By John Phiri
There are two inescapable conclusions about health minister Sylvia Masebo's enduring failure to supervise the chain for procurement and supply of adequate medicines and medical supplies to public health facilities.
The first one is that she seems to be a natural born expert in scapegoating. She has run the whole gamut of stakeholders, and heaped on them blame of various kinds in an attempt to explain the failure to manage the medicine supply chain since she was installed as political head of the Ministry of Health.
She has done this in order to cleverly absolve herself of any kind of responsibility for what is now roundly acknowledged as the crisis of shortage of essential medicines in public health facilities, which has become the subject of an unending public outcry.
But what is clear is that this whole saga of shortage of drugs has been fomented by her own characteristic belligerence and vindictiveness, which have been exhibited plainly in the major decisions she has taken in running the Ministry of Health.
Masebo first made people believe that the resident evil of the Ministry of Health was its whole procurement department, and, in short order, she unleashed on its offices a dramatic swoop by the Joint Investigations Team of police and investigative agencies.
All procurement department and related staff were sent on leave while investigators pored over documents to unearth what was expected to be the extent of the corruption Masebo alleged was being perpetrated in the drug procurement chain. The workers sent on leave continued to receive their full salaries and, to date, there has been no reckoning of whether the results of that operation justified the cost and drama. That probe whimpered to a close without a public statement of its findings.
Crucially though, this initial decision by Masebo sowed the seeds for what would become the full blown destabilisation of the drug supply chain. All the while Masebo displayed neither compunction nor understanding about the effect her actions would have on the critical issue of procurement of medicines for public health facilities.
Her pretence was that the unsettled and insulted procurement staff in the Ministry of Health were a dispensable cog in the wheel of drug procurement. It turned out they were not because shortages of medicines began to manifest shortly thereafter.
Added to her scuttling of the procurement department staff, Masebo also set upon pawing all over the new contracts for drug procurement and supply (as attested to by one permanent secretary), even as she pretended that the newly established Zambia Medicines and Medical Supplies Agency (ZAMMSA) was handling procurement operations.
Masebo also flatly refused to allow the ministry to procure some essential medicines that were already held in stock by some of the old suppliers for no credible reason.
Her masquerade was unmasked in the Special Report of a Parliamentary Committee tasked by the Speaker to investigate the growing incidence of shortages of medicines now constantly being raised by members of parliament. Despite Masebo's quarrelsome denialism, the Committee confirmed there was a crisis of shortage of medicines, manifested in the many stock-outs being reported, and also that since Masebo visited her brand of management at the Ministry of Health, procurement contracts had been cancelled nine times! The Special Report recommended that ZAMMSA be given true autonomy, rather than being left as a puppet agency whose strings were being pulled by the Minister of Health.
Stung by this recommendation, Masebo mobilised the base instincts of the ruling United Party for National Development (UPND) parliamentary caucus to vote to reject this Special Report which sought to help the country address the shortage of drugs that ordinary Zambians are still complaining about today. As the shortage of drugs persisted, Masebo clutched around for another scapegoat - drug supply cartels were working to frustrate efforts by the Ministry of Health and ZAMMSA to procure and distribute adequate stocks of essential medicines to public health facilities throughout the country. Just how these drug suppliers, whom Masebo had arbitrarily determined to exclude from drug supply contracts, would frustrate her ministry and ZAMMSA is unclear. It is all a ruse to divert attention of the public from her poor decision making and disastrous meddling in the medicine supply chain. But this drug supply cartel hoax also failed, especially after a hastily concocted television documentary, in which Masebo featured, recently bombed spectacularly.
Another one of Masebo's decisions that has contributed to failure to distribute adequate supplies of medicines to public health facilities thus far is her single-minded fixation on facilitating bulk procurement of medicines from Egypt. Masebo made people believe quick procurement of drugs from Egypt was possible by the end of last year or first quarter of this year because it was a "government to government initiative". Masebo simply refused to heed the advice of health and procurement experts who warned that this could not be consummated in the short term because of issues of lead times, and impediments of the bureaucracy in surmounting Zambia Public Procurements Authority (ZPPA) regulations.
Now the government may be forced to engage in hasty amendments to the ZPPA Act to remove "rigidities", as the final solution to ending this crisis of shortage of essential medicines in hospitals and clinics, regardless of the fact that this Egypt deal actually negates efforts of the European Union facilitated Zambia Pharmaceutical Manufacturing Initiative(ZPMI). Because the shortage of medicines in public health facilities has continued, Masebo is not done with her invention of scapegoats for failure by her ministry and ZAMMSA to make sufficient stocks of medicines available despite increased budgetary funding and timely disbursements of funds for drug procurement. Hence her latest, and most outrageous scapegoat to date - that shortages of essential medicines in public health facilities are being caused by theft of drugs by health workers, doctors, nurses, pharmacists and others.
According to Masebo many of the pharmacies that operate near public health facilities, are run by officers employed by the Ministry of Health, implying that the pharmacies are stocked by drugs stolen by health workers from hospitals and clinics.
This brings us to the second conclusion regarding Masebo and her unmitigated failure as Minister of Health. The reasoning that has made alleged theft of drugs by health workers the cause of shortage of medicines in hospitals and clinics is embarrassingly shallow.
Somehow, it is beyond Masebo to understand that security of product is also as much a function of managing the supply chain, as the procurement itself. At various points in the chain, there are parties responsible for the security of the procured products - at procurement, during freight, in storage, distribution, and final stocking in pharmacies at health facilities. Yes, pilferage does occur, but it cannot be on the scale of being the cause of shortage of drugs. If this were so, it would still be the result of failure by Masebo and her team to devise effective methods of securing medicines.
And, as Zambia Medical Association (ZMA) Secretary General Kaumba Tolopu said, the shortage of medicines in hospitals is so serious as to say "there is nothing to steal in the hospitals because the same medical personnel Masebo is accusing of stealing drugs have gone to the extent of donating their personal money to buy medicine in order to save lives." Tolopu said the shortage of drugs has persisted for over a year because the supply chain of medicines is broken and needs to be fixed, and that blaming it on health workers will not solve the problem of non-availability of medicines. The real question then is, who is responsible for this breakdown of the medicines supply chain?
From the foregoing, everything points to the Minister of Health, in which case it can be concluded that Sylvia Masebo has become the disease that currently plagues Zambia's public healthcare system.
Via The Mast Zambia