POLITICAL GRANDSTANDING OVER DRUGS SHORTAGE

During an election year, politicians, specifically elected Parliament representatives, are known for grandstanding. They look at every issue with a hawk’s eye in order to strategically engage their target audience. With the country going through a medical drugs shortage crisis, one would have expected the same strategy, but there has been none. Not even reports to the effect that patients have had to leave their sick beds to join a nurses’ protest action in demand of drugs and medical supplies have triggered Members of Parliament(MPs) into action.

The House of Assembly Portfolio Committee on Health should have been at the forefront of this grandstanding. It is not a crime to grandstand. Instead, it helps address issues and it makes the politician doing it to look good. An August 2022 study by Ju Yeon Park on ‘Electoral rewards for political grandstanding’ found that not all grandstanding statements are cheap talk. Political messages typically conveyed in grandstanding statements tend to contain elements resembling electoral campaign messages such as position taking, advertising and credit claiming.

In many representative democracies, legislators sometimes focus on making political points rather than making policy. Previous studies assumed or argued that they do so in an expectation of gaining more votes in the following election, but this claim has not been studied systematically. By looking at data on legislators’ statements, Park’s paper demonstrates that US House representatives who made statements conveying political messages more intensely in any given two-year term tended to gain higher vote shares in the following election. This suggests that legislators’ grandstanding remarks, often regarded as cheap talk, can be an effective electoral strategy.

Additional findings suggest that donors respond differently to members’ grandstanding behaviour.  Park’s paper presents one primary argument: The political messages that legislators communicate publicly are likely to have electoral consequences. For politicians to stay in office and be reelected, winning the hearts and minds of voters is key.

Every year, Eswatini has to go through shortages of medical drugs and there seems to be no end in sight to this challenge, despite huge amounts of money being allocated towards solving this unending crisis. This time it has gotten worse just leading up to the all-important national general election. Milking it for what it’s worth would benefit both the politician and the voter. The politician would get the matter addressed and win the voter at the same time. This is a desperate situation and it calls for desperate measures.

Everyone and anyone cares about the country’s health system because it affects all of us. The Executive will always take advantage of the situation and present their own grandstanding, just like it has happened, by going on national radio to put a political spin on the drugs shortage. The Auditor General (AG), Timothy Matsebula, in his report on the ‘Audit of Acquisition, Distribution, and Management of Pharmaceuticals’ stated that the Government Accounting System showed that the Ministry of Health spent over E1 billion on medical drugs in the financial year ended March 31, 2021.

He was explicit in stating that there was then a need to ascertain why there were shortages of medicines when government spent these amounts.
Although he noted that medicine shortage is a global occurrence in the health fraternity, with Eswatini not being spared from such, he emphasised on the need to find solutions to this. Yes, there is an ongoing forensic investigation to try and get to the bottom of the causes and hold accountable those responsible for the mess, it is worth revisiting Matsebula’s findings of the audit that have rise to the forensic investigation.

His findings tell a gory story of the country’s medical drugs supply. You wonder how and why the situation has been allowed to reach these levels. Here is part of what Matsebula said: “Medicine shortage is affecting low, middle, and high-income countries. Eswatini has developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole country. There were efforts by government to try and minimise the problem. Nonetheless, despite the intervention of the Ministry of Health, the problem persists. Of concern is that the shortage of pharmaceuticals mostly affects public health facilities and this results to patients being referred to private pharmacies, who then provide the service at a higher cost than they could have paid in the public health facility.

The question then lingers, what causes the public health facilities to run short of the medicines? Medicines and medical supplies among other things by nature are complex, attractive, therefore, need stringent controls.” How did we get here, really? Just look at the below findings and ask yourself how and why the situation has been allowed to continue unabated:

1. Out of stock medicines in the health facilities
The stock verification revealed that there were medicines that were out of stock and had been out of stock for a long period, in the 29 health facilities visited. However, there was an increase in the expenditure of E345 146 948 92 (50percent), from E690 000 160 51 in 2021 to E1 035 147 109.43 in 2022. Further, there was also obsolete stock of medicine worth E18 291 701.96 for the financial years 31st March 2019 to 2021.
2. Unaccounted-for pharmaceuticals and medical supplies
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.
The audit unveiled that there was missing stock of medical drugs amounting to E5977 042.11: E5 848 589.89 in the fiscal year ended March 31st 2022 and E128452.22 in the fiscal year March 31st 2021, as reported in the trading account. The financial statement disclosed the missing stock as a difference between physical count by the Central Medical Stores and Government Accounting System.Pharmaceuticals amounting E12 12 281.28 which were acquired during the financial years 2020/2021 and 2021/2022 were not accounted-for. They were either: not recorded in stock record cards; no stock cards to record the medicines; stock card balances and physical count balances were not tallying; and shortages in stock received. When projected to the population of public health facilities, the total of missing and unaccounted-for pharmaceuticals amounting to E151.6 million.
3. Lack of proper system to account for medication issued to patients:
The audit revealed that there is no way to trace and account for the medicines issued by dispensary to patients. It is difficult to ascertain if the medicines reached the patients. This is seen as the most critical part of the process where the question can be answered if the acquired medicines were all issued to patients based on the prescription. The developed Client Management Information System (CMIS) does not interface with the Electronic Logistics Management Information Systems (ELMIS) to at least give reports on accountability of medicines.
4. No automated data system for the quantification, procurement, management, and distribution of pharmaceuticals:
There is no automated data system for quantification, procurement management and distribution of pharmaceuticals. There is no data system that provides quantities of medicines needed (what to order) and available in the health facilities.
5. CMS supplying already expired medicine to health facilities
It was discovered that the CMS supplied already expired medicines to the health facilities, which contributes to the obsolete stock at the facility. It was also noted that the expired stock in the facilities is not disposed of timeously.
6. High volume of expired medicine/obsolete stock:
It was noted that there were high volumes of expired medicines (pharmaceuticals) without records. Due to the unavailability of records and the manner the obsolete stock was stored the audit team could not quantify it (both at CMS and facility level). The obsolete stock, had been in the warehouse for +/-10 years without being disposed. These are just a few of the findings but they represent a situation that is already disastrous. Why then is the portfolio committee not making noise about such findings? Mduduzi ‘Small Joe’ Dlamini, the Chairperson of the committee should have woken himself up and got his team screaming at what the AG found.

But the sun is now setting on the current legislators’ term of office and we will have to wait for the next Parliament for any hope of action.
The outgoing committee has not done justice to the medical drugs shortage issue. They have just missed a great opportunity for valuable grandstanding.   

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