Last month, a very unlikely Novel Coronavirus (COVID-19) patient walked through Yerer Hospital's halls. Yerer was the third private hospital licensed to provide treatment to the victims of the pandemic, a service that was previously limited to government-run hospitals and health centres in the country, though the new private options carry steep price tags that the average Ethiopian could hardly afford. The patient: a 60-year-old domestic worker.

Yerer, which is located in the Goro neighbourhood and has joined the ranks of Addis Abeba Silk Road and Hallelujah Hospital, was an option for those who were willing to pay for better care and attention than was provided at free government-run centres. The domestic worker, who wishes to remain anonymous, hails from a very modest background in the rural area of the country's northern region. Nearly 15 years ago, she came to the capital looking for work, and she found it in the domicile of a well-to-do family.

Over the years, she grew close with her employers, and their bond turned into one of family, a bond that would eventually help save her life. A family member in the house had tested positive a few days before she started showing symptoms herself. The illness would eventually require her to seek respiratory support, and the family took her to Yerer Hospital, where they paid an initial deposit of 90,000 Br. By the time she was discharged, 10 days of oxygen support, multiple laboratory tests, meals and other costs meant that the family had to top that up with an additional 30,000 Br.

Hers is one of the less shocking stories that would make the rounds in the city as people were reportedly discharged from private health centres with bills as high as 1.5 million Br. Initial deposits varied from one private health centre to another, ranging from 25,000 Br to nearly 300,000 Br.

Though intended to buffer and support the COVID-19 response, private healthcare providers' addition in the fight against the pandemic is turning out to be less altruistic than intended. The high bills come with an even longer list of justifications, primarily personal protective equipment (PPE), the cost of which is covered by the patient in care.

Face masks, face shields, hazmat suits and gloves are all tacked on to the bill upon discharge. Medication like Heparin, an anticoagulant prescribed for patients in critical condition, is valued at over 700 Br a pill while other commonly used ones are tallied around 300 Br. Risk pay for specialists like anesthesiologists, emergency specialists and internists is then added to the price tag, all before profit margins come into play.

At some hospitals like Addis Abeba Silk Road General Hospital, the costs run even higher as most staff live in a hotel to mitigate contagiousness, seeing as they provide around-the-clock COVID-19 healthcare. Silk Road, a Chinese-owned and operated hospital specialising in neurosurgery, was the first private COVID-19 treatment centre on the scene after signing a memorandum of understanding with the Ministry of Health to cater to high-end clientele such as diplomats.

The Hospital, built at a cost of 300 million dollars, originally opened its doors in November 2019 with acclamation from the then Minister of Health, Amir Aman (MD), who would leave his post a mere month before the pandemic dramatically altered healthcare both in the country and around the world.

In order to attend to needs arising from the pandemic, the Hospital shut down all other operations and dedicated its 100 beds to COVID-19 patients. Nearly 50 staff, physicians and nurses were relocated to stay at a nearby hotel, personal protective equipment was procured, and the Hospital even went as far as facilitating training and experience sharing by a team of Chinese doctors in April last year.

Its connections helped it source PPE relatively easier than other treatment centres. It provided disinfecting services to public health facilities and quarantine centres when they were still functional. Inadequate resources have since then forced the closure of all quarantine centres with only five public COVID-19 treatment centres still operating.

But costs were running very high for the Hospital itself, which had left its expensive, state-of-the-art operating rooms and diagnostic machines idle, according to Ruth Eshetu, human resources & administration manager at Silk Road. To mitigate the expenses, it contracted beds out to the likes of the United Nations and the Chinese Embassy.

The Ministry of Health then put a manual in place to involve the private sector in the efforts against the pandemic, which had an ever-rising number of positive cases, and as a response to patients who had the financial means for levels of personal care the government could not provide.

With nearly half of healthcare in the country provided by the private sector, engagement in COVID-19 care was unavoidable. Recently, Bethzatha General Hospital and the American Medical Centre have been added to the private COVID-19 treatment centres, bringing the total number in Addis Abeba to five.

But regulating the private sector in this regard would prove to be tricky, according to Yakob Seman, head of medical services at the Ministry of Health.

"We wanted to create a sense of confidence in the general public first before opening [treatment] up to the private sector," he said. With that in mind, training private facilities and slowly initiating them into the process through the provision of free testing centres was started.

The manual was set in motion last August to set a standard method of operation and to regulate COVID-19 treatment at private health centres with directions set to limit prices for treatment. The reviews on the price caps, which were based on price assessments conducted throughout hospitals in the city, were mixed. But even as operations commenced following the guidelines, complaints flowed in from patients who believed they were unfairly charged.

"There were centres operating within the legal lines but that were using other means to make more money," explained Yakob.

Laboratory test prices may have been regulated, but the frequencies would be manipulated, as assessments carried out by the Ministry revealed later on.

"Instead of running one test, they'd do five or six," said Yakob. The manual's loopholes were not taken for granted.

But the support was still substantial, explained Yakob, as it provided alternative options for treatment and elevated the image of the country. The complaints coming to the Ministry were handled through stern letters so as not to discourage efforts.