{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:12:45Z","timestamp":1772169165465,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.18403.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000}}],"reference-count":25,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["221559"],"award-info":[{"award-number":["221559"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>This paper evaluates the problem of medical debt in Kenya during the COVID-19 pandemic. The medical debt problem is compounded during pandemics such as COVID-19 when patients seek treatment and end up in insurmountable debt because illnesses related to the pandemic are not covered by the Kenyan National Health Insurance Fund (NHIF), the public health coverage body under government control. As a result, discharged patients may be detained in hospitals and dead bodies are locked away in mortuaries, until relatives and friends fundraise and clear the bills. Apart from causing vulnerability, fear, and emotional stress among the poor, this practice leads to a growing lack of trust in the healthcare system, with patients deliberately avoiding hospitals whenever they suspect they have COVID-19. The resulting vicious cycle makes healthcare more inaccessible by limiting the choices that people may have.<\/ns3:p>\n                  <ns3:p>User fees, which were introduced in all public health facilities by the Kenyan government as part of a World Bank prescription for cost-sharing, normally affect more women than men. Although Kenya has implemented a general waiver system in public hospitals for those who cannot pay their medical bills, the process of obtaining this waiver can be burdensome, demeaning, and dangerous for the health of the patients. This undermines the government\u2019s commitment to the provision of equitable and affordable health care for the citizens.<\/ns3:p>\n                  <ns3:p>In this article, the problem of medical debt in Kenya is addressed as a multi-faceted problem drawing on issues of justice and fairness, human dignity, good governance, the interplay between global and local policies, as well as politics and law. It argues that it is in the best interest of Kenya and other African countries to ensure that public health coverage covers pandemics so that the majority poor can afford and access healthcare.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.18403.2","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T05:10:57Z","timestamp":1690434657000},"page":"245","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Medical debt during epidemics: A case for resolving the situation in low- and middle-income countries such as Kenya"],"prefix":"10.12688","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1002-7122","authenticated-orcid":false,"given":"Tom","family":"Obengo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"346-361","DOI":"10.1080\/23288604.2018.1513267","article-title":"Kenya National Hospital Insurance Fund Reforms: Implications and Lessons for Universal Health Coverage.","volume":"4","author":"E Barasa","year":"2018","journal-title":"Health Syst Reform."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"342-368","DOI":"10.1353\/hrq.2018.0018","article-title":"Identifying the Components of a Core Health Services Package from a Human Rights Perspective to Inform Progress Toward Universal Health Coverage.","volume":"40","author":"A Chapman","year":"2018","journal-title":"Hum Rights Q."},{"key":"ref-4","article-title":"John Rawls: A Theory of Justice.","author":"B Duignan","year":"2022","journal-title":"Encyclopaedia Britannica."},{"key":"ref-3","article-title":"Message from the Executive Director: Global Fund Grants in Kenya.","author":"Executive Director","year":"11 March 2022"},{"key":"ref-5","article-title":"Medical Debt is the Enemy of Everyone","author":"R Goff","year":"2021"},{"key":"ref-6","article-title":"National Hospital Insurance Fund Act Chapter 255.","year":"2012 1998"},{"key":"ref-14","article-title":"Addressing the Global Health Crisis: Universal Health Protection Policies.","year":"2014"},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"1175-1185","DOI":"10.1111\/tmi.12912","article-title":"Examining Levels, Distribution and Correlates of Health Insurance Coverage in Kenya.","volume":"22","author":"J Kazungu","year":"2017","journal-title":"Trop Med Int Health."},{"key":"ref-8","article-title":"COVID-19 Exposes Weaknesses in Kenya\u2019s Healthcare System. And What Can Be Done.","author":"A Mohiddin","year":"2020"},{"key":"ref-9","article-title":"Body of Doctor Who Succumbed to COVID Detained Over Ksh.18M Bill.","author":"D Musau","year":"2022"},{"key":"ref-61","doi-asserted-by":"publisher","first-page":"912-920","DOI":"10.1093\/heapol\/czt073","article-title":"The progressivity of health-care financing in Kenya.","volume":"29","author":"K Munge","year":"2014","journal-title":"Health Policy Plan."},{"key":"ref-10","article-title":"Regulator probes Nairobi Hospital over don\u2019s body.","author":"E Mutai","year":"2022"},{"key":"ref-60","article-title":"Universal health care coverage: healthcare financing and access to health care services in Kenya.","author":"P Mwaambi","year":"2017","journal-title":"Clin Case Rep Rev."},{"key":"ref-11","article-title":"About Us: National Hospital Insurance Fund.","year":"2022"},{"key":"ref-12","article-title":"Kenya's Slum Vendors Rely on Savings Groups to Survive COVID-19","author":"D Njagi","year":"2021"},{"key":"ref-13","article-title":"A Utilitarian Assessment Of The Relevance Of Genetic Therapies For Hiv-Aids In Africa, With Special Reference To The Situation In Kenya.","author":"T Obengo","year":"2020"},{"key":"ref-15","article-title":"NHIF in Hot Water for Paying Sh336m to Unqualified Law Firm.","author":"A Oketch","year":"2022"},{"key":"ref-16","article-title":"Covid Millionaires Scam: Sh17 Billion Remains Unaccounted for at KEMSA.","author":"A Oketch","year":"2022"},{"key":"ref-17","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.10.020362","article-title":"Health coverage and what Kenya can learn from the COVID-19 pandemic.","volume":"10","author":"P Ouma","year":"2020","journal-title":"J Glob Health."},{"key":"ref-18","article-title":"Only 20% of Kenyans Have Any Form of Health Insurance.","author":"J Owino","year":"2021"},{"key":"ref-19","article-title":"Covid Millionaires Report to be Tabled in Parliament.","author":"S Owino","year":"2022"},{"key":"ref-20","article-title":"Detention of Patients for Unpaid Bills Illegal.","author":"C Oyugi","year":"2019"},{"key":"ref-21","article-title":"A Theory of Justice.","author":"J Rawls","year":"2002"},{"key":"ref-22","article-title":"Nairobi Hospital Managers Summoned to Explain Why Doctor's Body is Detained.","author":"A Robi","year":"2022"},{"key":"ref-23","article-title":"WHO Director-General's Opening Remarks at the Media Briefing on COVID-19.","year":"2020"}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T07:40:13Z","timestamp":1698651613000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,27]]},"references-count":25,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.18403.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.21914.r68291","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.21914.r68291","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,27]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.20403.r53961, Zhi Xiang Ng, School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, 17 Feb 2023, version 1, 4 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v1#referee-response-53961","order":0,"name":"referee-response-53961","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Tom J. Obengo<\/b>; \n<i>Posted: 03 Jul 2023<\/i>; I thank the reviewer for suggesting a more detailed elaboration on the limitation of current study and potential bias section. I will use the suggestion to revise the relevant section.&nbsp; I will also look into the use of pronouns and revise as may be found necessary. My&nbsp;use of first person pronouns was a result of recommendations from other senior scholars.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#referee-comment-5379","order":1,"name":"referee-comment-5379","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.20403.r56829, Lauren Paremoer, Political Studies Department, University of Cape Town, Rondebosch, Western Cape, 01 Jun 2023, version 1, 4 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v1#referee-response-56829","order":2,"name":"referee-response-56829","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Tom J. Obengo<\/b>; \n<i>Posted: 22 Jul 2023<\/i>; Thank you for this helpful review.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#referee-comment-5394","order":3,"name":"referee-comment-5394","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.20403.r57197, Alyssa Parpia, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, 01 Jun 2023, version 1, 4 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v1#referee-response-57197","order":4,"name":"referee-response-57197","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Tom J. Obengo<\/b>; \n<i>Posted: 22 Jul 2023<\/i>; Thank you for this helpful review. In particular, the suggestion for additional referencing has been taken seriously and applied in selected areas of the article.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#referee-comment-5395","order":5,"name":"referee-comment-5395","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.20403.r56831, Gianpaolo Tomaselli, University of Malta, Msida, 01 Jun 2023, version 1, 4 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v1#referee-response-56831","order":6,"name":"referee-response-56831","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Tom J. Obengo<\/b>; \n<i>Posted: 22 Jul 2023<\/i>; Thank you for this helpful review. In particular, the suggestion for additional referencing has been taken seriously and applied in selected areas of the article.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#referee-comment-5396","order":7,"name":"referee-comment-5396","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.21914.r68291, Jasper Ubels, German Cancer Research Center, Heidelberg, 30 Oct 2023, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-245\/v2#referee-response-68291","order":8,"name":"referee-response-68291","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Wellcome [221559] and the Department for International Development. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":9,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}