what public health workers are extorting from women seeking family planning services otherwise supposed to be free.
The bribes range from KES50 for oral pills, though this can rise to KES100, while inserting or removing an implant costs up to KES200.
The coil or intrauterine device (IUCD), commands the highest bribe of up to KES500 (about 5USD) with some health care providers claiming it involves too much work.
Amounts solicited varied, with long-acting reversible contraceptive methods costing more than short-acting methods.
The median amount, the study says was 1 USD (about KES100) which is equivalent to half a day’s pay for more than one-third of Kenyans living below the international poverty line.
And the bribery is not an irregular event with the study confirming bribes are involved in 36 per cent of all family planning visits.
The study had sent out 142 mystery clients; data collectors disguised as clients seeking family planning services and recorded the proceedings.
“Informal payments were solicited in 36 per cent of visits,” says the study which had involved 60 public health facilities in western Kenya.
The study published last week (30th September 2021) in the journal of Sexual and Reproductive Health Matters says informal payments are the biggest threat to Kenya’s Universal Health Coverage.
The study led by Katherine Tumlinson of University of North Carolina, US, also involved Kisumu County Department of Health, Kenya, Columbia University US, and the NGO Innovations for Poverty Action-Kenya.
In 2014 Kenya introduced free maternity services and removed user fees in primary health facilities, to allow the poorest to access care.
Since then the free maternity has been modified to be more accessible to every women through the National Hospital Insurance Fund (NHIF).
But informal payments women say makes mockery of Kenyan’s Universal Health Coverage (UHC) drive.
“When I do not have fifty shillings, even when my days have elapsed, I would not go, till I get the money, it’s then that I can return for the injection,” said a discontinued user.
“Because of the frustration, [women] will say, ‘Let me go away my dear, even if it is getting pregnant, let it be so,” said another woman in Kisii.
In March, Tumlinson published a similar study detailing how informal payments are denying women family planning services in public facilities.
The study published in the journal Conception, had covered Kisumu, Kisii, Busia and Bungoma counties in western Kenya.
Women told of how they have to live with expired devices, suffer intolerable side effects or delay a wanted pregnancy until they can afford a bribe.
In the new study, the team had gone out to quantify the prevalence of informal payments, their impact and possible solutions.
“Informal payments were solicited in 36 per cent of our visits,” reports the study. In one facility with four service providers, one of them solicited 23 of the 32 payments.
The authors however are reluctant to call these bribes or corruption because some of the solicitors claimed they used the money to restock the facilities.
“In this study, informal payments were frequently solicited, potentially creating an important cost barrier for the most vulnerable women.”
The authors recommend greater clarity, transparency, and visibility of policies prohibiting informal payments – even those left to the discretion of the patient.
By Gatonye Gathura
The report is available here: https://doi.org/10.1080/26410397.2021.1970958