SPEED UP HEALTH SECTOR REFORMS

While an unknown cabal is giving our Prime Minister Russell Dlamini sleepless nights, about 950 emaSwati can hardly sleep due to job losses caused by the sudden cut to funding for the United States Agency for International Development (USAID), which is one of the numerous Executive Orders issued by American President Donald Trump.

The public is eagerly awaiting the grand plan from Hospital Hill on how it will mitigate this impact, but there is greater anticipation towards ensuring the provision of adequate healthcare services at all public health facilities countrywide. The public has been assured that critical services such as the provision of antiretroviral therapy (ART) will not be affected, as government had taken up the bill to purchase this medication. What of the other services like paediatric care? But most importantly, is there any relief for the hundreds of health and social workers who had been carrying out vital programmes in the communities to the relief of government?

Impact

Trump’s decision to significantly curtail USAID funding has had a profound and multifaceted impact on health services across African nations, including Eswatini. USAID has long been a critical player in global health, providing substantial financial and technical assistance to developing countries. Its mission encompasses a broad range of health initiatives, from combatting infectious diseases like HIV/AIDS and tuberculosis to strengthening maternal and child health services.

USAID’s contributions have been particularly vital in several critical areas. The agency’s funding has been instrumental in expanding access to ART for HIV/AIDS, reducing malaria prevalence through insecticide-treated nets and preventative treatments, and improving vaccination coverage for childhood diseases. Moreover, USAID has played a crucial role in bolstering healthcare infrastructure, training healthcare workers and supporting the strengthening of health systems. In Eswatini, for instance, USAID funding supported vital paediatric services, which contributed to essential healthcare employment.

However, USAID’s funding has not been without its criticisms. Some argue that its focus on specific diseases, such as HIV/AIDS, has sometimes overshadowed the need for strengthening broader health systems. Others have raised concerns about the agency’s emphasis on US-based contractors and its alignment with US foreign policy objectives. Additionally, restrictions on funding for reproductive health services, particularly those related to abortion and gay rights have been a source of contention.

Consequence

Trump’s funding cuts created significant disruptions in health service delivery across Africa. The immediate consequence was a reduction in essential healthcare services, leading to increased morbidity and mortality. In Eswatini, the loss of USAID funding resulted in the loss of approximately 954 jobs within the health sector, further straining an already burdened healthcare system. Paediatric services, heavily reliant on USAID support, have been placed under considerable threat, potentially reversing hard-won gains in child health.

In response to these funding cuts, we have seen affected countries implement various mitigating measures. Some have sought to diversify their funding sources by exploring partnerships with other donor countries, international organisations and private sector entities. Others have focused on increasing domestic resource mobilisation through improved tax collection and budget allocations. Several countries have also prioritised strengthening their health systems, aiming to improve efficiency and reduce their reliance on external aid.

What about Eswatini? The setback from USAID should motivate us to expedite the implementation of our health reforms, which face numerous challenges. One has been encouraged to see the arrival of a drug management system that is expected to alleviate stockouts and provide a more secure tracking of the drugs that are hard to find when patients need them.

Transparent

The procurement system also needs urgent attention to ensure tender processes are transparent, while allowing room for direct purchasing from manufacturers for critical medication. This concern was raised, yet again, in the Senate on Wednesday, with Princess Ncengencenge apportioning part of the blame to the Ministry of Finance for allegedly delaying the release of funds to pay suppliers that would ensure more efficient deliveries.
Neal Rijkenberg, the finance minister, refuted this, stating that the problems stem from the Ministry of Health’s decentralised drug supply system.
Another area of concern is the maintenance of healthcare equipment, which has resulted in patients having to wait weeks on end for specific machinery to be fixed.

Despite receiving the second largest slice of the national budget, the health ministry is strained in keeping up with its subvention obligations to some of its partners, such as the RFM hospital, which has resorted to increasing costs of services to try and stay afloat.There is a lot more. For now, Eswatini needs to engage with its partners at regional, continental and global levels to draw on their experiences to minimise the impact of the latest challenges that have plagued the health sector.

It needs to proactively diversify its funding base and enhance its domestic resource mobilisation strategies, as developed countries are also scaling down on foreign aid and diverting funds towards the military as the US stance on the Russia-Ukraine war is raising fears of a third world war. This is a time when our health ministry needs to explore innovative financing mechanisms, such as public-private partnerships, which could go a long way to mitigate the impact of reduced USAID. Time is of the essence.
 

Post your comment

Your name:

Your e-mail address:

Add your comments:

Please enter the code you see in the image:

Image:

Code: