All ministries are headed by ministers. In fact, the ministers are in charge. They call the shots.
They can initiate disciplinary proceedings against blatant indolent, obviously irresponsible or professionally, if not technically and tactically uncooperative controlling officers. They are Cabinet members. They hold a weekly meeting under the chairmanship of the prime minister.
Ministers have a privilege to address both Houses of Parliament on the performance of their ministries. They respond to questions and concerns from the legislators who represent the people of Eswatini.
Mind you, they are also members of Parliament who can lobby for legislative and technical support. They have access to His Majesty the King – the Head of State. Tradition has it that the head of an organisation is to take blame for underperformances, inefficiencies, incompetence or unresponsiveness as a quality of people. The leaders can only save themselves by identifying the culprits within their organisations and reprimand them for diverting the ship to the sea rock or causing it to sink. Likewise, when ministries perform exceptionally well, the ministers take the credit. Therefore, it behooves the minister to ensure the effectiveness of their ministries.
Where necessary, the minister must crack the whip, without destroying morale. Since integrity, good leadership and efficiency are a desideratum, Lizzie Nkosi, the Minister of Health, should be held responsible for not strengthening the health system. It is too late to fire her because she has one or less than a month in her office. For now, she must write a five-page letter to the King and prime minister explaining why she shouldn’t be reprimanded for inefficiency.
Her ministry is a total mess. The protest by patients, unprecedented as it were, is indubitably the final nail in the coffin. In fact, Lizzie Nkosi has made history for being the first minister of health to face a patience protest. I wouldn’t be surprised at seeing patients, on drips, marching to Nkosi’s Ministry of Health. Wednesday’s protest by patients was squarely directed to the minister and her ministry. Nurses and doctors have done the same. It’s unbelievable. They protested over the shortage of drugs and medical supplies. Unprecedented!
Without medical drugs and medical supplies, why do you open the hospital for service? At worse, the protest occurred at the Mbabane Government Hospital, the country’s major referral public institution. If there is a shortage of drugs at the Mbabane Government Hospital, it goes without saying that the situation is terribly bad at Pigg’s Peak Government Hospital, Mkhuzweni Health Centre, Mankayane Government Hospital, Hlatikhulu Government Hospital and other public health institutions across the country. Referrals to Mbabane Government Hospital are unnecessary because doctors have nothing to prescribe. They may find themselves prescribing fervent prayers.
Prayer is powerful and I believe in its outcomes, but we expect doctors to prescribe medication. I am aware of Cabinet’s collective responsibility in terms of Section 69 of the Constitution of the Kingdom of Swaziland (Eswatini). I cannot, however, nail Dr. Thambo Gina, the Minister of Economic Planning and Development for the Ministry of Health’s shortcomings. Administratively, the minister of health may be innocent, but politically speaking, she plunged the health sector into a crisis. I doubt the diehards of the Tinkhundla System of Government are happy with Minister Nkosi. Poor service delivery by the Ministry of Health is a failure of a political system. There is no substitute for life. Any effective political system focuses on health.
In order of importance, the Ministry of Health ranks No.1 in any government system. For the other ministries to deliver quality services to the people, the human capital should be healthy. For the Ministry of Education and Training to improve the literacy rate in the country, its personnel must be healthy. The key portfolios that received special attention during the tenure of office for the late former Prime Minister, Sibusiso Barnabus Dlamini, were the Ministry of Health and Ministry of Education and Training. That is why the National Emergency Response Council on HIV/AIDS is under the Prime Minister’s Office. NERCHA’s successes are not a closed book.
At its current worst situation, I wonder what Cabinet, in terms of Section 61 of the Constitution, reports to the King about the Ministry of Health. Section 69 (1) provides that “the Cabinet shall keep the King fully informed about the general conduct of the government of Swaziland and shall furnish the King with such information as the King may require in respect of any particular matter relating to the government of Swaziland.” The prime minister should act as fast as possible in assisting Minister Nkosi address the crisis in her ministry because Cabinet, if silent as it were, shall be held responsible for the failures of the health ministry. This is terms of Section 69 (2) of the Constitution of the Kingdom of Swaziland.
Section 69 (2) reads: “the Cabinet shall be collectively responsible to Parliament for any advice given to the King by or under the general authority of the Cabinet and for all things done by or under the authority of any Minister in the execution of the office of Minister.” The minister of health should take cognisant of the fact that the country, at the present moment, is expected to convince the nation that it is committed to Sustainable Development Goal Number Three (SDG3). SDG3 aspires to ensure health and well-being for all, including a bold commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030.
Based on the prevailing circumstances, I doubt the country is ready to attain SDG3 by 2030. When WHO’s fourth Cooperation Strategy for 2022-2026 was signed, the minister of health, in her foreword, stated that the Government of the Kingdom of Eswatini was committed to improving the health and well-being of people of the country by providing preventive, promotive, curative and rehabilitative services that are of high quality, relevant, accessible, affordable, equitable and socially acceptable. She talked about SDG3, pointing out that it ensured healthy lives and promoting well-being for all at all ages.
The minister said government recognised that “improving health outcomes” would be achieved through “strengthening health systems” towards universal health coverage, addressing socioeconomic and environmental determinants of health as well as protecting people from health emergencies and leaving no-one behind. It is apparent to all of us that the health system in the country has collapsed. The former health ministers, Dr. Phetsile Dlamini, Dr. Derek von Wissell and Dr. Fanny Friedman (MBE), who excelled during their tenure of office, are supposedly unhappy with the performance of their former ministries.
When presenting the country’s national budget for the current financial year, the Minister of Finance, Neal Rijkenberg, said the Ministry of Health acknowledged the good fight against HIV and AIDS.He said government was planning to enrol even more HIV positive patients on ART by at least 1 974 patients by March 2024. That meant that targeted HIV positive people on ART would be increased from 204 483 in September 2022 to 206 457 in March 2024. At the current pace and determination within the Ministry of Health, I doubt again if this feat would be realised. Rijkenberg announced that the targeted HIV pregnant women on ART would also be increased to 98 per cent by March 2024 whilst TB success rates were to be increased from 84 per cent in September 2022 to 90 per cent in March 2024. I am looking forward, and I hope there would be no manipulation of figures to ‘cook’ success.
The minister of finance mentioned in his speech that the burden of Non-Communicable Diseases (NCDs) was increasing and required that every citizen followed a healthy lifestyle. He disclosed that the ministry continued to see the dominance of NCDs in the number of cases that the health sector transfers to hospitals within the Country, and to South Africa and Mozambique through the Phalala Fund. The decentralisation of NCD services has seen an increase to 212 of the targeted 229 primary health facilities. This is meant to diagnose, treat, or manage it early to reduce the burden so that there will be fewer complicated and costly cases to treat.
Underline this: “these commitments re-affirm the position adopted by Government a few years ago, that the health sector is a priority. Government has allocated E2.76 billion to the Ministry of Health.” If the health sector is practically a priority; why then patients protested over the shortage of drugs?
Rijkenberg conceded in his budget speech that despite positive strides in the health sector, government was still facing challenges to supply medicine effectively and efficiently to emaSwati. He also tabled a report that shed light on the problems the country is currently facing in the Ministry of Health on the supply of medicines to emaSwati.
The Central Medical Stores is not effective in terms of service delivery and integrity. The minister of health is in charge of this department. I can only prevail on the judiciary to preside over the cases of officers accused of maladministration in the health sector with the understanding that the health sector is collapsing. Judges should be made aware that human life is risk. The shortage of medicines in the public health institutions is a great cause for concern. It’s a national crisis. Technicalities and loopholes in the manner in which suspensions are being effected to correct anomalies are too secondary. What is of primary significance is that any officer who evidently contributed to collapse of the health system should be reprimanded and subsequently dismissed from the public service. Before this action is taken, the appointing authorities must deal with Lizzie Nkosi, the Minister of Health.
