Across the country, many people with Covid-19, especially the poor, are staying away from hospitals. The fear of financial ruin from hospital bills has kept many away – preferring instead to lean on private home medical care and natural treatment regimens.
More than a respiratory infection, Covid-19 has laid bare our dire financial straits and the shortcomings of government's preparedness and response to the pandemic. Many impoverished people lack access or cannot afford the basics, which can shield them from infection, despite billions of shillings spent.
As a preventive measure, government appropriated Shs 53 billion for the procurement and distribution of non-medical masks to all individuals aged six years and above.
According to the Covid-19 preparedness and response plan, the masks were expected to be procured and distributed in June, July and August 2020 and later again in March and April 2021. But many Ugandans to date haven't received a single free mask.
They can't even afford the cheap masks being sold on the streets for Shs 1,000 and Shs 2,000. Many have instead improvised with all sorts of outlandish nose and mouth shields.
The widely touted standard operating procedures to stem the spread of Covid-19 lay emphasis on social distancing, wearing of masks, washing hands with soap or use of sanitizers. But most of these basic requirements have been priced out of reach for many impoverished people.
Many slum dwellers can't wash hands that so often because clean tap water and soap are expensive. A jerrycan of water costs between Shs 500 and Shs 1,000. That is a day's meal for many. A piece of washing soap costs about Shs 1,000.
That too is not affordable either. Hand sanitisers are extremely pricey. A survey conducted by Daily Monitor in different pharmacies and drug shops around town in March 2021 found about 20 new and pricey brands of sanitisers on the market.
The most expensive sanitiser in the country then cost Shs 160,000 for a one-litre container, up from Shs 30,000 following the outbreak of the coronavirus in the country. Some pharmacies charge between Shs 60,000 and Shs 160,000 per litre for the sanitiser and Shs 4,000 for the small bottles.
The 42-day lockdown is taking its toll. Supplies are running low and frustration is high. And now the poor face a jail sentence for failing to afford a mask. The minister of Health Jane Ruth Aceng announced a two-month jail sentence for anyone found flouting Covid-19 SOPs including wearing of masks.
Doctors have advised that the best way to avoid serious ailment is to test for Covid-19 early as soon as mild symptoms manifest. Early testing, they say, enables early treatment and better outcomes. But the tests are too costly for the poor. Free screening in public hospitals is for people who have showed symptoms, not for asymptomatic people.
The lack of access to the essentials has made it harder for the unconnected to fight this viral infection. While the impact of Covid-19 has been felt by most households, the poor have been hardest hit. Even with the lockdown to contain the spread of the disease, little is being done to support the poor employed in the informal sector, who live off handouts, and stay in congested areas – which are super spreaders of the virus.
For more than 10 years, Esther Irumba, a street vendor in Kamwokya, has sold jackfruit. The current lockdown and ban on public transport has greatly diminished her clientele and earnings.
She can no longer ably look after her five children. Interviewed for this story, Irumba, a widow and family bread-winner, said she is a hand-to-mouth worker who cannot keep home during this Covid-19-induced lockdown. She said she relies heavily on pedestrians who buy her ready-to-eat jack- fruit at Shs 1,000. Before Covid-19, she would earn about Shs 80,000 to Shs 120,000 daily but that dropped to Shs 50,000 or less after the lockdown.
"In the last lockdown, government gave me only five kilograms of maize flour, which could not take us for more than three days. How do they expect me to stay at home this time? I will continue to walk from my home in Kiteezi (Kampala suburb) so that I feed my children," Irumba said, adding: "Life has become hard for the poor because even when a child falls sick, hospitals are full yet we cannot afford the hefty charges."
According to the 2019/20 Uganda National Household Survey (UNHS), the number of poor people increased from eight million to 8.3 million people. While releasing the report, Vincent Senono, a statistician at Uganda Bureau of Statistics, noted that people working from hand to mouth increased from 3.3 million to 3.5 million people.
"Overall, poverty levels have remained the same. However, the incidence of income poverty increased during Covid-19 from 19 per cent to 22 per cent. Increase in poverty is more pronounced in rural areas especially in Karamoja, Acholi, Bukedi and Busoga sub-regions," Senono said then.
The UNHS survey was based on the household population and excluded institutional population like police and army barracks.
COSTLY COVID-19 TESTS
In order to achieve the Covid-19 testing targets, the ministry of Health (MoH) planned to procure a total of 2,804,515 testing kits and sample collection materials throughout the Covid-19 response period.
As at March 31, 2021, the MoH had committed and spent about Shs 29.7 billion on procurement of test kits and sample collection materials for Covid-19 screening.
Overall, as at March 31, 2021, testing kits worth Shs 16,717,432,250 had been delivered to the Central Public Health Laboratories- Butabika and distributed to various Covid-19 testing laboratories including Tororo- Malaba, Adjumani–Elegu, UVRI and Makerere College of Health Sciences, among others.
The ministry of Health received over 1.8 million various types of testing kits and sample collection materials from both government and development partners. Todate about 1,341,182 Ugandans have been tested in the last year and four months out of about 42 million Ugandans.
Health experts consistently advise people that an early Covid-19 positive test enables one to isolate, treat and reduce chances of infecting others.
However, the only surest way to confirm the viral infection is through testing, which still locks out the vulnerable poor. It took Irumba at least three weeks to mobilize Shs 100,000 to pay for her daughter's Covid-19 test at Doctor's Medical Center in Mpererwe.
"Personally, I would like to test since I interact with many people on the street. However, If I test my other four children that returned from school, I will need at least Shs 500,000, which I can't waste when we don't have food," she said.
She prioritized one child because she is asthmatic and her schoolmates tested positive for Covid-19. Luckily, her test results were negative.
A random visit to various hospitals and testing centers showed the poor cannot afford the Covid-19 screening services. At Mengo hospital, the antigen test costs Shs 55,000 and takes 40 minutes to get the results while PCR results go for Shs 170,000 in 24 hours.
Lubaga hospital charges Shs 90,000 for an antigen test. Results are released in one hour. The PCR test costs Shs 250,000 and results are released in at least three days.
A staffer at Lubaga told The Observer that an instant PCR test costs Shs 300,000. The Kololo-based Medipal International hospital charges an ordinary PCR test at Shs 250,000 and results take 24 to 36 hours while an express PCR test costs Shs 400,000.
City Medicals Limited charges Shs 200,000 for a PCR test. Results are released between eight to 12 hours while the antigen test costs Shs 100,000. The price of an antigen test soared because the facility ran out of kits.
"We are using PCR kits for antigen tests since many companies have been testing their staff and we ran out of kits. Literally, one does an antigen test at Shs 100,000 but gets PCR results printed as antigen tests. Before, it was Shs 70,000 and it would take only 30 minutes. When kits are made available, we shall revert to the old price," a staff at the facility said.
At the upscale Nakasero hospital, an antigen test goes for Shs 80,000 and results take an hour while PCR tests go for Shs 200,000. Case hospital charges Shs 100,000 for an antigen test and results return in 15 minutes while PCR tests go for Shs 200,000.
Meanwhile, Lancent laboratories charges Shs 220,000 for a PCR test and Shs 150,000 for an antigen test. At Test and Fly laboratory, an emergency PCR test, costs Shs 500,000 (results return in six hours), a Standard PCR test goes for Shs 245,000 and results are got in 12 hours.
An antigen rapid test costs Shs 100,000 and an antibody test costs Shs 75,000 and both results take 20 minutes. At border points, Test and Fly charges travellers or truck drivers, Shs 170,000 and results are received in four hours.
Following the ministry of Health directive that all travellers from category one and two countries currently experiencing high Covid-19 infections be subjected to a mandatory PCR test before they proceed into the country, Test and Fly charges $60 (Shs 250,000) and the turnaround time for re- sults is four hours.
"OPT FOR FREE SERVICES"
As private facilities continue to charge steep prices, the president of the Uganda Medical Association, Richard Idro, advised vulnerable people to opt for free Covid testing in government facilities.
"If you choose to go for a private facility for testing, whom can you blame when you have decided to take yourself there intentionally? Honestly, testing is expensive but government is paying for the service and offers it free to the public. You either pay for the private service or come to the government centers," Idro said.
When this reporter told him that she once tested for Covid-19 at a government facility free of charge but never received her results, Idro said, "Maybe the results got lost in transit but usually all PCR samples end up in the central laboratory whether taken from a private or public facility."
In a public notice signed by the medical director of Nkozi hospital, Dr Criscent Tumuhaise, testing for Covid-19 is free of charge. The RDT antigen test results are released in 15 minutes while the PCR results take at least four days.
However, a source at the hospital told The Observer that while the antigen tests are received in the shortest time, the PCR free test results take seven to 14 days. "If someone urgently needs PCR results, Nkozi hospital charges Shs 300,000 and samples are taken to a private laboratory in Kampala. This takes at least three days for one to receive results," a source said.
"Many people in villages around the hospital would like to test but this service is limited to only those with signs and symptoms of Covid due to inadequate testing kits," the source said.
Idro confirmed that given the rate at which the virus is spreading lately, focus is on testing only symptomatic people yet asymptomatic people continue to infect others. Already, at Nkozi, some staff have tested positive while their contacts are in isolation and others recovered.
Some hospital employees are also reluctant to pay for PCR tests. "If I only have flu and can move, why should I waste my money to pay for urgent results from private laboratories? That's a lot of money yet we're living in abnormal times. Even with free tests, results take long and sometimes return when some people are positive but have already mingled with others," the source adds.
As of June 30, there have been more than 82,082 confirmed cases of Covid- 19. The virus has killed 1,111, and 54,158 have re-covered. At least 861,645 have been vaccinated and 1,341,182 samples have been tested.
NOT A POOR MAN'S DISEASE
As the poor hustle to raise testing fees, Dick Nvule, a journalist working with Radio Simba, who beat Covid-19 at Mulago hospital, said even the free service comes at a cost. He spent four days on oxygen support in the High Dependence Unit and two days in the general ward. This was after treating a chest bacterial infection from home until he got shortness of breath.
"I can now agree that Covid-19 is not a poor man's disease. Even when you are admitted free of charge, getting a bed is a problem. I spent close to four hours seated on a veranda on oxygen but without a bed," Nvule told The Observer.
He added, "While on the ward, you really have to eat well in order to recover. You need flasks and a percolator to boil hot water, fruits, among others, which a poor man may not be able to afford."
While Covid treatment at Mulago is free, Nvule also incurred costs. He purchased some drugs to save his life at the government facility.
"One time, they told me to buy a particular drug that had run out. I bought two doses at Shs 50,000 each. It's painful that I bought this drug twice because on the first purchase, the drug didn't reach me. The person told me he had labeled my drugs well for delivery in the ward but I didn't get them. I had to buy two more doses, thus spending Shs 200,000 in one purchase," Nvule recalled.
According to those who have been in Mulago, the delivery system of drugs and other supplies for Covid-19 patients is run through gatemen and cleaners. This means patients are at their mercy.
nangonzi@observer.ug
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