Overview
Access to public health services in Kenya is determined in part by ability to pay informal charges. Patients seeking faster access or priority care pay health workers bribes. Patients seeking medicines pay nurses informal charges. This informal payment system creates inequality in access to care and extracts resources from poor patients, a form of petty corruption with major consequences.
Doctor Consultation Payments
A patient seeking to see a doctor at a public health facility may be told that the doctor requires payment for consultation, even though the facility is supposed to provide free or subsidized care. A health worker (receptionist, nurse, or doctor) may demand payment before allowing the patient to see the doctor.
The going rate varies but might be KES 100 to KES 500 depending on the facility and the perceived patient wealth.
Poor patients who cannot afford informal payment are deprioritized. They wait longer. Urgent cases are pushed to the back of the queue if the patient cannot pay.
Medicine and Supply Charges
Patients seeking medicines at public health facilities encounter informal demands for payment. A patient prescribed an antibiotic may be told the facility is out of stock (incorrect) and directed to a private pharmacy, or may be told to pay for the medicine (even though medicines are supposed to be provided free or subsidized).
Nurses may demand payment for bandages, gloves, or other supplies even though the facility is supposed to provide them.
Maternity Care Corruption
Pregnant women seeking delivery services encounter particular corruption. Patients may be asked to provide money for "transport" (actually a bribe to health workers), for bandages and gloves (supposed to be provided), or for use of the delivery room itself.
Women in labor who cannot pay may be denied care or deprioritized until they secure payment.
Preferred Provider System
Health workers develop relationships with private pharmacies and clinics and send public facility patients to those private providers. The health worker may receive a commission or kickback from the private provider for each referral.
The patient is sent to a private provider and incurs cost, while the public facility receives no benefit.
Diagnostic Service Corruption
Laboratory tests that should be performed at the public facility are sometimes claimed to be "unavailable" and the patient is directed to a private laboratory. The health worker may receive a referral commission.
This diversion means the public laboratory does not receive patient volume or revenue, contributing to its deterioration.
Staff Absenteeism
Health worker absenteeism means that even patients willing to pay may not receive care because the health worker is absent. A patient arrives at a health facility and finds no nurse or clinician present despite the facility being officially open.
Patients may find the facility locked during official hours or find that the one health worker present is overwhelmed by patient numbers.
Ambulance Services
Ambulance services at public facilities may be unavailable or may be diverted for private use. A patient seeking emergency transport by ambulance may be denied if the ambulance is not available or may be asked to pay an informal charge.
Systemic Inequality
The informal payment system creates healthcare inequality. Wealthy patients can afford informal payments and receive prompt care. Poor patients cannot afford payment and are deprioritized.
This reproduces socioeconomic inequality in health outcomes. The poor, who have higher disease burden, receive lower-quality care.
See Also
- Health Sector Corruption
- Fake Medicines Kenya
- Civil Service Salaries and Petty Corruption
- Kemsa Scandal
- Impunity Culture
- Corruption and Service Delivery
- NHIF Scandals