Masebo now has nowhere to hide
By John Phiri
When summing up Nellie Mutti’s tenure as Speaker of the National Assembly of Zambia , it will definitely be mentioned that she once appointed a parliamentary committee to probe reports of persistent shortage of drugs in public health facilities, which Health Minister Sylvia Masebo had spent nearly two years denying existed.
The report of that committee, recently made public, and already the subject of several media reports, paints an unflattering picture of Masebo’s stewardship, in which her greatest contribution is a dangerous bungling and disruption of supply chains for medicines, from which the government has not recovered since she strutted fashion-parade style into the Ministry of Health.
Essentially confirming that the unending public complaints of shortage of drugs and other medical supplies in public health facilities are true, the parliamentary committee observed in its report that deliveries of medicines to health facilities by the Ministry of Health supervised ZAMMSA, were insufficient, erratic and inconsistent.
National availability of medicines in health facilities, the Committe found, stood at 53.1%, which is far below the World Health Organisation (WHO) recommended stock availability rate of 70 – 80%.
The Committee found, through visits to health facilities, that essential equipment such as CT Scans, at tertiary and general hospitals, and x-ray machines in most stations were either not functioning or totally absent.
Perhaps the most critical finding of the parliamentary Committee was the fact that current procurement procedures had excluded most previous suppliers and manufacturers, who had both the capacity and experience in long term supply of drugs and medical supplies, and replaced them with citizen owned firms without capacity.
During this time remotely controlled ZAMMSA has contrived to cancel contracts nine times. This is what has resulted in supply rate of drugs and medical requirements being at barely 50% since the current government took over.
The Committee’s recommendation for mitigation this disastrous drugs supply situation is therefore inescapable:
“Citizen owned companies lack capacity to supply huge national requirements…One way to mitigate the current shortages is for ZAMMSA to consider renegotiating and reinstating the nine cancelled contracts, while at the same time building capacity of both ZAMMSA and new suppliers.”
For this to happen, the Committee further recommends, ZAMMSA should be given autonomy to operate independently without external influences.
But what makes the Committee’s findings most scandalous is the fact that these shortages have persisted in the face of adequate funding from the treasury.
Apart from the first quarter of 2022 when disbursement was delayed, supply of funds to ZAMMSA for procurement of drugs is currently up to date!
However, it is also be an indictment against the parliamentary Committee itself that in all its work, over the 10 days, it did not deem it fit to venture to visit any of the local drugs suppliers shut out of the current procurement misadventure.
For many observers, notably Socialist Party President Fred M’membe, have repeatedly said that the shortage of drugs has been largely caused by the refusal by Minister of Health Masebo to buy essential medicines in the warehouses of suppliers blacklisted for political reasons.
Was this a genuine oversight by the parliamentary committee, or was it an attempt to deliberately whitewash this probe?
What does all this mean, in terms of understanding the cause of this unfortunate shortage of drugs?
It has been caused by vindictiveness and incompetence at the level of political leadership in the Ministry of Health, and discordant relations among its technical-management staff.
And as admirable as the Committee’s work has been, much of what it found was already common knowledge among observers, and many of them had voiced concerns.
Remember ex-President of the Resident Doctors Association (RDAZ) Brian Sampa?
As early as March 2022, Dr Sampa had raised alarm over a new organisational structure under which heads of parastatals would report to the Minister of Health instead of the Permanent Secretary, and said the move was tantamount to turning the civil service into political bedrooms, as it would give too much power to the minister to manipulate statutory bodies.
The parliamentary Committee is obviously reticent about pinpointing out the manifestation of what seems to be clear manipulation by the Minister of Health, Masebo in the work of ZAMMSA.
To redeem themselves, or is it to be non-controversial, Committee members have no doubt found themselves recommending greater operational autonomy for ZAMMSA.
The question is whose hands should get out of ZAMMSA drugs procurement affairs, which have contributed to this embarrassing shortage of drugs in public health facilities?
The nature and substance of this meddling is also well known, and the government has so far failed to counter many serious charges.
Again, as early as March 2022, Socialist Party President M’membe had this to ask regarding the shortage of drugs, many of which could have been procured within the country:
“Why are they failing to truthfully and simply explain this drug shortage?
It cannot be denied that there’s a critical shortage of drugs in our health centres, clinics and hospitals.
And the government at the highest level has failed to truthfully and simply explain the reasons for this shortage.
Why is it difficult to truthfully and simply explain this drug shortage? Vested business interests. Our people’s lives are being sacrificed on the altar of business expediency.
The problem is indecision over who should be given the business contracts to supply the drugs.
We have a local drug supplier who is forced to send workers home because the government doesn’t want to buy drugs from the company.
The needed drugs are there in the country. It’s simply a question of not wanting to buy drugs from those who have them.”
The parliamentary Committee report has vindicated M’membe’s observations.
The Ministry of Health has had an agenda of focusing more on the identity of suppliers, rather than their capacity to supply or the lack of it.
But we have a point of disagreement with the Parliamentary Committee.
It is not the Zambia Public Procurement Agency Act, 2019 that has excluded most previous suppliers and manufacturers, in favour of “citizen owned firms” that lack capacity to supply the huge national requirement of drugs.
It is the decision of the political leadership, and it has now become a familiar theme of interaction between government and the business community.
This will clearly have future consequences for the government of President Hichilema, and for Helath Minister Masebo personally, for there is a human life cost to such alleged irresponsibility. Zambians and watching, taking stock of the impact of these decisions that have led to continuous shortage of drugs.
Dr Canicius Banda put this in quite stark terms when he discussed this:
“Unavailability of essential commodities, be they laboratory, medical or surgical, is a ’cause’ of death at health facilities.
A cogent case can be made that such deaths have occurred in Zambia since August last year. Zambia has among the best supply-chain managers in the world.
Ask the UN. So what then explains the current, protracted, non-ending and life-threatening shortages of drugs, medical, surgical and laboratory supplies in our public health facilities?”
His answer is simple: a government seeing corruption in every procurement process, began to repeatedly audit everything.
” Though audits are a required starting-point, undertaking for any newcomer, or new manager to any organisation, they need NOT disrupt ongoing supply-chain management.
This is where he failed. His accounting intervention led to chaos. His government, fueled by emotion and vindictiveness, bearing a jaundiced view of existing government systems, gravely disrupted the supply-chain management of these commodities for Zambia.
This political interference, though somewhat well-intentioned, is now the explanation for why someone has died and has been buried in Zambia today.
Responsible officers were fired. Supplies were stalled. New orders were not placed in time. Old suppliers were not paid. Procurement relationships were soured. Suspicion and fear became the norm.”
But if Masebo can be accused of interference and bungling, evidence shows that her boss President Hakainde Hichilema is guilty of poor supervision.
When reports of serious shortage of drugs first emerged, what was President Hichilema’s initial response?
Just as he had done for his Minister Stanley “Calendars” Kakubo , he went straight to the subject of the complaint to ask if it was true!
He went on a visit to the Ministry of Health where he declared his Minister to be very hard working, blah blah blah…
As observed before, he could have diverted his motorcade from his Community House in Chalala and passed through Chilenje Level One Hospital, to get a feel of the problem from ordinary people and staff, and then his courtesy call on the seemingly untouchable Masebo could have been more meaningful than a cheap photo-op.
Perhaps now that Speaker Mutti’s Parliamentary Committee has reported on this unfortunate matter, and whose report counts as an aberration on the government’s management of such a critical issue, will rouse President Hichilema from his election mandate-induced stupor.
What he needs to do is simple enough: eliminate political interference from the medicines supply chain, and follow the parliamentary Committee’s first, and key recommendation on mitigating or resolving the current shortages of drugs and medical supplies throughout the country.
In the Committee’s own words:
“ZAMMSA should put in place stop gap measures to raise the supply rate of medicines and medical supplies to above 80 per cent availability level.
One way to mitigate the current shortages is for ZAMMSA to consider renegotiating and reinstating the nine cancelled contracts, while at the same time, building capacity of both ZAMMSA and new suppliers.”
Drug shortages in public health facilities have been endured long enough.
This is an opportunity to end them and ease the suffering off ordinary Zambians.
Speaker Mutti has done her part in an effort to establish something very close to the reality on the ground. This effort must not be wasted.