Patients Pay for "Free" Drugs at North Afghanistan Hospital

At the Balkh public hospital in the northern Afghan city of Mazar-e Sharif, 24-year-old Yasin was by the bedside of his father, Mahmud, who had been admitted with a head injury. His fellow villagers in Badghis province had beaten him up.

“My father was admitted here eight days ago, and since then the doctors have only provided him with eight IV drips,” Yasin told an IWPR reporter. “I bought the rest of the medicine with my own money. Now I have nothing left in my pockets.”

It had been three days since Yasin had been able to buy the right medicine for his father, whose condition was worsening by the day.

“The doctors say, ‘If you have 47,000 afghanis [1,000 US dollars], your father will be treated,’” Yasin said, as a nurse stood nearby. “Otherwise, don’t waste your time – take the patient away. We can’t treat your father out of our own pockets.”

Yasin, and many others like him, are facing the same problem – they have to buy medicine from pharmacies to get their relatives treated at the Balkh state hospital.

This is happening despite the international aid the hospital receives to provide medicines. Health officials and pharmacy owners say hospital staff sell large amounts of donated medicines to private pharmacies, which then sell it back to patients who were supposed to get it for free.

“Unfortunately, many of the medicines intended for patients in the hospital are sold in the bazaar,” one pharmacy owner who gave his name as Zabiullah said. “There are groups of people who sell these drugs because they are of good quality and expensive. These drugs are them sold to patients’ families at a very high cost, and some of the profits go back to public health officials.”

Dr Ghausuddin Anwari, head of the hospital, said the public health system was trying to serve patients properly, but he acknowledged that medicine and equipment were being “illegally taken by medical staff”.

“But it is not a major problem,” he added, arguing that the poor salaries of hospital staff were the likely cause of such thefts. Anwar said the authorities were trying to curb the practice, but he was unable to give any examples of how this was being done.

Mohammad Afzal Hadid, the new chairman of the provincial Council of Orthopaedic Specialists, said the lack of free medical services which are supposed to be constitutionally guaranteed is a major concern.

Hadid is a doctor himself and has worked at the public hospital, which he said gets a comparatively large budget each year, as well as support from donors. The hospital has skilled doctors, he said, but not the free services that should be expected.

“I have visited the hospital several times, and I have shared these problems with the hospital authorities,” he said. “The continuing situation at Balkh public hospital has raised concerns among all of the province’s residents.

Hajji Abdurrahman, head of the provincial economics department, said that in addition to its government allocation, the hospital received eight million US dollars from foreign donors last year to improve its capacity to provide free health services, including medicines.

Hamyun, a doctor in Mazar-e Sharif, said that if healthcare in the province was to improve, the corrupt practices that led to medicines going missing needed to be tackled.

“There is no official oversight of these donated medicines. No officials come to check the situation in the public hospitals,” he told an IWPR reporter. “Beside government assistance, the funds and assistance provided by donor organisations should go directly to the patients, under the supervision of an impartial group. Such supervision might stop the misuse of aid medicines. Otherwise the problems may increase.”

Doctors at the hospital say they are forced to ask patients’ friends and family to buy medicines for them from private drug stores, because there are not enough in the hospital.

“The in-house medicines service has no drugs for patients,” said Wakil Matin, a doctor. “All the patients… buy their medicines on the market.”

As a doctor, he said, patients are important to him. He writes prescriptions and gives them to whoever brought the patient in to hospital, so that they can go out to buy it.

Mirwais Rabih, another doctor at the hospital, agreed that the medicines section of the hospital was severely lacking in medicines due to theft. But he said the hospital did provide free drugs and medication in its surgical, paediatric and general care sections.

A small industry has grown up outside the hospital, with 51 shops and pharmacies in close proximity. Store owners say about half their customers come from the hospital. Pharmacies sell medicines bearing labels that indicate they have been donated. In one pharmacy which IWPR visited, many packages and bottles of medicines and vitamins were marked in this way.

Mohammad Zahir, a drug store owner here, says he buys his supplies from the hospital, because the medicine is “high-quality and cheap”. This means customers keep coming back, and can avoid expired or low-quality medicines.

Doctors at the hospital say they are doing their best with what they have, but with limited finances, it can be difficult.

Hamida Halimi, who works at the hospital, said that sometimes funding does not arrive from Kabul. “Sometimes when we don’t have the budget, patients may face problems receiving free medicine,” she added.

Shokrullah, another doctor at the hospital, said it had an annual contract with a drug store to keep medicine supplies in stock.

The director, Dr Anwari, said the hospital was undergoing reform, and once that was completed, many of the problems would be solved.

That is little comfort for those who already have loved ones in hospital – people like Mohammad Nabi, a resident of Mazar-e Sharif, whose wife was recently admitted with heart disease.

Not only does Nabi pay for her medicine, he also has to pay for medical examinations by hospital staff.

“They also charge money for some examinations and X-rays which are supposed to be free,” he said. “And if I don’t pay the money, no one will do any work, and the patient will die.”

Gulab Shah Bawer is an IWPR-trained reporter in Afghanistan.

This report was produced in November 2011 as part of the Afghan Investigative Journalism Fund project, and originally published on the Afghan Centre for Investigative Journalism website which IWPR has set up locally.