Private healthcare providers in developing countries get UK aid investments but are excluding, and exploiting people in poverty

Oxfam’s report, Sick Development, found that rich country governments, including the UK, as well as the EU and the World Bank, are allowing their development finance institutions (DFIs) to fund fee-charging for-profit healthcare providers in low and middle-income countries, many of which have become go-to destinations for health tourists. This is money that should instead be spent strengthening public health systems to help those living in poverty to access healthcare.

British International Investment (BII), the UK government’s DFI, has channelled hundreds of millions of pounds in this way. Over 90 per cent of their health investments are out-of-sight and unaccountable, made via fee-charging and profit-hungry private equity funds mostly domiciled in tax havens. An International Development Select Committee inquiry into the UK’s use of DFIs is due to publish its findings in the coming weeks.

Oxfam’s Senior Health Policy Advisor, Anna Marriott, said: “This is far more than just a case of a few bad apples; wherever we looked we found cases of exclusion or exploitation and some appalling human rights violations.

“It’s sickening that the Development Finance Institutions, including British International Investment, are being allowed to use taxpayers’ money to help boost the profits of powerful healthcare corporations in the Global South, while turning a blind eye to the harm and impoverishment they are causing.

“Woeful levels of scrutiny mean BII even invested in a Kenyan hospital chain a year after its director had publicly confirmed that patients who don’t pay their bills would be detained.”

Key findings of Oxfam’s report include:

• Dozens of cases, from a BII funded hospital chain in Kenya, of patients being imprisoned until they paid medical fees, including a secondary school student who was held hostage in hospital for 11 months, a new-born baby whose twin had died and a refugee who was involved in a car accident whose son had been killed. There have also been several cases of the hospital refusing to release dead bodies until fees are paid, in at least one case for over two years. BII’s funding came a year after the hospital director publicly confirmed the hospital policy of detaining patients for non-payment of bills.
• In India, private hospitals funded by BII have been denying people treatment, even though they had government health insurance cards entitling them to free care. Oxfam spoke to people who had been pushed into poverty by health fees of up to $36,000 (almost £29,000). There were also cases of emergency patients, including a stab victim, not being treated until relatives turned up with cash. Oxfam also heard allegations of patients being pressured to have unnecessary surgery, and of aggressive, deceptive and manipulative behaviour to extract more money - for example mis-selling of private insurance that didn’t actually cover patients. Fees charged to patients who sought care at these hospitals ranged from between three-and-a-half months to 14 years’ worth of wages for an average earner in India.
• At the height of the COVID-19 pandemic – where deaths were four times higher in lower-income countries - some BII funded hospitals denied entry to patients or sold intensive care beds to the highest bidder at eyewatering costs. One BII funded hospital in Zimbabwe reportedly charged between $800 and $1000 a day (between £650 and £800) for a COVID-19 intensive care bed. Another BII funded hospital in Uganda, reportedly charged one patient $32,000 (£25,500) for two weeks of treatment and care for COVID-19.
• The numbers of women dying in pregnancy and childbirth is rising across the world, yet BII funded private hospitals are charging astronomical fees for maternity care. In one hospital in Nigeria the lowest price for an uncomplicated birth, is the equivalent of 12 years’ wages for the poorest 10 per cent of the population, and the price for a Caesarean is the equivalent of 24 years’ wages. In one private hospital in Uganda, childbirth costs rose by an extraordinary 60 per cent following BII’s investment. In another BII supported hospital in India, a mother was reportedly charged $63,000 (£50,460) for the treatment of her premature twins, who both sadly died - the equivalent of 35 years income for more than 70 per cent of the population who live on $5.50 or less (£4.40) per day.
• While the hospitals being funded by development finance should be providing care for those who can least afford it, many have become go-to destinations for wealthy elites including health tourists. Examples include a Chinese Dental hospital and a retirement community development with medical care in Costa Rica marketed to expats and tourists.

Oxfam warned the risks to patients’ rights and health and to public healthcare systems are too high to allow this stream of funding to continue. It is calling for a stop to all future DFI funding to private health care providers as well as an urgent independent investigation into existing investments.

Anna Marriott said: “Every second, 60 more people are pushed into poverty by catastrophic health costs and instead of helping to tackle the problem, this way of spending UK aid is fuelling it. At a time of spiralling need and decimated aid budgets, it’s more crucial than ever that any development funding for health is spent as effectively as possible to reach those without access to healthcare.

“Aid should be used to support governments to strengthen public health care systems that can reach everyone, not channelled through these huge money-making corporations that are clearly doing harm.

“The Government has said reducing maternal deaths is a priority for the UK’s development strategy so I think British people would be shocked to learn that it is supporting for-profit hospitals where childbirth can cost the equivalent of a year’s salary for some of the poorest. The abysmally unaccountable way this is happening risks undermining support for UK aid.”

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For more information, or to receive a copy of the report, Sick Development, please contact: Sarah Dransfield, Oxfam Senior Press Officer, on 07884 114825 / sdransfield@oxfam.org.uk

Example case studies

In 2019, BII’s former Chief Operating Officer was quoted regarding one of the hospitals they funded in India - which received $48million (£38.4m) in BII investments - saying the whole reason the hospital existed “was to reach the poorest people”. The same hospital refused to treat a boy who had been stabbed, despite the fact he had his government insurance card. The community health worker who brought him in had to go and quickly collect donations form the local community to raise the funds (INR 20,000 / £195) and only when she returned with the money did the hospital began treating the boy.

Another BII funded hospital in India left Santosh, a man Oxfam spoke to, with a $21,000 (£16,800) debt he is unable to pay after his brother Ravi was critically injured in an accident. The hospital refused to accept Ravi’s government health insurance card and saddled with debt from Ravi’s intensive care treatment, the family were unable to pay for the physiotherapy crucial for his recovery.

After her mother’s health insurance card was refused without justification by a BII funded hospital in Odisha, India, Eva and her father were left with a $36,000 (£28,840) bill for her mother’s care, the equivalent of more than 7 years of their combined income. Eva’s whole life collapsed. She was forced to sell the family’s plot of land and take out loans. The consequences were devastating for Eva, who was no longer able to marry the man she loved because of her huge debts. “The doctor has killed all my hopes and aspirations in life (..) I’m financially killed; I’m psychologically damaged; my family life has collapsed.”

Notes to editors:

• Over recent years the government has increased its allocation of aid to BII while other departments have seen their budgets cut.
• Over the last decade the number of people pushed into poverty having to pay for their healthcare has been rising in lower-income countries. Evidence from across the world suggests that a higher share of private financing for health is linked to higher rates of premature death and a bigger gap in life expectancy between the richest and least well off. During the COVID-19 pandemic it led to higher rates of infection and death. The World Health Organisation’s guidance says to reduce reliance on private financing in order to achieve health for all.
• Oxfam is concerned that private hospitals funded by DFIs, including BII, are undermining public healthcare by causing brain drain from already shockingly understaffed hospitals and clinics and are diverting public funding for health via tax breaks, exploitation of government health insurance schemes or via other public subsidies. It says that DFIs are funding some of the world’s largest, most established corporate hospital chains – helping to further the wealth of some of the richest men on the planet while turning their backs on those most in need of healthcare access.
• Oxfam says that when aid is directed to strengthen free government healthcare it has been shown to work to slash unnecessary deaths especially for women and children. In the lower-income countries who’ve done the most to stop the poorest women dying in childbirth, 90 per cent of healthcare comes from the public sector.
• Oxfam also published a report today looking at the support to private healthcare provision in India by the World Bank’s private sector arm, the International Finance Corporation (IFC). The report, First, Do No Harm, says the IFC’s support for healthcare in India is failing on many levels, resulting in widespread patients’ rights violations. It says that not only does the IFC fund primarily expensive and out-of-reach corporate hospitals and other facilities, but there is also evidence that those hospitals are causing harm.
• BII uses UK aid funding and the BII’s existing assets to invest. The FCDO, on behalf of the UK Government, is the sole shareholder of BII (formerly CDC Group plc). From 2016/17 to 2021/22, the UK Government allocated around £3.7 billion into CDC/BII. Source: https://researchbriefings.files.parliament.uk/documents/CBP-9560/CBP-9560.pdf
• UK bilateral aid to health decreased by 39% in 2021 compared to 2020 to a value of £970 million. Some of this is explained by a reduction in spending on COVID-19. Statistics on International Development: final UK aid spend 2021