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MBABANE – Hundreds of emaSwati whose lives depend on Phalala Medical Referral Fund to foot their medical bills are at risk, as the fund has stopped new intakes due to financial constraints.

The fund, whose objective is to assist deserving emaSwati, who would otherwise not have access to specialised medical care, cannot perform its mandate, due to financial constraints.
Some of the specialised treatments are done locally in private hospitals, but in most cases, experts from neighbouring countries, in particular from South Africa, are often used. Alternative
This has led to hundreds of emaSwati, who require the specialists’ services being left to die or rather find alternative means to pay for their medical procedures. The non-performing fund affects the poor of the poorest, who cannot afford medical aid.

This occurs at a time when public health facilities are also facing a serious drugs shortage, which has led to the formation of a special task team to restore public healthcare. During a visit to the Phalala offices on Friday, which are located at the Mbabane Government Hospital, this journalist saw first-hand the hopelessness and plight of emaSwati, who desperately need the services of the fund. People who had come to seek the services of the fund, carrying referral forms from their doctors, left the offices dejected, after they were told that the fund was no longer taking in new applications. During engagements with some of the employees, it was revealed that the officers were idle most of the times, because the sole purpose of the office could not be served.

While the reporter was observing this, a woman and an elderly couple came in with forms to submit to the office. Another woman made enquiries about a child who required heart surgery outside the country. She was told by the employees that she would not be assisted as yet because the fund stopped over two years ago to take heart-related referrals to South Africa. Among the elderly couple, one needed the services of a local doctor, but required the fund to foot the bill. The employees received the forms but were heard talking among themselves about the plight of the patients. They rhetorically asked each other when these individuals would be assisted since the fund was as good as non-existent.


The disappointment was written all over the patients’ faces, as they left for the premises, passing piles of files, which were assistance request forms. It was gathered that the fund had not been taking new patients for over two months now (since December 2023). At first, they stopped taking those who required assistance in institutions outside the country. Currently, the fund is not even considering applications for referral to local doctors. Sources confided that the fund had a waiting list of over 150 people since its last intake last year. However, it was alleged that the list might be longer, because some patients had been on the waiting list even before the fund stopped entertaining the applications. It was further revealed by sources that there were suspected activities of fraud among some of the invoices that had led to the debt exceeding  E200 million, which is E50 million more than the annual budget of the fund.


The sources stated that some of the invoices were suspected to have been doctored or there were double payments that were made to some of the specialists. The sources said the investigation of the invoices might take longer, because there were a lot of them and there were many stages that needed to be passed. “It is unfortunate that the suspected fraudulent claims have left emaSwati to die,” said the source. According to a highly-placed source, the fund owes over E250 million in medical bills. As a result, specialists in South Africa no longer accept patients who come through the fund, unless at least 50 per cent of the bill could be paid up-front. The sources revealed that it was not only the specialists in South Africa who were sceptical of Phalala patients, but even those operating locally. “Would you continue to offer services to someone who doesn’t pay you?” asked the source.

It was further revealed that there were piles of files of applications for Phalala’s help. This is not the first time that the fund encounter challenges. At the end of October last year, a monthly management report of the fund showed that the debt owed to the South African health facilities had shot up to over E220 million. In August last year, 23 Phalala patients were stuck in South African hospitals without assistance, as government owed E181 million. The facilities included the Chris Hani Baragwanath Academy Hospital and Charlotte Maxeke Johannesburg Academy Hospital.


It was said both hospitals, including Concordia Lodge, where they were accommodated during the course of their treatment, were owed monies dating back to 2018. At the time, when the Finance Minister, Neal Rijkenberg, was asked about the payments not being made to the service providers, he said the ministry had submitted payments for Phalala Medical Referral Fund during the month of July, amounting to E58 million. In 2019, the fund owed SA hospitals medical bills estimated to be around E66 million and the waiting list was over 315. It was stated that some of the outstanding bills dated back to the year 2013. In 2014, the same occurred as the Phalala Medical Referral Fund was haunted by debts to the tune of nearly E40 million. The debts, mainly unpaid bills to health service providers, in and outside the kingdom, were accrued from the year 2008 to 2012. At the time, about 128 patients could not benefit from the Phalala Medical Referral Fund, as the State was defrauded E9 million due to multiple payments in the past three years.

Accountant General (AG) Phestecia Nxumalo, in her performance audit report on the utilisation of Phalala Medical Referral Fund at the time, said the State lost the money due to multiple payments. She mentioned that an estimated 128 patients (E8 990 882.92) could have benefitted emaSwati when using the average service charge of E70 000 per patient. Nxumalo said when reviewing the payment vouchers, auditors discovered that 297 invoices were double paid or even paid three times. The auditors discovered that payments amounting to E1 068 810.51 were overpaid for 2010/2011, while the 2011/2012 financial year was heavily overpaid with E6 412 264.62. She said 2012/2013 was the second most overpaid period, with E1 509 807.79.


MBABANE – The Ministry of Health Principal Secretary, Khanya Mabuza, confirmed that the fund was not performing normally and was not taking in new patients.

He said there was a huge backlog of cases and payments that they were trying to sort out. “We are verifying all the unpaid invoices and we are working on paying the debts of Phalala. Some of the debts are old. The Ministry of Finance is assisting us as well,” he said. The PS could not disclose how many patients were in the waiting list. He conceded though that there were indeed challenges in terms of having new patients, because the specialists needed upfront payments. When he was asked about the hundreds of emaSwati who have been left to die while they investigate the invoices, the PS said they tried to negotiate with specialists when there were extreme cases. “We negotiate for critical cases that need to be transferred outside the country and also speak to our local specialists as well,” he said.

The PS was also asked to; Enlighten the public on the duration for which the fund stopped accepting new patients? How many patients were on the waiting list? Provide an update on how much had been paid so far, and how much was remaining. If the ministry requested a supplementary budget to settle the debts to resume the acceptance of new patients? Provide an update on the suspected cases of fraud in the fund?


MBABANE – The Trade Union Congress of Swaziland (TUCOSWA) urges government to ensure that no one dies while verifying the invoices.

TUCOSWA Secretary General (SG) Mduduzi Gina said the Phalala Medical Referral Fund was a very good initiative, which was part of what they classified as quality public health support. “This means you then get to be referred through the support of the State for private attention, save that it appears that there is a threat that the whole health system and operations have been engulfed with corrupt tendencies,” he said. Gina said the irregularities meant that there was too much money that was not being supervised. The SG said it was depressing that while the ministry decided to close shop while verifying invoices, the most vulnerable class was left to die.“This is because it will only be the most vulnerable citizens who can wait for the fund to function again, because they would not have alternatives. Those who have alternatives would be treated,” he said.

The SG added that it was demotivating that the ministry would announce certain initiatives aimed at stopping activities that jeopardised the operations and performance of the sector, but there were no changes on the ground. He highlighted that currently, the ministry said it was saving the health system and delivering medication in public health facilities, but the nurses on the ground said there was still a shortage of drugs and nothing had changed. “While government is busy with whatever, please give the country confidence that people will not die. Government must do everything in its power to ensure that no lives are lost while verifying the invoices, which in our view are as a result of non-supervision,” he said.

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