Masebo brewing bigger disaster over drugs, not suppliers
By John Phiri ( the assertions in this article are the views of the author)
With the two service delivery fiascos already chalked up in the nation’s agriculture sector, there is cause for even greater worry that Minister of Health Sylvia Masebo is helping incubate a disaster to overshadow the current shortage of mealie meal.
Many are agreed that, apart from parading herself at every conceivable public function of the Ministry of Health, Minister Masebo is roundly considered to have already failed, and has remained planted in her cabinet job for the political consideration of maintaining the Lusaka Province support base for the ruling United Party for National Development (UPND).
Masebo seems more invested in the optics of media functions and an iron-fisted haranguing of technocrats in the Ministry of Health. The list of senior officers she will weed out of the Ministry structure is bound to keep growing, without regard to the negative impact this has on capacity of her Ministry to deliver services to citizens.
Periodically, the government releases impressive figures of disbursements of increased funds allocations for purchase of medicines and medical supplies, but this has failed to bring any appreciable improvement to the stock levels of medicines in public health facilities.
Earlier public relations stunts by the top government officials, notably that of Vice President Mutale Nalumango, are currently the butt of jokes about stacks of empty boxes set before cameras that have simply led to louder public cries about shortages of drugs.
Any listener to morning phone in radio programmes will attest to the fact that everyday there are complaints of patients with all kinds of illnesses leaving clinics and hospitals with prescriptions to buy medicines because public health facilities have inadequate supplies of drugs.
Shortages of essential medicines have now become an accepted fact of life in Zambia’s public health facilities in both urban and rural areas. Hospitals and clinics countrywide are now being forced to use operational grants and paltry income from user fees to buy some drugs from the local market to cover for the periods of acute shortages.
The Zambia Medical Association (ZMA), concerned that its members are being asked to attend to patients without the required supply of essential medicines, has been raising this issue consistently almost every week.
But they too now seem reluctant to discuss this issue and in the latest report, ZMA General Secretary Roy Tolopu said his group has been raising the issue of shortage of drugs for a long time and was now fatigued.
In the light of increased allocation of treasury funds to the Ministry of Health, particularly for purchase of drugs, it is surprising that procurement and delivery is still proving problematic. The question is why?
Part of the answer is a loss of confidence by the community of drugs suppliers, arising from unpredictable and the uncertain business environment created by the new Ministry of Health’s not-so-subtle interference in operations of the Zambia Medicines and Medical Supplies Agency (ZAMMSA).
Former Pharmaceutical Association of Zambia President Jerome Kanyika put a finger on this aspect when he said there is a dangerous standoff between ZAMMSA and drugs suppliers as the latter are reluctant to undertake procurement and supply of drugs because the tenders had become invalid due to the lapse of time.
Kanyika explained that prolonged evaluation of tenders had gone beyond the stipulated 21 days and gone up to 120 days, and as a result, the fluctuations in the exchange rate had affected the pricing of the suppliers’ bids, hence their reluctance to undertake the procurements.
What is the explanation for this prolonged evaluation process?
The Special Report of the Parliamentary Committee on Health on the Availability of Medicines and Medical Supplies in Health Facilities Countrywide, that Masebo fought so hard and managed to get rejected by Parliament, contains the answer.
The Committee found that ZAMMSA, apart from its general capacity challenges, has a specific major problem with decision making because of debilitating “external influence”.
This is the same influence that they found had resulted in cancellation of nine supply contracts by the Ministry of Health, without any mitigation plan being put in place; there was also no transitional procurement plan by the Ministry of Health for the responsibilities that shifted to ZAMMSA.
The Committee’s Special Report also proffered a solution – ZAMMSA should be given autonomy. Masebo said of the Report that she could not understand what autonomy the Committee was talking about, even when in one explanation for the shortage, technocrats had put it on record that she personally cancelled some contracts, and procurement processes had to be re-initiated.
From all this, the inference is that the shortage of drugs has everything to do with the management of the Ministry of Health and the decisions by the Minister, and has nothing to do with suppliers, whether old or new.
There is ample evidence that Masebo as Minister has been identified as being central to the Ministry of Health’s failure to resolve the problem of continued shortage of essential medicines and other medical supplies.
But since the drugs supply problem first surfaced, the United Party for National Development (UPND) government machinery sprung to Masebo’s defence, declaring satisfaction with her work. Her failure now threatens to engulf the whole goverrnment.
While all this was going on, Masebo decided that the solution to Zambians crippling shortage of drugs was in the hands of Egypt.
At first the Egypt adventure was styled as a stop-gap measure of bulk supply to be used to bridge the period of critical shortage now publicly acknowledged, and was expected to have materialised by end of last year, only to be deferred because of financial and bureaucratic requirements Masebo and team had failed, or refused, to consider.
Hence, after she went to Egypt to smooth over the process of this procurement, the team led by Presidential Adviser Roma Chilengi was dispatched, and ZAMMSA was directed to invite the bid from Egypt for supplies worth $70 million.
But there are two issues that will arise regarding the Egypt connection, military-run Unified Procurement Authority of Egypt, through which ZAMMSA will buy drugs from manufacturers, an arrangement for which this agency will receive 7% commission. The UPA itself was just established in 2019 to coordinate healthcare initiatives in Egypt.
The procurement is faulty as the agency is not manufacturer of medicines but is expected to contract other Egyptian companies to source medicines to supply to Zambia.
There is really no difference between ZAMMSA buying through the UPA of Egypt, which is not a manufacturer, and the old system where Zambian registered suppliers procured from Indian manufacturers.
Since ZAMMSA, under the new arrangement signified by the bid document, is not buying directly from manufacturers, there is, therefore, the special incentive that has convinced the government to take this route cannot be that of getting rid or middlemen. It must lie somewhere else and will certainly come to the fore in future.
The second issue that causes disquiet about procurement of drugs from Egypt, worth $70 million, is that the government is denying the country’s nascent drugs manufacturers the significant fillip of the required demand boost envisaged under the Zambia Pharmaceutical Manufacturing Initiative (ZPMI) supported by the European Union.
The ZPMI took a major step forward just a month ago when the EU brought European pharmaceutical manufacturing firms to partner with Zambian emerging drugs manufacturers. The opportunity cost of this $70 million procurement from Egypt will therefore be reckoned in lost impetus to grow local pharmaceutical manufacturing under this initiative.
It is disingenuous of President Hichilema and Minister of Health Masebo to proclaim that they are moving the country towards greater local manufacture of medicines, when they are spending the greater amount of drugs allocations simply shifting such dependency from India to Egypt.
Part of the rationale behind the EU supported ZPMI is that the Zambian government’s contribution to its actualisation should be to channel significant drugs procurement orders towards the few emerging manufacturers so that they can grow their production capacities.
This has not been done. Instead there has been demonisation of old suppliers, disturbance to the medicines supply chain, scattering of most senior public officers who previously managed the system, and heavy handed interference in the handling of tenders by ZAMMSA.
All these are reported to be the handiwork of the Minister of Health. The outworking of all these factors will not produce pretty results. Should these machinations backfire, its fallout will make the current shortage of mealie meal look like child’s play.