Times of Eswatini
Probe, recover E151.6m missing drugs - AG
MANZINI – As drugs and pharmaceuticals estimated to be around E151.6 million are either missing or unaccounted for; the auditor general (AG) says the Ministry of Health should investigate this to recover them.
The AG, Timothy Matsebula, in his proposal for a forensic investigation on the notification of suspected irregularities, as issued by his office on the acquisition and distribution of medicines to public health facilities, recommended that among other things, the Lizzy Nkosi-led Ministry of Health should investigate the missing stock and unaccounted for medicines, with the aim of recovering and reporting any unrecovered stock to the losses committee at the Ministry of Finance.
Matsebula reported that the total of missing and unaccounted for pharmaceuticals amounted to E151.6 million.
The AG reported that during the investigation he observed that there was missing stock of medicines and or unaccounted for pharmaceuticals amounting to E18 793 823.99 in the fiscal years ended March 31, 2021 and 2022.
His findings were that there was missing stock of medical drugs amounting to E5 977 042.11, which was made up of E5 848 589.89 in the fiscal year ended March 31, 2022 and E128 452.22 in the fiscal year March 31, 2021, as reported in the trading account.
It was said his findings further detailed that the financial statement disclosed the missing stock as a difference between physical count by the Central Medical Stores (CMS) and the Government Accounting System.
Matsebula was said to have observed that pharmaceuticals amounting to E12 812 281.28 which were acquired during the financial years 2020/2021 and 2021/2022 were not accounted for.
Theses pharmaceuticals, it was said, were either not recorded in stock record cards; had no stock cards to record the medicines on; the stock card balances and physical count balances were not tallying; or there were shortages in stock received.
He said when projected to the population of public health facilities, the total of missing and unaccounted for pharmaceuticals amounted to E151.6 million.
In light of these findings, Matsebula said: “The ministry should investigate the missing stock and unaccounted for medicines with the aim of recovering and report any unrecovered stock to the losses committee at the Ministry of Finance.”
He said the ministry (of health) should have a system that monitors the medicines from ordering, receiving, stores until dispensary to patients and that it should strengthen internal controls and implement monitoring controls to ensure that facilities adhered to regulations.
Furthermore, he recommended that the ministry should evaluate the use of the stock record cards and design controls which would help mitigate the risk of misuse of medicines in public facilities.
Also, the AG’s investigation recommended that a forensic audit should be conducted to ascertain misappropriated medical stock under the Ministry of Health.
Matsebula also recommended that the ministry should ensure that the CMS had adequate medicines to avoid stockouts at facility level, while also fast tracking the full installation and implementation of an effective inventory management system.
He said: “Enforce the reporting capabilities to give a comprehensive view of the current stock in the facilities. Facilities should make follow up communications with CMS whenever an order has been placed. CMS should ensure that medicines are delivered promptly to the health facilities, since the medicines are for essential use.”
Regarding the lack of proper systems to account for medication issued to patients, the AG recommended that the Ministry of Health should engage central agencies and its development partners to map a way forward on piloting and full implementation of the stock management system.
He said the system should then interface with the client management information system (CMIS) so that the stock issued to health facilities was accounted for and medicine issued to patients is traced.
Furthermore, he said in facilities where the system cannot be rolled out, a manual system should be developed where all patients attended to, at a particular date, were recorded, their prescription and a provision to show acknowledgement of receipt of all the prescribed medicine.
Also, he said the ministry should have an automated data system for the quantification, procurement, inventory control and distribution of pharmaceuticals.
In light of this, the Principal Secretary in the Ministry of Health, Dr Simon Zwane, was sought for comment on whether the investigation by the office of the AG had been tabled to the ministry and its findings.
Dr Zwane said: “The report was forwarded to the ministry. A recommendation to do a forensic audit was made and we are waiting to be advised on a way forward.”
It is worth noting that the perennial challenge (shortage of drugs and pharmaceuticals) has existed since time immemorial and has been a subject to various debates in the august House with some legislators claiming that the best solution to the drug shortage would be to pass a vote of no confidence on the 11th Parliament’s Cabinet.
This publication also reported its investigation on mushrooming one room retail pharmacies, which were taking advantage of the shortage of medical drugs in public health facilities.
Furthermore, there were cries from members of society, wherein they were bemoaning the shortage of drugs as they were offered prescription letters due to the shortage.
In light of this, at various instances nurses have picketed and also delivered petitions as they raised concerns that they were no longer able to render their services due to the shortage of working tools.
This is despite that the Ministry of Health is awarded the better share of the national budget. Despite government’s efforts to improve the availability of medication by adding 50 per cent to the allocation of drugs, the shortage was still there.
This is because the ministry at the end of the past financial year spent E1 035 147 109.43 on medical drugs with a recurrent expenditure of E884 368 584.22.
The 50 per cent is derived from comparing the two past financials which reflects an increase in the expenditure for medical drugs by E345 146 948.92. This is because the amount of money spent by the ministry on medical drugs increased from E690 000 160.51 (the expenditure in financial year ended March 31, 2021) to E1 035 147 109.43.
Last year, the Minister of Finance, Neal Rijkenberg, in his National Budget for 2022 allocation speech said: “The health of the nation is an important resource that the government will continue to invest in. In this regard, the government has allocated E2.42 billion to the Ministry of Health. This translates to about E2 069 spending per capita, putting us in the top 10 per cent of health spending in Sub-Saharan Africa.”