The protracted drug shortage crisis will only be resolved by fixing the nation’s broken medical supply chain before attempting any other major sectoral overhauls, says Ekuphileni Clinic Chief Executive Officer Dr Advocate Dlamini.
Dr Dlamini, a legal scholar, practising clinician and hocpital administrator, said the ongoing crisis could not be solved through piecemeal innovations or pilot projects if patients still arrive at public facilities to find no medicine available.
According to his assessment, government appears determined to modernise the sector, introducing reforms such as the Client Management Information System (CMIS), revamping the Central Medical Stores and engaging in budgeting reviews with global partners like the World Bank, but misses a key point, a sense of urgency in fixing the supply chain.
“If the health sector is to recover, it must be anchored in realism. This means facing up to the fact that while innovation is essential, it cannot substitute urgency,” he stated.
“The very first step must be to ensure the procurement system is functional, transparent, accountable and time-sensitive. That includes fixing tendering inefficiencies, addressing logistics bottlenecks and ensuring medical stock levels are monitored and maintained rigorously,” he added.
proposed
The proposed interventions to the health sector, Dr Dlamini said, while potentially transformative, are being layered onto a system that remains fundamentally broken at the base.
“Three years since the crisis first reached national prominence, the country’s health system remains dangerously unstable. Shortages of life-saving drugs, recurring stock-outs and weak distribution logistics continue to plague public hospitals,” he decried.
“This is therefore, why I strongly believe the problem lies not in ambition, but in priorities. For me, rather than rushing into systemic overhauls, government’s immediate task is to stabilise the fundamentals, particularly the procurement and distribution of drugs,” he added.
Dr Dlamini argued that without medicines on the shelves, even the best technologies and strategies are rendered irrelevant. The health system, he said, is akin to a vehicle that has broken down.
“To be busy polishing the dashboard and installing new gadgets while the engine remains inoperative doesn’t help.
“No amount of innovation will restore functionality until the supply chain, the very core of healthcare delivery, is repaired,” he stated, emphasising that he believes what has been missing throughout the crisis is a functional contingency mechanism to absorb this spillover.
He complained that instead of designing and implementing a survival framework to tide the public over, such as subsidies or negotiated private sector partnerships, government has allowed the public to absorb the full shock of system collapse, stating that this is not only avoidable, but inexcusable.
While he acknowledges that the ministry of health has faced persistent challenges, from underfunding to capacity gaps, Dr Dlamini said the country has had opportunities to address the crisis decisively.
Recent state borrowing, he said, could have been partly channelled towards bulk procurement of essential drugs or setting up emergency supply pipelines.
That no such decision has been made, he argued, reflects a misalignment of priorities.
“Eswatini has in recent years sourced loans for infrastructure, energy and other projects, yet health, despite its centrality to national development and social stability, has not received similar strategic intervention,” he highlighted.
explained
He explained that rather than attempting to push through a full sector overhaul while core components remain unrepaired, his view is that the State should have pursued a two-track approach: stabilise the existing system through temporary but effective survival mechanisms, and in parallel, continue building the long-term reforms.
The absence of such pragmatism, he warned, has placed the entire reform agenda under unnecessary strain.
“Policy initiatives, no matter how visionary, cannot perform under the weight of a system that is still bleeding. And when change is driven too hastily, simply to calm public anxiety, it runs the risk of producing weak and unsustainable results,” he said.
Dr Dlamini went on to emphasise that the impact of the crisis has not been felt by anyone more sharply than frontline healthcare workers, who, he said were already overstretched due to staff shortages and under-resourced facilities.
The loss of basic medical supplies, therefore, according to him, has stripped doctors and nurses of their last remaining tools of trade.
“Morale has plummeted, and the sector’s most committed professionals are left increasingly demoralised.Without medicine, their ability to diagnose, treat, and save lives is compromised,” he stated.
“For clinicians, a drug is not just a pill; it is the final link in a chain of professional duty. When it is missing, the entire health system collapses into a hollow shell,” he added.
Dlamini further contended that it is also time to treat access to health not merely as a policy outcome, but as a national emergency as public hospitals and clinics are the backbone of the nation’s health and wellbeing.
Eswatini Observer Press Reader
