MANZINI – In the heart of Eswatini’s industrial hub, a new kind of skyline is forming.
It is not made of factories or skyscrapers, but of the glowing green crosses of retail pharmacies.
In Manzini, a city of roughly 75 000 people, the proliferation of private pharmacies has reached an all-time high, prompting citizens to speculate on the reasons behind the trend, whether it is a sign of a robust healthcare market or a symptom of drug shortages in public health facilities.
Walking through the city centre, it is nearly impossible to go two blocks without encountering a pharmacy. For many residents, the sheer number of these outlets is a positive development because it creates healthy competition based on price and service.
However, others have expressed concern that when pharmacies become a lucrative business, it reflects deeper problems within the public health system. Some have even questioned whether the city has surpassed its saturation point. “Some of the shops that close down are replaced by a pharmacy, in most instances,” said Nomcebo Mkhonta, a regular commuter in the city.
“We used to have grocery stores and clothing boutiques; now we just have shelves of medicine. It makes you wonder why they are all rushing to open here.” According to many residents, the primary driver behind this boom is not a sudden entrepreneurial spirit, but the ongoing chronic drug shortages in Eswatini’s public health facilities. For years, government hospitals and clinics have struggled with stock-outs of essential medications, ranging from basic painkillers to life-saving treatment for hypertension and diabetes.
Some citizens are blunt in their assessment, claiming that the private sector is thriving because the public sector is failing.
“The pharmacies are taking advantage of the fact that the government has no drugs,” said Mfanzile Simelane, who claimed to have recently visited a clinic and returned with only half the prescribed medication.
“They know we have no choice. If the public hospital says ‘no stock’, I have to walk across the street and pay five times the price at a private pharmacy just to stay alive. They aren’t here to help us; they are here to profit from our desperation.”
Recent data suggests that the availability of essential medicines in the public sector remains significantly lower than the 80 per cent benchmark set by the World Health Organization (WHO), often dipping below 40 per cent for specific originator brands.
However, those within the pharmaceutical industry argue that the expansion is a necessary response to a global disease burden that has shifted dramatically since the COVID-19 pandemic.
Experts point out that the pandemic did more than introduce a new virus; it disrupted routine care for non-communicable diseases (NCDs) and contributed to a surge in mental health issues such as anxiety and depression on a global scale. “We are seeing a post-pandemic reality where people are more health-conscious, but also more chronically ill,” explained a local pharmacist who requested anonymity.
“The international disease burden has increased. We are seeing more cases of heart disease and respiratory illnesses that were exacerbated during the lockdown years. The demand is real; it is not just about public sector shortages.” As His Majesty King Mswati III recently issued a directive for government to end the medicine crisis, the future of some of Manzini’s many pharmacies hangs in the balance. “If public health facilities are fully restocked, will the city still need a drugstore on every corner?” asked a resident.
Bhekani Maziya, the Public Relations Officer of the Business Pharmacy Association of Eswatini, said he doubted the belief that pharmacies were proliferating because of medicine shortages in public health facilities. He said some pharmacy owners were previously employed in the public health sector and had consistently spoken out against illegally operated pharmacies. “I suppose they saw the loopholes and took advantage of them,” he said. Maziya said those who assumed pharmacy was a lucrative business would soon be disappointed. “They will get the correct picture and soon close down, because pharmacy must be a calling. We are not doing this for the money,” he said.
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