Health Ministry’s unhealthy drama
Tdrama that unfolded in Parliament last Tuesday, during the first sitting of the Public Accounts Committee (PAC) was more confirmation that the Ministry of Health is disorganised. This is a pity because it is one of the most crucial portfolios of any government system – if not the most important.
Evidence of the glaring lack of coordination among the ministries structures has been widely publicised in the last decade or so. The last two or three years have been particularly worse. The issue of medical drug stock-outs has been publicised so widely that it is now boring to even read or hear about it. This is unfortunate because by now, we should have found lasting solutions to it.
In recent weeks, we have heard complaints from cancer, diabetes and hypertension patients. Renal patients who rely on dialysis to live from one day to the next have also been complaining of malfunctioning equipment in public hospitals closer to where they live. As a result, they have to spend hundreds of Emalangeni – money they actually do not have – on transport to ensure they get to where such machines are still operational. This is usually the Mbabane Government Hospital, which is itself regularly overwhelmed by the numbers of renal patients requiring use of these life-saving machines. Just this past Friday, the Times of Eswatini carried the sad story of patients on antiretroviral therapy (ART), who get their pills from the Luyengo Clinic.
The patients are supposed to get three months’ supply of tablets but of late, they are forced to visit this government health facility every month because they are only given 30 days’ supply. This obviously requires that they have more money for hospital visitations than they usually do. In public health facilities, ART drugs are usually given to patients at no cost, but they should have money for transport and related costs. As the media, we have seemingly been flogging a dead horse by reporting on these challenges and calling for solutions.
Many possible reasons for the chronic medical drug stock-outs have been peddled in recent years. Some people were even accusing the country’s leadership of using the money for other things. Minister of Finance Neal Rijkenberg put paid to these allegations at the People’s Parliament (Sibaya), in October last year when he said enough money was always allocated for the purchase of medical drugs, but the problem was emagundvwane (rats).
This was in reference to ‘human rats’ who have made the medical drug procurement system their cash cow. In the past week, we also learnt that a giant company was enjoying a monopoly of the medical drugs supply in Eswatini. Obviously, where there is monopoly, service delivery is always compromised. A couple of weeks ago, former Minister of Health Njabulo Mabuza also opened our eyes a bit when he revealed that Eswatini would always have drug shortages because of its size.
Mabuza said anyone who could stand up and promise that the country would have sufficient medical drugs would be lying to the nation. The former minister was a guest speaker at the birthday celebration of former Hhukwini Member of Parliament (MP) Saladin Magagula.
He revealed that Eswatini did not have a buying power and was always overlooked when orders were received by global suppliers. “For a country to have enough medical drugs, it has to purchase them from the global market in bulk. For a country to be made a priority, it has to have a large population. Eswatini has a smaller population when compared to other countries, so it is not prioritised.”
PROFOUND
Coming from a former minister who no longer has anything to gain – or lose – this statement struck me as profound. I recalled that immediate former minister Lizzie Nkosi had also alluded to this dilemma during the time of COVID-19. When healthcare workers were complaining about personal protective equipment (PPE), Nkosi mentioned that government had placed orders for same, but suppliers were prioritising countries with larger populations. This is apparently because they pay more and suppliers are always concerned about the bottom line, which is money in their bank accounts. As a concerned citizen, former minister Mabuza has added his voice to this dilemma.
The Ministry of Health, specifically and government in general, has many educated and experienced technicians and administrators. If they knew this challenge facing Eswatini as far as drug procurement was concerned, they should have found a solution. They should have long explored other alternatives to ensure that drug shortages are minimised. There should already be a system in place to ensure that the procurement of medical drugs and supplies is rotational in such a way that stock-outs never occur.
Now, after the drama that unfolded in the House of Assembly on Tuesday, when the PAC sat to scrutinise the ministry’s financial reports, I am not optimistic that we are about to see an end to the health crisis in Eswatini. It really does not look good because the ministry is itself in a crisis, administratively.
Ministry of Health officials, led by Principal Secretary (PS) Khanya Mabuza, showed up without the important documents required for them to take questions and provide answers. The PS gave a few reasons for their ill-preparedness, saying some of the senior officers accompanying him were still new, much like he was. He also said they had been unable to find some of the required documents. He said he had been afraid to bring half-done documents or ones that would not show a true reflection of what was happening on the ground.
Some of the relevant officials, like Director of Health Services Dr Velephi Okello and Acting Principal Procurement Officer Lovemore Magagula were also absent. PAC members took turns lambasting the PS and his team. They spoke about possible sabotage and wondered if the ministry came ill-prepared because it had something to hide.
MP Manzi Zwane hit the nail on the head when he said the PS may be new to his office but the ministry was not new. One cannot wait for the seven-day period the ministry was given, to see if the PS and his officials will make an impressive comeback from this rather embarrassing drama.