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VII. The Government Response

The government has an immediate duty to end the detention of poor patients for non-payment of their medical bills, and a longer-range responsibility to progressively realize the right to health of its citizens. Senior government officials and hospital staff alike often deny or minimize the problem of hospital detentions. The chef de cabinet in the Ministry of Health told us,

In my opinion, this is not detention or imprisonment. It is a long waiting period. If people cannot pay at all, they are allowed to go. They might overstay two to three days or a week.¹¹⁵

The director of Prince Louis Rwagasore Clinic said,

We have a small hospital so we let people [who cannot pay] leave because we realize they cannot pay, or because they find a benefactor. As soon as people have recovered, they are released. We just keep the bills. One speaks about prisoners but in reality there are no prisoners. They themselves say tomorrow, the day after tomorrow a person will come and pay for me.¹¹⁶

The director of Roi Khaled Hospital declared that “this is not a prison,” and said that people who cannot pay their bills are released.¹¹⁷ Several hospital managers questioned the use of the word “detention.”¹¹⁸

The reality was different, as shown above. In nine of the eleven hospitals we visited, patients were detained, and many of them for far longer than one week. While denying or minimizing the problem, government and hospital officials contradicted themselves by attempting to justify hospital detentions. According to the chef de cabinet in the Ministry of Health:

Hospitals managers have to ensure financial stability. If the directors don’t pay attention, they have to shut down the hospital.¹¹⁹

The chef de cabinet in the Ministry of National Solidarity, as well as several hospital managers, echoed this argument, pointing out that hospitals would have to close if they lacked the funds to operate. Others suggested the alternative was to refuse treatment.¹²⁰ Government and hospital officials alike presented the issue as deplorable but refused to take responsibility for it.

In December 2005, the Ministry of National Solidarity—apparently at the initiative of the president—ordered the release of patients and announced it would pay for their bills. The move was widely reported in the press, and one formerly detained patient we spoke to expressed her gratitude to the president for this initiative. The minister’s chef de cabinet reportedly told hospitals that they should release their detainees and send the bills to her Ministry. But when asked by the press whether detentions in hospitals would now end, she replied evasively,

There is no reason to believe that the problem of insolvability will be resolved if the majority of the population continues to live in conditions of extreme poverty. To eradicate this phenomenon completely, one needs a series of projects that allow people to pay for their medical treatment.¹²¹

To the dismay of hospital officials, the government did not reimburse the bills as promised. By May 2006, the government owed the four major hospitals over U.S.$50,000.¹²² According to the chef de cabinet, the responsibility for the non-payment lay not with her Ministry, but with the Crédit de Relance Economique, a World Bank-financed fund for reconstruction activities.¹²³

Ad-hoc measures such as the December 2005 “charitable” release of detainees in hospitals may bring the government good publicity but do nothing to solve the real problem. Shortly after Christmas 2005, hospitals were again filling up with insolvent patients in detention.