An administrative error by Eswatini’s Ministry of Health led to critical shortages of pain and mental health medications. (Photo: iStock) Records and insider testimony from Eswatini’s main pharmaceutical supplier have revealed how a simple, avoidable administrative error by the government in 2023 probably led to a months long stockout of several critical medicines.
Following the error, the Ministry of Health suspended Fortunate Bhembe, the only official empowered to authorise controlled medicine imports, without preparing for the resulting disruption to the supply chain.
Leaked high-schedule stock cards from SwaziPharm — the Eswatini government's primary pharmaceutical supplier — reveal a dire shortage of essential medications between February and November 2024. During this period, stock levels for critical drugs used to manage pain, epilepsy, and psychiatric conditions remained at zero.
The affected medications included:
- Analgesics: Morphine, fentanyl, pethidine, codeine and dihydrocodeine.
- Neurological/Psychiatric: Phenobarbital and haloperidol.
SwaziPharm employees attributed these life-threatening stockouts to an administrative paralysis following Bhembe’s suspension. Because the ministry failed to appoint a successor or delegate her exclusive signing authority, the company was left without a valid pathway to secure import permits.
Stockouts in context
Since at least the mid-2010s, Eswatini’s public health sector has battled with repeated drug shortages. In recent years, this has led to civil society protests throughout the country.
In late 2022, the government commissioned Funduzi Forensic Services to conduct an audit into the country’s acquisition and distribution of medicines to public health facilities.
Drug stockouts in Eswatini have been attributed to non-payment of suppliers, weak procurement systems, and poor inventory control. The Funduzi report further highlighted procurement irregularities, evidence of possible fraud, and weak or ineffective internal controls across the supply chain.
The report was not without controversy. Funduzi was accused of having misled the government about its corporate identity and credentials. Some of the report’s findings have also been disputed by the World Health Organization.
Still, many of the findings and recommendations were accepted by the government.
An unintended consequence
Our investigation has uncovered a critical, unintended consequence of the Funduzi report’s findings. The report implicated several officials — including Bhembe — for “fruitless and wasteful expenditure”, alleging they had ordered surplus medications that were not in high demand.
Following these recommendations, the Eswatini government suspended Bhembe on November 7, 2023. However, this disciplinary action created an immediate systemic bottleneck: at the time of her removal, Bhembe was the sole official authorised to sign the import permits required for suppliers like SwaziPharm to bring controlled medicines into Eswatini.
In the aftermath of the Funduzi report, SwaziPharm donated its reserve stocks of several medicines — including morphine, fentanyl, pethidine, phenobarbital and haloperidol — to the government.
SwaziPharm spokesperson Shaun Morgan said, “We were dealing with the fallout from the leaked report, but with patients already suffering, we chose to act in the public interest.” The donations meant that the stock levels for several medicines fell to zero in February 2024, as reflected in stock records.
“Under normal conditions, closing stock never reaches (or stays at) zero because new deliveries continuously replace what is issued,” said Morgan.
“In a functioning system, stock cleared in January would be replaced through new imports. That did not happen, and that gap coincides with the suspension of Fortunate Bhembe.”
Bhembe’s position as deputy director for pharmaceutical services was only filled in September 2024, with the appointment of Nomsa Shongwe. This means that no one in government was able to sign for imports for 10 months.
The director of a medicines supplier, speaking on condition of anonymity, confirmed that there was no government signatory for the import of medicines during the 10 months.
Prolonged pain
Drug stockouts in Eswatini have a long and complicated history. But, the suspension of Bhembe — and the government’s apparent failure to mitigate against the dire impact that the removal of her signing power had on the country’s medicines supply chain — shows that sometimes easily avoidable administrative mistakes can deepen the crisis.
The impact is felt most by patients, often living in poverty, who are unable to access the medicines they needed to overcome debilitating pain and ailments.
A doctor at a major government hospital spoke about not having access to fentanyl and morphine injections, used to control severe pain after surgery, trauma and advanced cancer.
“There were times when patients who should have received proper injectable pain relief could not get it. We relied on weaker alternatives or asked families to source medicines privately,” the doctor said.
The result, he said, was prolonged pain and slower recovery.
Stockouts of phenobarbital, another of the medicines affected by Bhembe’s suspension, can have dire consequences for seizure patients.
“In seizure cases, delays [in administering medication to the patient] matter. Seizures can last longer or recur, increasing the risk of complications and longer admissions,” the doctor said.
Psychiatric care can be similarly strained by the absence of the correct medicines. The physician noted that haloperidol — a critical drug used to stabilise patients experiencing acute psychosis — was frequently unavailable to both him and those under his care.
“When it is not there, patients remain unstable for longer, which affects both their safety and that of staff,” he said.
Ministry’s right of reply
The stock records and testimony from suppliers suggest that the Ministry of Health made a grave error when it suspended Bhembe without a contingency plan for the national medicine supply chain.
However, the Ministry of Health spokesperson, Nsindiso Tsabedze, dismissed this and denied that the government was to blame for the stockout.
Suppliers, however, were unequivocal in their assessment, squarely blaming the ministry.
“You cannot remove a signatory without ensuring that the function continues,” remarked one supplier. “That is a basic systems failure.” DM
Sibusiso Dlamini is an investigative journalist at the Eswatini Observer, where he reports on politics, the environment, public procurement and public health, with a sustained focus on the country’s drug shortage crisis. He is the founder of The Open Word Podcast and is pursuing an honours degree in Journalism and Media Studies at the University of the Witwatersrand.
This report was produced by the Southern Africa Accountability Journalism Project (SA | AJP), an initiative of the Henry Nxumalo Foundation, with the financial assistance of the European Union. Under no circumstances can it be regarded as reflecting the position of the European Union.