Let's ponder on this

In recent months, the audit reports released by Eswatini’s Auditor General, Timothy Matsebula, have stirred controversy and scepticism in the public domain, raising pressing questions about transparency and accountability within government operations.

This growing uncertainty demands urgent and decisive action by the Government of Eswatini, guided by the leadership of the Minister for Finance, Neal Rijkenberg and Prime Minister Russell Dlamini. The establishment of an Independent Audit Review Commission, staffed by respected experts across multiple disciplines, emerges as the only credible route to resolving doubts and restoring confidence in the audit process and the institutions involved.

The suggestion for such a commission is neither frivolous nor an indictment of the Auditor General’s Office but a pragmatic recognition that only expert, impartial assessment can provide clarity in the midst of conflicting narratives.

This commission should comprise established forensic investigators drawn from the Southern African Development Community (SADC) region, chartered accountants, judges and other professional experts. Their mandate would be clear - to scrutinise and verify the audit reports thoroughly, conduct interviews with office holders within the Auditor General’s Office, implicated individuals and entities, members of the Public Accounts Committee (PAC) and actively engage with concerned stakeholders and interested members of the public.

It is only through this holistic and transparent process that the truth, freed from political connotations and public misconceptions, can finally emerge.

The urgency of this call is necessitated by the controversy surrounding Swazipharm Wholesalers (Pty) Ltd, a private company with a rich trading history exceeding four decades.

It is essential to distinguish between the company, Swazipharm and its individual director and shareholder, Kareem Ashraff. Swazipharm, unlike the sometimes-personalised critiques it faces, is an institution with a long-standing record of service to Eswatini’s healthcare system. Its role in supplying medicines to the Government of the Kingdom of Eswatini dates back well before the economic turbulence caused by cash flow constraints around 2011, when it often extended credit for critical medical supplies. Benedict Xaba, the former Minister for Health and current Clerk-to-Parliament, can bear testimony of the role this Matsapha-based company has been playing in the country since its inception.

Throughout the COVID-19 pandemic, Swazipharm proved indispensable in times when sourcing pharmaceuticals internationally was fraught with challenges. Dr Simon Zwane, former Principal Secretary in the Ministry of Health, can attest to Swazipharm’s pivotal role in securing medicines through established trade links that proved invaluable when conventional supply chains stalled.

Similarly, I am pretty sure that Lizzie Nkosi, then Minister for Health and now a Senator, can confirm the complexities faced in liaising with drug manufacturers. South African manufacturers prioritised quotas linked to larger purchasers, making it particularly difficult for Eswatini pharmacies and hospitals to obtain sufficient quantities of essential medicines.

Swazipharm’s intermediary function was, therefore, a vital lifeline for the country’s public health sector at a time when direct procurement was not feasible. However, this nuanced truth has often been overshadowed by the narrative shaped in some media and public forums, which wrongly attributes blame for drug shortages solely to Swazipharm or Ashraff.

The online backlash against raising legitimate questions about the company evidences how damaging single-sided media perception can be, especially when nuanced reporting is lacking.

As journalists ourselves, whose role is to objectively inform the nation, we too bear responsibility for the distortions caused. We failed to adequately clarify that the crisis involves a shortage of certain drugs rather than a blanket unavailability across all public hospitals – giving rise to a public misconception of a healthcare system in total collapse due to supply failure.

My own reporting encountered challenges in identifying specific drugs that were missing from public health facilities. This gap was distressing, as it complicated efforts to convey a clear and accurate picture of the health supply situation. Unfortunately, such ambiguities contributed to the impression, especially disseminated during the People’s Parliament in 2023 held at the cattle byre of the Ludzidzini Royal Residence, that no drugs were available at all in government hospitals. This was a serious factual inaccuracy, leading many to believe that patients were universally turned away or forced to buy medicines privately in town pharmacies.

I can fearlessly say that this perception does not wholly reflect reality. Direct experience, as well as testimonies from medical professionals, reveal a more layered situation.

Dr Comfort Shongwe of the Mbabane Government Hospital can attest that on occasions, patients, including my own family, received a variety of medications at government facilities.

One of my colleagues also recently testified that he was successfully treated there. These individual stories suggest that while many did obtain treatment and medicines, there remains an unresolved issue affecting access for some patients, especially those with particular health conditions.

Regrettably, for patients unable to receive their prescribed drugs from the public health system, the consequences have sometimes been tragic. I extend my deepest sympathies to families who suffered loss, potentially as a result of failure to obtain necessary medications. It is vital that this human dimension not be overlooked amid discussions of audits and corporate reputations.

Amid these complexities, it is important to reaffirm certain facts. Kareem Ashraff legally took over Swazipharm in 2023 and he has openly acknowledged as much in public fora, including a recent press conference. As a liSwati businessman, he exercises his constitutional right to freedom of expression and therefore deserves to be heard fairly and without prejudice.

Crucially, the auditor general’s report for 2021/2022 does not implicate Swazipharm or Ashraff in causing the health crisis. The report does not attribute the non-delivery of drugs to fraud, reminding us that such disruptions often stem from multifaceted supply chain challenges beyond mere corruption.

The failure to receive drugs may have numerous explanations. For instance, manufacturers—some based in India—may encounter production delays or logistical hurdles. It is simplistic and misleading to pin the blame exclusively on local wholesalers without accounting for these global complexities. This reinforces the need for an independent, expert-led review that can identify root causes clearly, free from political interference or media bias.

Eswatini’s struggle with drug shortages is unfortunately part of a broader pattern experienced by many African countries. In Botswana, a neighbouring country long regarded for its relative economic stability, intermittent pharmaceutical stockouts have caused concern in recent years, especially during the COVID-19 pandemic and its aftermath.

According to Botswana’s Ministry of Health reports, supply chain disruptions were compounded by global demand surges, manufacturing bottlenecks and freight delays.

Remarkably, Botswana’s government responded by reinforcing its Central Medical Stores (CMS), improving inventory management systems with technology and establishing direct procurement arrangements with key international manufacturers to circumvent intermediaries and reduce costs.

Last month, President Duma Boko approved over a billion Emalangeni (One Billion Pula) to address the issue of drug supply challenges or availability in the public hospitals and clinics.

Similarly, countries like Zimbabwe, Kenya and Nigeria frequently face medicine shortages despite their sizeable healthcare infrastructures.

Kenya, for example, has embarked on public-private partnerships to enhance drug procurement efficiency, deploying digital stock tracking tools and decentralised medical supply depots to reduce delays in distribution. Nigeria has recently launched efforts to produce generic medicines locally to lessen dependence on imports, striving to build more resilient pharmaceutical supply chains.

These examples illustrate that drug shortages are rarely isolated incidents, but rather symptomatic of systemic challenges ranging from fiscal limitations and bureaucratic inefficiencies to fluctuating global markets and geopolitical tensions affecting supply chains. Countries that successfully mitigate shortages do so through a combination of transparent governance, technology adoption, diversified procurement avenues and active stakeholder engagement.

What Eswatini can learn from its neighbours is the importance of transparency in procurement processes and open dialogue with suppliers and healthcare providers. An Independent Audit Review Commission, as proposed, would fit this mould by offering an impartial platform to scrutinise the current system’s weaknesses and recommend informed and practical reforms.

A strengthened and credible audit process can underpin confidence not only in drug supply but in the entire public health sector.

In light of these regional experiences, brothers and sisters, it is clear to all and sundry that while Eswatini’s pharmaceutical supply issues are challenging, they are part of a wider African health sector reality.

This wider perspective should curb undue stigma and direct energies instead towards collaborative solutions that improve accountability, efficiency and ultimately, patient care.

Despite being cited in the AG report, they have a right to question the audit queries. If people have a right to question the High Court judgments through the Supreme Court, the PAC must be also available for auditing clarity.

After all, we are a democratic society – thank you very much.  

Former Principal Secretary in the Ministry of Health Dr Simon Zwane. (Pic: Courtesy)