Millions of dollars have been poured into the French Medical Institute for Children (FMIC) Hospital in Kabul. Have the services fallen short of expectations? A Killid investigation.
Affordable healthcare for children was the goal of this ambitious multi-million dollar hospital project launched in 2003 by the Afghan and French governments in cooperation with two non-governmental organisations (NGOs), the French La Chaîne de L’Espoir /Enfants Afghans and the Agha Khan Development Network (AKDN).
The MoU (Memorandum of Understanding) promised to deliver specialised services to the poor, train a cadre of health workers and prevent the drain of money for medical treatment abroad.
Abdul Qadeer Khairi, the head of planning, policy and international relations in the Ministry of Health, says this was the first project under the public-private partnership model (PPP); the government could not have done it on its own.
The government provided land and took on some financial responsibilities, a reported one million USD every year. The decision was taken by the cabinet of former president Hamid Karzai to also meet the hospital’s electricity and water needs, an annual expense of 200,000 USD. Moreover, tax waivers were thrown in, also on the import of equipment.
Under the MoU, the French government and two NGOs were committed to pay 2.5 million USD every year to make the hospital affordable for all.
Some patients, however, have had a different experience. Mrs Saghra complains doctors told her to admit her child who had very high fever but she could not afford the cost of three days admission, an estimated 25,000 Afs (roughly 400 USD).
Haji Dawood, a Kabul resident who took his grandchild for a blood test says he was presented with a bill of 3,290 Afs (53 USD). While Saadat, a daily wager who had come from Panjsher province says he had to pay 67,000 Afs (1,082 USD). He took his son, Abdul Waris, to the hospital with a kidney problem. Doctors said he would be admitted for six days, which would cost Saadat 94,000 Afs (1,517 USD). A copy of the bill is with Killid. Roughly a third – 27,000 Afs (436 USD) – was paid from the hospital’s charity fund.
FMIC authorities say the hospital’s fees are no higher than in other hospitals and when they are there is a reason. Dr Abdullah Fahim, the medical director, explains prices depend on the type of machine being used. For instance, the fee for ultrasound is higher because of the machine. Also, since it’s a multi-specialty hospital, patients are billed for tests that are done simultaneously.
Some failure
Unfortunately there are also complaints of wrong diagnosis of patients. Killid was shown the papers of the infant daughter of a driver, Mohammad Yasin Hakimi who works with a private organisation. She was brought to FMIC with “blood dirt” in her eyes. Hakimi says the doctors conducted tests and took pictures that were sent to Pakistan. When the results came, he was told his baby had a tumour and needed immediate surgery, which could only be done abroad. Since the pre-operative tests that the hospital was equipped to do would cost 50,000 Afs (807 USD), Hakimi consulted doctors in Cure International Hospital, Kabul. To his surprise, they dismissed the FMIC diagnosis and said the baby had blood spots, which they proceeded to rectify with an operation that cost Hakimi 8,000 Afs (130 USD). He says his daughter’s eyes not only healed immediately, but there has been no problem since.
Mohammad from Bamyan brought his one-year-old daughter, Aqela, who suffers from anaemia to FMIC. But the doctors were unable to diagnose her condition, and instead told him to bring her to the hospital every month, which he cannot do. In fact, the frustrated father does not know where to take his daughter.
The hospital’s Dr Fahim says in defence that it is not possible to have a 100 percent success rate. There are bound to be mistakes and misdiagnosis, he says. “We have made mistakes in the hospital. We cannot claim 100 percent success.”
He says FMIC has been able to help many poor patients through the hospital’s charity fund.
The fund, worth some 3.5 million USD, was set up for the welfare of the needy. Annually until two years ago, the Afghan government was contributing 50 million Afs (807,150 USD), the French government some 2.5 million USD and the rest was from the two NGOs.
Dr Fahim says the government has scaled down its share and paid only 30 million Afs (484,300 USD) in 2014 and this year, 20 million USD (322,900 USD). The doctor would not say how much the other contributions were.
Authorities in FMIC hope the Ministry of Health will review its decision.
The hospital has not fixed a discount for needy patients. Many people are not aware of the FMIC’s charity fund. In some cases, the discount is between 10 and 15 percent. For Saadat, the daily wager from Panjsher who brought his one-year-old for treatment, the hospital reduced costs by one-third.
Ali Karimi, a patient, chafes at the arbitrariness of the fund, and would like to see more transparency in the process. FMIC medical director Dr Fahim rejects the charge and says some 305,000 patients drew from the charity fund in 2014.
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