Phalala Fund’s E1bn debt tip of the iceberg

MBABANE – The gaps in terms of management and over E1 billion debt are but a drop in the ocean of the Phalala Fund’s troubles.

This was detailed by the Principal Secretary in the Ministry of Health, Dr Simon Zwane, before the Public Accounts Committee (PAC). He said although this was the case, a way to rectify that would be to ensure that emaSwati use more of the local medical services rather than those outside the country.

Principal Planning Officer in the Ministry of Health Dumisani Shongwe detailed that the debt accumulated by the Phalala Fund painted the country in bad light because service providers from neighbouring countries now regarded the Ministry of Health as unreliable in terms of payment.

In the Auditor General, Timothy Matsebula’s 2021 Financial Audit Report, the findings included that the fund had an overdrawn balance of E1 359 377 101.63, with no activities of income and expenditure. He further reported that the outstanding debts or unpaid invoices from the service providers for the fund were not disclosed or reported in the financial statements.

Shongwe said this then made it hard for the ministry to request for medical services from health facilities in SA or Mozambique due to a tarnished reputation in terms of delayed payments and debt.

“Our relationship with suppliers is bumpy due to the way we pay. The ministry has made the effort to devise strategies to decrease the debt the fund has accumulated. These strategies include localising the services, by supporting specialist institutions in the country, which would help us lower the debt we have with South Africa. Further, allowing off duty staff to assist in special care, especially theatre workers and prioritising imaging requests, and only accepting requests from specialists.” He further said using the BusaMed strategy, across all services, by sending a group of patients then paying for them before sending the next group.

How this will work is that while a group is being sent another will be issuing its payment to ensure that once it is the next group’s turn they are able to access the services having cleared payments.

“Tests where possible, should be done locally and to try and also follow Phalala regulations to the letter, such that emaSwati are the sole beneficiaries of this fund. We are looking at ensuring that those who are benefitting from other schemes allow those that only use Phalala to mainly benefit, in the spirit of solidarity,” he said.

Upgrading

Shongwe said it was also necessary for the ministry to look into upgrading the current Phalala regulations as one of the strategies to get out of the debt.

He said these were the strategies they were implementing this year in order to decrease the fund’s debt.

The PAC Chairperson Gege Member of Parliament (MP) Musa Kunene questioned the group strategy highlighted by the principal planning officer, asking what would happen to patients who were in a critical state yet they had to wait for their group’s turn. “If the critical patient is not in the group which will soon be offered services and then passes away, due to delayed assistance, in that case, are we still benefitting from the Phalala Fund?” asked the PAC chairperson.

Mangcongco MP One Boy Zikalala wanted to know who was the rightful person to determine if a person was liable to be included under Phalala services.

“For example, it is possible that the patients’ illnesses are not at the same stage, you find that one person might be sicker than the other. In that case how is it determined as to who is attended to first?” questioned the Mangcongco MP.

Selection

He further questioned whether the selection process was done by the ministry or outsourced.

Nhlambeni MP Manzi Zwane, in his submission, wanted to know if there were any emaSwati still getting assistance from Phalala Fund as the fund was now being considered an unreliable customer by neighbouring countries who Phalala is indebted to.

Allen Stewart, who is Lobamba MP, while debating the matter, questioned how the issue of people who already had medical aid or schemes would be handled by the ministry. Dvokodvweni MP Mduduzi Magagula said resolving to send the patients to receive medical services in groups was potentially detrimental to the welfare of emaSwati because those who might not be critically sick may be able to receive services while they are still cheap, but instead through this method they would have to wait until the illness advances, making the healthcare services expensive.

“There are patients that I know who were involved in a car accident and have not been given even a cast for their broken limbs but are simply prescribed pain killers. They are informed that they should go to Phalala, which is a struggle for them as they are currently admitted to Mankayane Government Hospital and are in excruciating pain. There is no cast cement to at least help treat them in the meantime,” said Magagula. He alleged that this was also a delaying tactic used to ensure less expenditure, by making it difficult for the patients to receive Phalala services.

The Accountant General Manqoba Dlamini, highlighted that as the Treasury Department they had a problem with paying Phalala.

Guarantee

“The loan guarantee which is attached against the person, you find that the bill becomes more than the loan guarantee, such that the person is rendered more service than was initially intended,” said Dlamini.

He questioned which controls had the fund put in place to ensure this did not happen going forward.

The Principal Secretary in the Ministry of Health Dr Simon Zwane, in reponse said what the fund was intended for, was being executed and even today, there were emaSwati who were benefitting from it.

“There are still gaps in terms of management, in that the money allocated to it is far less than what is needed by emaSwati who are sick. I want to highlight that there is change in this scale, as there are now more emaSwati who are receiving help in the country rather than outside.”

He said they were putting pressure to accelerate the process of emaSwati receiving medical assistance locally, because in this way we will be in better control than in a foreign land. Dr Zwane said there would be less talk about the Phalala issue if they worked on having services being rendered locally.

Treatment

“When speaking on BusaMed for instance, you find that you send 10 people to BusaMed, which says you can bring the people for treatment and then once they have been treated you will pay. they further say once government had paid the bill for the 10 people they can then accommodate more, however, this cannot be done if the ministry does not pay. We cannot control that and the only way to control it is to pay them as soon as they render treatment,” said the PS.

He said most of the health facilities in South Africa were not willing to offer services to patients using Phalala and this BusaMed situation was a negotiated settlement.

In response to the question of who refers a patient to Phalala, the PS said the healthcare system had levels and specialists after doing assessments.“Phalala facilitates the referral and has a committee which handles the referral and case managers,” he said.