THE HEALTH CRISIS

As one schooled in health economics, I am going to comment on the current health crisis in the country.

This is very concerning as it has profound impacts on access to health for the lower caste of our society, it amplifies the issue of the health divide that we are battling with as a nation. At the current state of affairs, access to health has become a commodity for the wealthy and reverses all gains that we had attained as a country in an attempt for universal health coverage. It has taken quite a long time for the authorities to fix the problem; and that is even more problematic.

The paradox

This crisis continues to afflict the country even in periods where one would expect the kingdom to be in a period of stability. I recall during the central bank’s post-budget summit, I posed this question to the minister of Finance; “Given that the ministry has tabled a fully-financed budget, has caution been made to ensure that expenditures tally with expected cash flows? And can the minister take the nation in confidence and assure us that the problem of drug shortages will not be experienced?” A few weeks ago, I was asked for a comment on the good news that government had settled all arrears owed to the private sector. My response was, it is a good thing for the economy as a whole, I only cautioned that this ought not to have been done at the expense of critical expenditures such as health. The public is made to understand that the current crisis is not primarily an issue of finances but rather an issue of inefficiencies within the procurement system. We have seen inquest after inquest and just ‘yesterday’ we were made to understand that a select committee of ministers has been set up to address the issue.

At what cost?

It is a known fact that fiscal policy tends to have a longer inside lag. It takes policymakers a longer period of time to formulate requisite policies. The cost of this long fiscal lag is huge on the population, the discussions and the inquests and committees are crucial, but what the nation needs right now are drugs within facilities, not discussions. These can commence while we have put stop gap measures to ensure that access to healthcare is restored to at least some level of functionality. The country has a number of development partners that it can use to aid get drugs in the country; I believe it is time the Ministry of Health ropes in the clout of those development partners, at least in the negotiations with suppliers to get a consignment of drugs in the country for the population to access proper healthcare.

The health divide

It is disheartening to note that this is a problem for emaSwati who cannot afford private healthcare. The private sector has drugs and other inputs they need to provide health to their clients, this is a problem that is felt by the large proportion of emaSwati who have to rely on the tax-financed public health system. History, and research in general, shows that problems faced by the poor are not addressed with the agility that is given to problems where the well to do have a stake. The fact that no concrete action has been taken to solve the current problem seems testament to that fact. The paradox I am battling with, though, is that the research also shows that during election years, the poor usually take priority because most of the votes come from them. I would have hoped that the problem would have been sorted by now, since we have already started the elections cycle, but alas here we are.

Regression

We recently received accolades for our efforts in attaining HIV epidemic control. On July 31 all PrEP in this country expired. One can only imagine the impacts this health crisis will have on new HIV cases, what measures have we put in place to ensure that this message is communicated to the population. It is imperative that we continue preaching the gospel of abstinence and or protection use. I do not imagine that it will be easy to get the PrEP dependent populations back to safe and protective sex. However, the fact that drugs go bad while in stock is a precursor to inefficiencies within our health system.

The inefficiencies

The current crisis has revealed apparent inefficacies within the Central Medical Stores and there has been a lot of finger pointing on who the culprits are and where the problem lies. The Ministry of Health has perpetually received a lion’s share of the budget and this needs to translate to efficient delivery. We need an external benchmark of an efficient health system and an internal benchmark so we can, as a first step, work towards internal efficiency benchmarks and then focus on attaining the externally benchmarked efficient health systems. I challenge the Ministry of Health to task itself with identifying areas of potential improvements through finding better and efficient means of execution.

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