E80M PLEDGED TO TRANSFORM MEDICAL STORES

MBABANE – Over E80 million has been pledged for the transformation of the Central Medical Stores (CMS) and supply chain management system.

This information was shared by the Minister of Health, Mduduzi Matsebula. The minister was explaining the processes that are in the pipeline to improve the availability of medical drugs and supplies in public health facilities. Currently, the CMS operates as a department of the Ministry of Health. In its transformation, the CMS would be a semi-autonomous entity. The transformation of the CMS is made to improve its efficiency.“This change will lead to increased efficiency, consequently positively impacting the buying of medical drugs and pharmaceutical products, strengthening security and management of stock and to do away with bureaucracy that affects service delivery, among others,” the minister said.

“Partners have pledged over E80 million for CMS transformation and supply chain management,” he added. This comes after the minister, two weeks ago, announced that Cabinet approved the transformation of the CMS to be a semi-autonomous entity. It was previously reported that there were suggestions to have CMS placed under the National Emergency Response Council on HIV and AIDS (NERCHA). The minister added that they have been working with the Global Fund and World Bank to fast-track the CMS transformation process.

Regulations

According to Matsebula, what they have done and also ongoing includes, reviewing procurement regulations and they are looking forward to regulations that will suit the procurement needs of the healthcare sector. He stated that through the Global Fund, a management firm is being recruited to lead the development of the CMS organisational structure, human resource recruitment, change management, improving skills capacity building and facilitate digital systems improvement. Adding, the minister mentioned that a legal drafter is being sourced for the development of CMS transformation regulations under the Health Act of 2023.In terms of controls, Matsebula said by March to June next year, systems control will be running fully. This system will track medical drugs from suppliers to the CMS, to hospitals, as well as the patients.

Further, all vehicles that will be transporting medical drugs and supplies will have been installed with cameras, to ensure that the medical drugs do not get lost in the process. The Minister of Commerce Industry and Trade, Manqoba Khumalo, mentioned that a consultant is already on the ground to ensure the transformation of the CMS. “The minister mentioned that CMS transformation has been funded by the Global Fund and there is a consultant on the ground to make sure that CMS is transformed. This will help hospitals and ensure that CMS manages the dispensary of medical drugs and supplies,” he said. Khumalo further stated that the CMS transformation will end the disconnection between CMS and public health facilities. 

“The acceleration of this initiative will help in particular in the issue of medical drugs and supplies. The disjoint between the two is causing the problem, because no one is accountable to each other at the moment, but the minister is sorting that out,” he said.  Noteworthy, in June this year, a Global Fund representative advised Eswatini to model the Kingdom of Lesotho’s CMS.  This was during a virtual meeting that was attended by the chairpersons of portfolio committees in Eswatini, Lesotho and Zambia.  On the other hand, the pledges towards the transformation of the CMS are against a backdrop of an alarming drugs shortage in the country.

Operations

As such, this publication, last Thursday, reported that the Mbabane Government Hospital had suspended surgical operations due to the shortage of pharmaceutical supplies. Due to the shortage of medical drugs and supplies, an ordinary liSwati needs to have at least E1 500 to be operated on in the country’s public hospitals. This is because of the shortage of drugs and medical supplies that haunts the country’s health sector. Some of the drugs and medical supplies that are constantly out of stock include those needed when people have to undergo serious medical operations in public health facilities. These include anaesthetic medication, bandages and sutures, among others. Due to the shortage of these medical drugs and supplies, patients are expected to purchase them from private pharmacies for the much-needed surgeries to take place.

Over a week ago, Maseyisini Member of Parliament (MP) Nokuthula Dlamini, moved that the minister of Health initiate an investigation to ascertain the causes of shortages of critical drugs and medical consumables for theatre patients, which among others, including reagents for pap smear and surgical sutures, also known as a stitch or stitches, which are used to hold body tissues together and approximate wound edges after an injury or surgery. The application generally involves using a needle with an attached length of thread, bandages (primapore bandages), Paracetamol IV Adco and other related drugs and medical consumables for theatre patients. The MP, who was seconded by Lomahasha MP Zanele Mashaba, further directed to table a comprehensive report detailing findings and lasting solutions to address the shortages.

Supplies

She added that there are no sutures as people have to pay up to E6 000 if they need to be operated on government hospitals. The MP said the sad part is that not everyone could afford it. Dlamini added that after operations, hospitals cannot clean the wounds because there is also a shortage of medical supplies used to clean wounds. An independant investigation that was conducted by this publication unveiled that the least amount of money that people who might need to be operated on in any government theatre in the country need, is not less than E1 500, to be able to buy all the medical drugs and suppliers that might be needed during the operation and aftercare, which is three to five days.

However, those who may need major operations will need way over E3 000. This reporter visited pharmacies located in Matsapha and Mbabane to get prices of the medical drugs and supplies that are a must-have for an operation to take place.  These are the very same drugs and supplies that are out of stock in most government hospitals. These include anaesthetic drugs, sutures and Paracetamol IV Adco. The first stop was made in pharmacies around Matsapha and Manzini. In five pharmacies, prices of the listed  drugs are not less than E1 500, excluding aftercare supplies.Some of the medical supplies are not available in some pharmacies. All five pharmacies that were visited in Manzini and Matsapha did not have primapore bandages. Primapore is an adhesive non-woven wound dressing ideal for use on large cuts and grazes. The highly absorbent and low-adherent wound pad maintains a good healing environment and ensures minimal pain when the dressing is removed.

Fixation

Primapore provides a secure dressing fixation and the soft material makes the dressing comfortable even on more difficult areas like shoulders. The protector paper of the dressing allows a quick application without the risk of touching the absorbent pad or the adhesive area.  It may be used as a secondary dressing over gels, ointments and other primary dressings and is individually wrapped and sterile. The only bandage that could substitute primapore is E586, which is a package of 20 patches. The Paracetamol IV Adco costs around E66.50 across the pharmacies. According to health practitioners, patients require not less than four bottles of this medication, which costs around E266. The most expensive of them all are anaesthetic drugs, that cost between E600 to E1 071, since they vary in strength. The prices around Mbabane are lower for some drugs, such as the Paracetamol IV Adco, as some pharmacies sell it for around E36.

Only one pharmacy in Mbabane had primapore and it cost E214 per pack and E51.50 each. Depending on the operation, this bandage needs to be changed at least twice a week.
This means someone who cannot afford to buy a full pack at a go will need not to have less than E100 per week. On average, emaSwati who require surgical services in public hospitals should have money that is way above the lowest paid worker in the country. The lowest paid worker, according to the 2023 wages council issued by the Ministry of Labour and Social Security, get E1 400. It is almost three times the elderly grant of E500 per month and almost four times the disability grant of E400 per month. According to the Eswatini Central Statistical Office (CSO), under the Ministry of Economic Planning and Development, approximately 59 per cent of the population lives below the national poverty line and 20.1 per cent are in extreme poverty.

The poverty is skewed towards rural areas than urban areas, at 30.3 and 5.9 per cent, respectively. The national population is projected to be 1 187 956, of which 43 per cent are children under the age of 18. Young children, zero to four years, constitute 12.2 per cent, while older adolescents 15 to 19 years are 10.9 per cent. Around 75 per cent of the population is concentrated in rural areas. The constant shortage of medical drugs and supplies in Eswatini’s public health sector does not depicts the universal health coverage. Universal health coverage means that all people should have access to the full range of quality health services they need, when and where they need them, without financial hardship. The issue of shortage of drugs and medical supplies is not unique to Eswatini, as the government of Zimbabwe also communicated the serious shortage of medicine and drugs in public hospitals. This has left patients in Zimbabwe at the mercy of private health facilities.

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