Seriously ill people, including cancer patients, in Swaziland / eSwatini are being denied life-saving treatment because the government had not paid its bills to hospitals.
At least E66 million (US$4.6 million) is owed through the government-funded Phalala Fund that pays for Swazi people to travel to neighbouring South Africa for treatment. Some of the unpaid bills date back to 2013.
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 size of the debt was revealed by Phalala Fund Administrator Thabsile Dlamini, following media reports in Swaziland that cancer patient were not being assisted by the fund.
The Swazi Observer reported that the E66 million owed was not the only debt, that included unpaid bills for optical treatment.
In 2017, the Swazi Government owed E170 million through the Phalala Fund. In March 2018 South African health institutions stopped giving medical assistance because of the unpaid bills and more than 100 people were immediately denied treatment.
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 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 the funding scheme, 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 the Phalala Fund provided a ‘blank cheque’ for South African doctors and hospitals: whatever amount they asked was paid 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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