Hundreds of lives are being put at risk and at least three people have died because the Swaziland Government has not paid its bills to South African medical service providers.
This has led to health facilities refusing to accept patients under the Phalala Fund. According to the Times of Swaziland newspaper on Thursday (26 October 2017), the Swazi Government has unpaid debts of E170 million (US$12 million).
Patients on both the Phalala scheme and the Civil Servants Medical Referral Scheme are affected, according to the newspaper.
According to the Swaziland Government, The objective of the Phalala Fund is to assist deserving Swazi citizens who would otherwise not have access to specialist medical care to get it either, within Swaziland or “in special circumstances” outside the kingdom.
The newspaper said in the present financial year (2017/18), 455 Phalala Fund patients and 130 civil servants had been referred, several suffering from cancer.
There is nothing new in this situation. The Phalala Fund has been riddled with incompetence and corruption for many years. Many times in the past South Africa stopped taking patients because of unpaid bills. For example, in 2014 a Ministry of Health’s Senate Portfolio Committee Report said E40 million (less than a quarter of the present day debt) was unpaid and patients were being refused treatment.
In November 2014, the Accountant General Phestecia Nxumalo reported that the Phalala Fund had been defrauded of E9 million because single bills had been paid multiple times.
As long ago as 2006 a report published by the World Bank recommended sweeping reforms to both funding schemes, but these have not taken place.
The report said ‘only a tiny segment’ of the Swazi population benefitted from the large medical subsidy the government paid. It said there were no cost-effective guidelines so the fund could be used on patients who were too sick to benefit from treatment.
Also, fees and other prices were not negotiated before treatment and were ‘completely supplier-determined’.
The report concluded, ‘Thus the two funds provide a “blank cheque” for South African doctors and hospitals: whatever amount they ask is paid for by Government, since it has no recourse but to pay up.’
It also said that management of the funds were poor and it was easy to mistakenly pay bills more than once “due to multiple reminder billings”.’
The report recommended that as far as possible medical care should take place within Swaziland rather than outside using both public and private health facilities and investment should be made to make this happen.
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