HEALTH SERVICE DELIVERY

“THERE is no such thing as standing still; you either move forward or regress.” ― Bohdi Sanders. This quote resonates with the health crisis that the country has grappled with for over 16 months now. One might be misled to think that we are at a standstill regarding the status of health care in the kingdom.

The honest truth is we are undoing the decades and efforts invested in improving access to health care for emaSwati. We are brewing a crisis within a crisis. I say this because, for  the past couple of decades, we were vigorously dealing with HIV, and we have made marked attainments with 90/90/90 attained and 95/95/95 within our grasp. Epidemic control was near, but I argue it cannot be attained if our health sector is not able to respond. Also, the numbers show that non-communicable diseases (NCD’s) are on a surge. Hence we need a health sector that is able to respond to these challenges. Regression in HIV containment and failure to cure and prevent NCD’s precipitates yet another crisis, which will require even more investments than we are failing to make at the present moment.

Why?

One cannot avoid asking the question, why are we moving slowly in addressing the problem? Why are we not prioritising the lives of our people? Why is the very government that is doing good work in other areas watering down its efforts? I say this because, if this government purchases cars, or continues to engage in international diplomacy or infrastructure investments, the people view this as an insult. One cannot fault the populace for feeling insulted when the government buys a fleet of vehicles, while there are no drugs in hospitals. No matter how noble those efforts, they are just not primary to the people and the tax payers. What is primary to the tax payer is access to health and access to education - the very basic of human needs, basic functioning, nothing major. Hence, when other ministries utilise their budgets while the health crisis persists, the people will feel insulted. I call upon the government to exercise collective responsibility.

Collective responsibility

It is the responsibility of all ministers of the crown to uphold the government in good standing among the people. Furthermore, ministers of the crown understand that the actions of one reflect on the entire government. In that spirit, I call on all ministers of the crown to work together to ensure that public health facilities are adequately supplied. We are now in the 7th month of the 2024/25 financial year, what is the health budget doing? Is it even being spent? Is it still fair to the nation to blame the delays on supply chains, inefficiencies within the health system? I think not, this current Cabinet has had, at least, 12 months to deal with this problem, a whole calendar year, but still no tangible results. As a nation we cannot squarely place the blame on the Health ministry and the procurement challenges, ranging from the size of our orders to corruption within the supply chain.

Procurement

One understands the intricacies of procuring drugs, it is a norm that drug manufacturers will always prioritise bigger orders compared to smaller orders. We have the SADC Pooled Procurement programme. SPPS is an initiative that aggregates bulk orders from all SADC Member States, through negotiated prices and delivery conditions with manufacturers. Is this an avenue we have explored? This would have long fast tracked the procurement of drugs and other essentials within the health sector. We could have used other diplomatic relations such as asking to procure together with bigger countries.

I believe the procurement challenges would have long been circumvented if the government, through collective, responsibility was steadfast in solving the problem. I know of quite other such procurement arrangements that small countries are able to utilise, to ensure that they get a fair price and delivery of critical health commodities that we could have utilised as a country. We can even learn from private hospitals, they have never been barren of drugs yet their orders are likely very small, how do they procure?

Supply chain management

It is a common understanding that with the domestic health supply, the CMS needs to be realigned. The modality through which hospitals order drugs and inventory management needs to be improved. However, I ask what are we doing in the interim to ensure that, while we are fixing that which requires fixing, we have some semblance of operational feasibility. Where is the disaster or risk management plan? The government needs to do better, surely we can do better. In economics we always deal with assumptions, some which will be explicitly stated, while some will be implied. The lack of adequate action by government to address the problem implicitly implies that the value placed on the lives of the people is quite small.

Crisis

Can we even continue to call the inadequate supply of drugs and equipment a crisis? I believe not, this has just become the norm, the people will even doubt when eventually supply is restored.

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