The Public Accounts Committee (PAC) has raised alarm over severe inefficiencies plaguing Eswatini’s public healthcare system, warning that failure to adopt proven regional and international practices is deepening the crisis.
Chaired by Madala Mhlanga, the 12-member PAC conducted a benchmarking exercise comparing Eswatini’s drug procurement and distribution systems with those in South Africa, Lesotho, and India. Their investigation uncovered that over E83 million worth of expired drugs accumulated at the Central Medical Stores (CMS) in just two years — a stark contrast to Lesotho’s National Drug Service Organisation (NDSO), which limits drug expiries to under three per cent annually.
The committee found that Lesotho’s health sector maintains a stable three-month drug supply and operates clinics round the clock with doctors available, unlike Eswatini’s overstretched facilities. PAC members expressed frustration that, despite several study visits and presentations to the Ministry of Health, implementation of recommended reforms has not progressed. 
The PAC demanded that the ministry provide reasons for the delays and submit a clear implementation timeline within 14 days.
In its report, the committee praised South Africa’s approach to drug procurement, which includes direct purchases from WHO-approved manufacturers, oversight by the South African Health Products Regulatory Authority (SAHPRA), and systems for tracking medicines and holding suppliers accountable for defects.
The inquiry also extended to India, from where Eswatini sources many of its pharmaceutical imports. Although the supplier under scrutiny did not appear before the PAC, members met with India’s Food and Drug Administration (FDA), which confirmed that under Indian regulations, manufacturers must reimburse governments for defective or recalled products — a principle seemingly neglected in Eswatini’s contracts.
Locally, the PAC’s site visit to Nhlangano Health Centre revealed a collapsing facility. The maternity ward and operating theatre have been shut for years due to structural issues. One of the two ambulances has been out of service for nine months owing to brake failure, and the centre often relies on well-wishers for repairs. Fuel shortages plague the only operational ambulance.
The PAC also found that the health centre has lacked a telephone line since 2019, hampering emergency coordination, while the Switch Board Operator post remains unfilled. Drug shortages remain widespread, with a storeroom piled high with expired medication. Staff were forced to stop dispensing aspirin and enalapril, citing safety concerns. The Ministry of Health only issued a public recall on the day of the PAC’s visit — prompted by the committee’s threat to escalate the matter to Parliament.
The PAC further noted that although the Nhlangano Health Centre is classified as a lower-tier facility, it now serves more patients than the regional referral hospital due to its TB treatment designation and the area’s population growth. Meanwhile, staff at the TB unit protested after being issued incorrect face masks, placing them at risk.
