A
government directive preventing departments from hiring or creating new posts
is leaving them understaffed and overworked to the point that children aren’t
being taught and people are dying.
The
cash-strapped Kingdom of eSwatini [Swaziland] has attempted to be “cost
effective” by issuing a directive to all ministries and departments that “all
vacant posts including creation of new posts and promotions across government
be frozen”, according to circular no. 3 of 2018, which had to be implemented
from 1 August last year, writes Magnificent Mndebele.
In a
nutshell, the circular meant that if a government employee dies, resigns,
retires or is transferred, vacant posts will simply not be filled. Civil
servants have described the decision as “suicide”. The heavily indebted and
understaffed departments of health and education were hit hardest by the
directive and have since collapsed as they “no longer serve their purpose of
existence”.
Too little state funding
Previously,
parents of learners in eSwatini had to pay school fees from primary to
secondary school, and sometimes up to tertiary level. In 2010, the government
announced that parents will no longer pay for primary education. According to
the eSwatini Ministry of Education and Training, there are 12 560 teachers
in 600 primary schools with an enrolment of 239 793 learners. When free
education was implemented, the enrolment of learners from grade 1 to 7 jumped
to 242 037 from 230 242 the previous year.
The
government spends between R650 and R725 a year for each learner. Parents only
pay for secondary education. The state takes care of orphaned and vulnerable
children in secondary schools through grants paid to the schools. But parents
who can afford it pay between R3 400 and R8 000 in school fees whereas
the government pays R1 905 to R2 500 for orphaned and vulnerable
learners between grades 8 and 12.
The money
received from the government “is a mini-skirt, and usually finishes around
October”, says Siphasha Dlamini-Madonsela, 52, a school administrator at Sigcaweni
High School, which is heavily dependent on the grants for orphaned and
vulnerable learners. Her school has 217 pupils, the majority of whom fall into
this category. Only 20 of the school’s learners have parents who can afford to
pay school fees, but they aren’t always able to pay on time.
Primary
and secondary schools are now struggling to pay their operational costs. This
has led to thousands of children from impoverished backgrounds being robbed of
a better future as schools have turned into “daycare centres instead of
educational institutions”.
Dlamini-Madonsela
says that since schools have started running out of money, some teachers are
expected to teach as well as scout for donations so the schools can continue to
function. “Most of the time we improvise. We’ve been turned into beggars
because we go to businesspeople to ask for donations,” Dlamini-Madonsela says.
“You are committing suicide if you keep a nation uneducated. You are saying
there’s no future in the country if you don’t invest in education of the
citizens.”
Swaziland
National Association of Teachers secretary general Sikelela Dlamini says some
schools can no longer pay for the basics, such as electricity bills, and that
support staff such as librarians, secretaries and cooks have not been paid
since the start of the year.
“In terms
of improvement and maintenance of the physical schools, it means there can be a
broken window and it will remain so the whole year because the teacher has to
prioritise between the structure and the imminent needs of a learner,” Dlamini
says. “There are kids who normally have their first and last meal at school.
This means that the teacher has to make sure there’s food to be eaten by the
kids. The situation is bad.”
Teachers
and other stakeholders worry that the quality of education in the country has
dwindled significantly.
“Swaziland
was ranked as one of the highest in terms of education, but now it’s not. The
rich teach their children outside the country. But the painful part is that the
average citizens’ children are forced to stay here because they can’t afford to
take their children to other countries where the quality of education is high,”
says Dlamini-Madonsela.
Aside
from permanently employed educators, Dlamini says only a third of the
4 000 contracted teachers in eSwatini have had their contracts renewed
since the freezing of government posts. This has resulted in a shortage of
teachers for some learners since the beginning of the year, despite being
expected to start writing trial exams in September.
Dlamini
says there are more than 100 teachers in the country that need debt counselling
and psychological help because their salaries, as civil servants, have not been
adjusted for the past three years despite an inflation hike of 20% in the
country over that period. “The effects are far-reaching and negative on both
learners and teachers … It is dangerous to keep a sick teacher at school,”
Dlamini says, commenting that ill educators are forced to continue working
because schools are understaffed.
The teachers
in need of psychological aid are suffering a double blow as they, along with
others in eSwatini who are critically ill, cannot rely on health centres and
hospitals in the country as they have become “slaughter houses” instead of
lifesaving medical institutions.
Shortage of medications
There are
five heavily understaffed government hospitals and six health centres in
eSwatini, which have to accommodate a population of about 1.3 million
people.
At the
Nhlangano Health Centre, about 130km from the capital city of Mbabane, there
are three crucial and frequently used antibiotic medications that haven’t been
available for the past two months. These injected medications include
ceftriaxone, which is used to treat a wide range of bacterial infections, the
cloxacillin injection is commonly used to treat infections of the skin, bone,
heart valves, blood and lungs, and the amoxicillin injection is for treating
ailments such as pneumonia, bronchitis, tonsillitis and ear infections.
Other
medications that have been out of stock include a broad-spectrum antibiotic
called fortified penicillin, plaster of Paris used to mould plaster casts to
immobilise broken bones and catheters for draining urine from the
bladder.
“There
was a woman who was crying that she can’t hold herself as urine was burning her
bladder. We told her we can’t help her because we don’t have catheters of all
sizes at the centre,” says one Nhlangano Health Centre nurse who spoke to New
Frame on condition of anonymity.
It’s not
only medication and injections that are unavailable, sometimes there is no food
for patients as the hospital kitchens have not received funds to buy
ingredients. Additionally, the cooks contracted by the government haven’t been
paid since October last year. In June, the administrator of the Nhlangano
Health Centre had to buy food for the patients over a weekend from his own
pocket after the cooks ran out of supplies.
The
situation at the Mbabane Government Hospital, one of the biggest referral
hospitals in the country, is equally menacing. Late in November and again in
June, the hospital experienced patient food shortages for two weeks. In August,
there was a shortage of simple things such as requisition forms, which patients
have to sign before X-rays can be done, prescription notepads and several vital
medications.
According
to senior staff at the hospital, the government has been redirecting medication
from rural health centres to the Mbabane hospital to try and prevent people in
the city from noticing that there is a shortage.
Health
workers in the country say the government has prohibited them from disclosing
the direness of the situation to patients. “You are caught in a dilemma, to
tell the truth or a lie. If you tell the truth, you might find yourself losing
your job. But because you took an oath to save lives, you then tell that person
the truth. If you see that this person can afford, we tell them in confidence
that in order to get healed, get such and such medication,” says one of the
senior staff members at the hospital.
Understaffed nurses and doctors
Apart
from the shortage of medications, the challenging working conditions and being
understaffed contributes to the inability of medical professionals in the
country to effectively attend to patients. At the Nhlangano Health Centre, at
least seven staff members have left since 2017 and only one person has been
hired, says the nurse from the facility.
In 2016,
a maternity ward was completed at the Nhlangano centre that needed at least 44
staff members to run it. To date, it hasn’t been opened. In February, eSwatini
Minister of Health Lizzy Nkosi came to the centre to command the hospital staff
to open the ward despite being notified that this wasn’t possible owing to the
shortage of staff.
Mbabane
Government Hospital is similarly affected by understaffing issues. Since June,
there has been a vacant sonographer post for someone who specialises in the use
of ultrasonic imaging devices to produce diagnostic images and scans. The
sonographer who left the hospital specialised in examining and diagnosing
pregnant women, by ultrasound, and vital organ conditions.
“She was
being overworked and she ended up resigning as she’d attend to about 800
patients per month,” says the senior staff member at the hospital, adding that
pregnant women who have to undergo ultrasound examination are transferred to
the Mankayane Government Hospital 57km away, where they are put on a
three-month waiting list.
“If the
ultrasound examination is required for urgent purposes due to a life-threatening
illness, there is a high chance that she will lose her life even if she’d have
survived,” says the senior staff member. “It’s more frustrating and so
depressing to see someone die knowing very well you’d have saved that life.
[Not so long ago] there was a shortage of oxygen, and we lost a baby.”
The
Mbabane Government Hospital’s outpatient department has one medical doctor and
two interns who attend to about 400 patients daily. “The doctor is not coping.
It’s become that instead of thoroughly diagnosing a patient, you are pushing to
finish the queue because if you take 10 minutes on one client, the ones waiting
outside will start complaining,” says the senior staff member.
Hospitals have become ‘slaughter houses’
The
shortage of staff and medication has led to a high rate of fatalities. In a
year, the Mbabane Government Hospital loses two infants on average in the first
month after birth, which is “a serious concern”. But in June, the
hospital lost 10 infants in this timeframe to neonatal sepsis, a bacterial
infection of the blood affecting babies up to 28 days old. This level of
fatalities has never before been recorded in the history of the hospital. Every
month, the hospital contributes directly to the deaths of at least 100
patients, says the senior staff member.
In June,
at least four older patients died because of the shortage of hypertension
medication at the Nhlangano Health Centre. In July, 66 children were diagnosed
with diarrhoea and six of them died. “A lot of under-five children are dying, yoh!”
says the nurse from the health centre.
“The
health system has collapsed. If you’re no longer doing your purpose of
existence, you are dead. We save lives. But now we can’t save lives, why we are
still existing?” asks the senior staff member from Mbabane.
This
article was first published by New Frame on
12 September 2019
See also
Up
to 200 Swaziland teachers ‘die of stress’ as schools meltdown due to economic
crisis
Number
of child deaths from diarrhoea in Swaziland rises
