MEDICINES, DRUGS TENDERS: OVER 100 SUPPLIERS PAID E1.2BN

MBABANE –Is the investigation into the shortage of drugs being handled fairly?

This is because government, between 2021 and 2023, engaged over 100 companies to supply drugs to the public health facilities. However, it is not clear whether it is justified to single out one supplier for vilification. There is available evidence that over 100 companies were paid E1.21 billion to supply drugs and medicines for the fiscal years 2021 to 2023. In fact, government made about 122 payments. This is not to suggest that these companies did not supply the drugs after they had been paid by the Ministry of Health. It must be said though that all the audit documents seen and analysed by this newspaper indicate that these companies may also probably assist in the investigation into the shortage of drugs.

There are 10 highly paid suppliers, with E609.6 million being shared by eight companies unrelated to the one presently at the centre of controversy.  The auditing samples were for 2021 to 2023. In 2021, the singled out entity was paid E137 131 831.00 and E128.17 million for 2022 and E84.3 million in 2023.  In 2023, a sum of E300.7 million and E100.2 million were paid to other companies to supply drugs. Other two entities shared E57 million. Three companies had also shared E53.6 million in 2021. In 2022, three suppliers were paid E90 million to procure and deliver drugs to government. 

Pertaining to the list of 10 highly paid suppliers, there were 15 payments. Five were given to the most criticised company and its subsidiary. Ten payments were made to eight companies who make the list of the highly paid suppliers. On average, the over 100 companies were paid in the region of E50 000 and E10 million. It is not clear why one of these companies did not make the list of highly paid suppliers because it received a payment of E25 million. The least paid among the top 10 highly paid suppliers received E11 million.

Impeccable sources said the issue of drug shortage was complex wherein it may be cumbersome to narrow it down to the perceived failure to supply or deliver the drugs. They said, at some point, delivered drugs were allegedly stolen from the Central Medical Stores, with assertions also flying back and forth that certain officers at the public health institutions inculcated a culture of selling drugs and medicines to some pharmacies. “It boils down to the necessity to look at the issue holistically as opposed to adopting a narrative that narrow down the issue to one factor,” the source said.

A senior government technocrat said the drug shortage must be understood in the context of the Forensic Investigation Proposal and Audit of Acquisition, Distribution and Management of Pharmaceuticals, which Timothy Matsebula, the Auditor General, compiled and tabled by Neal Rijkenberg in March 2023. At that time, the technocrat said emaSwati were preoccupied with the civil unrest and assassination of Thulani Maseko and never bothered much to follow the issue of drug shortage.

“There were so many issues that were raised at that time which we didn’t notice because shocking elements, unprecedented as they were, diverted our attention to the civil unrest,” the source said. In the published report, Matsebula said pharmaceuticals amounting to E151.6 million were either missing or unaccounted for. Drugs valued at E9 308 963.02 for Mbabane Government Hospital were unaccounted for. On the other hand, the Pigg’s Peak Government Hospital did not account for pharmaceuticals valued at E2 283 688.91.

“It clearly shows that some drugs reach hospitals and get stolen,” the source said. Siphofaneni Clinic did not account for drugs amounting to E111 089.08 and Mpolonjeni Clinic had medical drugs valued at E45 990.19 unaccounted for. It was observed that there was missing stock of medicines and/or unaccounted for pharmaceuticals amounting to E18 793 823.99 in the financial years 2021 and 2022.It must be said that the Ministry of Health acknowledged missing stock of medical drugs amounting to E5 848 589.89. This was reported in the Medical Drugs Trading Account for the financial year ended March 31, 2022.

In his own investigation, Matsebula, the AG, discovered the following as some of the main causes for drug shortage in the country -  

• Weak information management systems;
• Weak manual control environment;
• Cash flow constraints;
• Human resource shortages due to hiring freeze and fuel shortages.

Theft of medical drugs is an old issue. In October 2018, medicines were stolen at Central Medical Stores (CMS) and police launched an investigation which resulted in the arrest of two civil servants. They appeared before the Matsapha Magistrate Court charged with theft of government medicines. Medical sterile gloves were also stolen from the CMS, resulting in the arrest of three other civil servants. Another two males were also arrested and charged with theft of government medicines from CMS.Our sister publication, Eswatini News reported in June 2023 that an internal report by the Ministry of Health revealed how medical drugs were being stolen by some employees from the CMS.

The ministry acknowledged that the theft of medical drugs resulted in the shortage of medicines. Two former employees of the CMS recounted during a probe instituted by the Health Ministry how they were able to steal medical drugs from the shelves without anybody noticing. The Ministry of Health had commissioned a team of three members to investigate the issue in terms of Regulations 41 of Civil Service Commission (CSC) of 1963 and A944 of Government General Orders.

A certain clerk was arrested for being found in possession of government medical drugs from CMS during a police raid in his rented flat in Matsapha. He allegedly revealed during the police investigation that he was working with others from CMS in the alleged theft of the drugs.“We mustn’t lose sight of the theft of drugs as well. It’s another serious cause for the shortage of drugs. Drugs are supplied and get stolen,” the sources said.Meanwhile, the names of the over 100 companies plus the top 10 highly paid suppliers cannot be mentioned because the audit documents do not indicate any wrongdoing, except that they show the taxpayer where his money has been spent.  

However, sources and analysts said, if all audit documents were carefully read and analysed, they would demonstrate clearly that the issue of drug shortages was complex and needed to be tackled fairly and holistically. For instance, the source took the Times SUNDAY to what Auditor General (AG) Timothy Sipho Matsebula queried at the Ministry of Health in his report tabled in Parliament. Matsebula said the Ministry of Health transferred funds amounting to E281 162369.68 from the Consolidated Fund to the National Emergency Response Council on HIV/AIDS (NERCHA) for the procurement of medical drugs (antiretroviral medications) in the financial year ended March 31, 2023.

A foreign company styled iPlusSolutions delayed the delivery of the medical drugs (antiretroviral) that were fully paid as an advance. “Do you now see the problem? A foreign company is also in the mix. It delays the delivery of the drugs despite the fact that it had already been paid,” the highly placed source raised this concern. For this newspaper to understand the issue, our sources tried to unpack it, now bringing a sum of E138 million to the picture. Matsebula had pointed out that the National Emergency and Response Council on HIV/AIDS (NERCHA) paid three advances amounting to E221.8 million to the foreign supplier mentioned above.

The crux of the matter is the undelivered medical drugs (antiretroviral) amounting to E138 611473.70. “It’s a concern that such issues are not flagged by the media. There is an audit query that some purchase order PO7278 had short deliveries amounting to E6 245 679.00,” the source said. Other orders had short deliveries of E48 million. “We never hear the media and critics in the civil society calling upon all the companies to account for the drugs, but only hear you nailing one or two of them,” the source said.

At some point, Matsebula, the AG, raised a concern that NERCHA, for instance, kept E138.6 million in the hands of a foreign supplier.   Expired and dumped medicals were also observed in several facilities such as the King Sobhuza Clinic, Lobamba Clinic and Mbabane Government Hospital. In an interview, Thembinkosi Dlamini, the Executive Director of the Coordinating Assembly of Non-Governmental Organisations (CANGO), said a forensic audit, naturally or ordinarily, “does not follow the person conducting the exchange but rather the transaction itself.”

He suggested that the starting point should decide what was a reasonable sample, say 10, 15 or 20 per cent of all transactions? “Once sampled, all in the sample are scrutinised, whether or not they followed laid down procedure and reasonability, i.e. whether the prices were not superficially inflated. If the answer is yes, a secondary enquiry would then look at the relationship between the role players who may include the company owners and the public officials,” Dlamini said. He said it was on the basis of the sample and finding of the 'smoking gun' that audit findings were being drawn.

The executive director mentioned that it could be the conclusion of the sample audit that a larger sample be done or a holistic audit be done. “It can be a race against time with scant  resources.  So, one cannot draft terms of references with 100 per cent sample size. What if after two years of audits and spending E2 billion you do not find nothing prosecutable,” he said. Dlamini said the audits may turn out to be like the South African State Capture Commission, yet another wasteful and fruitless expenditure that would not yield any investment return on the fiscus or value for money.

Khanya Mabuza, the Principal Secretary in the Ministry of Health, did not respond to our questionnaire, but this newspaper can reveal that the ministry suspended nine officers for issues related to drug procurement. The employees challenged the suspension in court. The Office of the Auditor General has published a statement clarifying its work. It said, as a supreme audit institution, it has noted with grave concern the ongoing baseless assertion made about the office. The AG Office says its audits are done to provide credibility  to the executive and confidence to the public at large. The AG said accountability, transparency, efficiency and effectiveness in the use of public funds are assertions tested and proven in an audit.  

 Four arrested for medicine theft in SA

 Sometime ago, four suspects were arrested for allegedly stealing and selling state medicine worth about E200 000 in the Eastern Cape, South Africa. Police arrested three women and a man. It was reported that some of the stolen medication was allegedly found at their homes. Police have been investigating, with the help of the provincial Health Department when it received information that medication meant to be distributed to state hospitals and clinics were being sold by the officials to enrich themselves. The medication was allegedly stolen from the department's depots in the province and sold to private doctors and pharmacies.

A 32-year old male was arrested in possession of presumably stolen anti-retroviral medicines on February 9, 2023 in Bergman Square near Bloemfontein. Members of Mangaung Metro Tactical Response Team operationalised intelligence on a suspect in possession of Anti-retroviral drugs with the purpose of selling them illegally. The team arrived at the identified house and conducted a search. Three boxes containing Adco Lamivudine, Zidovudine, Aluvia and Euthyrox bottles were found hidden under the bed and confiscated. The medicines had the name of pharmacy and prescription details. The value of the ARVs was estimated at E40 000.00 when sold in the streets. The 32-year-old suspect was arrested and a case of possession of presumably stolen property and Contravention of Medicines and Related Substances Act was opened at Bloemspruit Police Station.

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