REVITALISE PUBLIC HEALTH UNIT

In light of changes in the global development assistance landscape, it remains incumbent on the country to ensure adequate access to health for all inhabitants of the kingdom. As His Majesty outlined on the Speech from the Throne, there is need to ensure that all emaSwati have access to affordable care. The government of the day must therefore make it a point that His Majesty’s aspirations are realised and in my view, this is a feasible endeavour that we can attain with optimal resources, far less than the reported aid from the United States (US) people figures. As a nation, we have weathered a number of pandemics and we rolled out an immunisation programme that got us close to 100 per cent immunisation coverage among our infants. This, we attained through an effective Public Health Unit (PHU), built on a resilient primary healthcare system. It is time to revert to the basics and strengthen local systems for vector control and outbreak preparedness. Granted, we will need support, but just optimal support not excessive support.

Public health unit

I recall back in pre and primary school, government rolled out an immunisation coverage programme. Staff from the PHU travelled around the country vaccinating and deworming all children in all schools. Based on my calculations, if the country were to revert to this model, we would need a modest E61 000 000. The calculations were based on a nurse’s salary of E18 000 and supposing we need 2 600 nurses to roll out the programme, a conservative estimate on the number of people we already have employed in the not-for-profit sector. We have 60 constituencies and if we allocate a couple of cars to each constituency for use by the PHU, we get E96 000 000 once-of expense.

It should be noted, however, that government already has some vehicles and it would not necessarily need to purchase this 120 fleet of vehicles. Annual fueling expenses and vehicle maintenance costs would be estimated between E45 000 000 – E75 000 000 based on a daily rate of E1 500 and or E2 500. This would bring the total costs of the shock absorption plan to E202 000 000 – E232 000 000. I contend that these costs can be lowered even further if we anchor the PHU strategy on the primary healthcare system and the Rural Health Motivators programme. I will elaborate further on this assertion as I delve into the primary healthcare system in the country.

Primary health system

According to the World Health Organisation (WHO), there are 215 clinics and outreach sites in Eswatini. Essentially, we have at least 215 nurses littered around the country. Taking advantage of these facilities would drastically lower the costs estimated above. Furthermore, we have six public health units already established in the country. If these figures are factored into the analysis, we may not even need to add 2 600 nurses to aid in the response. Realistically speaking we would need 1 000 – 1 500 nurses and the Human Resource (HR) cost would be E28 182 500, this figure excludes HTS counsellors since the nurses can handle this aspect.

Note that in the above calculations, HTS counsellors were included. Furthermore, there are 697 rural health motivators trained by the Ministry of Health UNICEF (2020) these can be upskilled to provide HTS services and do community follow-ups, taking up the role of linkage officers at a fraction of the costs and estimated annual costs would seat at E37 368 000, calculating monthly costs for each RHM. The total HR cost would be E65 550 500, plus E75 000 000 for transport and the total cost is E140 550 500. The lovely aspect here is the cadre would offer a broad range of services, not just for HIV services, but also to strengthen our public health system.

Resources

The main question that everyone reading this post is asking is where will we get the E140 550 500 or the E232 000 000.001? The country loses approximately E90 000 000 to corruption a month, a total of E1.08 billion per year, Inhlase, (2023). All we need do is tighten the screws on corruption and we would have that money, this excludes the efficiency gains that we would make if we restructured government machinery to get efficiencies. Elon Musk and Trump are on to something by setting up the Department of Government Efficiency.

Optimal aid

The Government of the Kingdom of Eswatini already allocates above E232 000 000 towards purchasing ARVs. The first line is purchased by government, however, our PrEP is purchased by donor funding and estimates show that there are approximately 27 000 people in Eswatini who are on PrEP and a cost of generic PrEP is estimated at US$40. Total costs for PrEP are estimated at E255 004 320 plus the cost of condoms which I have not been able to estimate because of a lack of data. A conservative estimate for required aid is therefore E370 000 00 not the E1 billion reported and if we close the taps on corruption, there would be very minimal need for aid towards health.

Sustainability

I contend we have the resources to drive to sustainability, we just need an optimal amount of aid to support our deficiencies. We must close the taps on corruption and grow the economy. We can only be sustainable if we look inward.

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