Health financing, efficiency
ESWATINI runs a highly subsidised healthcare financing modality; given the socio-economic dimensions of poverty, income inequality and unemployment, a tax financed health system is better positioned in attaining the objectives of universal health coverage for all. The main problem with this avenue of financing is the over-reliance on government revenue, which remains vulnerable to fiscal shocks.
Also, in our current system, the management of healthcare and the health supply chain fall prey to the slow wheels of bureaucracy, with hospitals and other points of service operating as government departments. The cracks and inefficiencies in the system have become so apparent with the health sector, contending with crisis after crisis. A common thread in our health crisis is that of the Phalala Fund; consequently I am going to weigh in on this form of health insurance.
Resource pooling
Ideally a good health financing mechanism should incorporate resource pooling. That is, all beneficiaries should contribute something to the pool before they reap the benefits. One would argue that we all pay taxes, as such a tax-based financing system ensures both pooling in resource mobilisation and in extraction. This would be true if the resources were infinite such that extraction would be unlimited as well. However, we live in a world of finite resources and as a result it is imperative to rationalise the resource allocation. Also, there are multiple needs for public funds and those needs exceed the available budget on any given year. The health sector needs to mobilise resources in order to ensure the needs of the population are met. The Phalala Fund is crucial in ensuring that our health system attains the objective of universal coverage, however, something must be improved to ensure that the service is run efficiently.
Restructuring the fund
The fund must be restructured and totally removed from government to a private company. In my view, the government ought to transfer the running of the fund to a reputable fund manager and pay a small management fee. This will ensure that the fund operates efficiently, the key word being efficiently. The funds invested in the Phalala Fund should be made to go a bit further than they are at present. An alternative to appointing a fund manager is establishing the Phalala Fund as a fund and have it operate like a fund within the Ministry of Health. This would require hiring a fund manager with the relevant acumen and business management skills, equipping the office with aptly qualified finance personnel and case management personnel.
These officers will be charged with ensuring that all invoices are paid on time and the country can continue to refer patients to specialists who are not available in the country. The current trend should not be allowed to continue because the financial losses are too great. The sad reality of these losses is that every cent lost to inefficiencies within the fund has a direct implication on life, it is a direct cost of life. The continuous over-spending and invoice accumulation simply means while funds are being utilised to pay for services rendered in yesteryears, there are no funds left to save lives in the present year. The inter-temporal costs are too great on the lives of emaSwati.
Capitalisation of health sector
Restructuring of the fund must be in tandem with continuous capitalisation of the sector. The country should continue thriving to improve the capacity of the health sector. Data from the Phalala Fund should be analysed on an annual basis, with the view to understand emerging morbidity trends followed by congruent efforts to ensure that the high frequency referral disease areas can be treated and managed locally. This will grant some relief on the Phalala Fund and the resource requirements for external referrals. This will have direct impacts on the quality of life of emaSwati. This will also close the health divide in Eswatini.
At present, access to health is a privilege of those who earn enough to buy private healthcare, leaving a majority of our people without access. There is also a need to improve our health human resource planning; the country pays scholarships for a number of emaSwati, and these should be targeted at paying for skills and specialties we do not have in the country, including the medical specialties we lack. This is an attainable feet if one looks at the amount of money that is lost to corruption per year and other revenue leakages. Our suffering is really self-inflicted, yet we can do better.
Sustainable financing
The country needs to adopt the mentality of sustainable financing for all its developmental programmes. The government machinery must change to ensure adequate service delivery to the people. It is imperative that all decisions are appraised of how they will be sustainably financed. Also, we cannot even begin to talk sustainable financing until and unless the taps on corruption are closed. The vitality of our health sector and overall social provisioning in the country depend on our ability to close the taps on inflation and propping up efficient methods of executing the mandate of government; we can attain more with the current resources.