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MANZINI - Patients of health facilities under the ENHI could be in for a shock as the institution is in the process of implementing reviewed user fees, some going up to 200 per cent.

Eswatini Nazarene Health Institutions (ENHI) is a major player in the health care sector in Eswatini as it services about 40 to 50 per cent of the country’s population. The ENHI health facilities include the Raleigh Fitkin Memorial (RFM) Hospital, which is located in the densely populated region of Manzini and about 20 other Nazarene Community Clinics, which operate across the four regions of the country. According to a source within the Nazarene health institutions, the ENHI management is in the final stages of finalising the process of reviewing its user fees. The source claimed that according to the proposal, which is still being deliberated upon, the increment could range between 50 and 200 per cent, depending on the services. Worth noting is that the source said the final reviewed fees would be implemented on August 1, 2023.


He said some of the departments which would be affected by the proposed changes include user fees at the Outpatient Department (OPD), which is paid by patients in order to access their OPD cards. It is worth mentioning that currently, patients pay E20 at the OPD. Again, according to the insider, at the theatre, the fees for major and minor procedures would increase. At the moment, he said a major procedure cost E150, while a minor one, like dislocations, among others, were done for E50. The source claimed that the ENHI management had covered a lot of ground in terms of engaging stakeholders. He said the final step which the management was working on, was getting an approval from Cabinet.

Meanwhile, ENHI Acting Chief Executive Officer (CEO) Dr Raymond Bitchong, said they were still finalising their stakeholder engagement regarding the matter. In that regard, he asked not to comment about it until they concluded their stakeholder engagements. When pressed further about the proposed fees, he said these were being reviewed and amended as they consulted the various stakeholders. He said it could be possible that any document that this publication might have received (regarding the proposed fees) was likely to be outdated and might misinform the public. “Once finalised, the revised fees will be displayed openly at our facility,” the CEO said.

He then highlighted that as an institution, they already issued a statement to inform members of the public about the implementation of the reviewed fees, starting from August 1, 2023.
In the statement, the acting CEO highlighted that they were in the process of implementing cost and revenue improvement initiatives. He said the institution was a non-profit public entity and had been operating under a major deficit for a long time. He said the inflow, which consisted of a subvention from government and other income (mainly patient fees), had been perennially lower than total operating costs. To make ends meet, from month to month, he said the institution had all along been using funds which were raised from default payments (pay-as-you-earn (PAYE), pension fund and the stretching of creditor obligations).

However, he said as the costs continued to escalate at a rate higher than income, due to recently enforced lighter controls by the Eswatini Revenue Service (ERS) and growing creditor demands, the institution had no alternative, but to implement stringent measures to reduce costs and increase revenue. In terms of cost reduction, the acting CEO said personnel emoluments at ENHI constituted the single highest cost at 73 per cent of total cost and 88 per cent of total income. He said due to this heavy weighting, the wage bill constituted a major portion of the savings required (five to eight per cent).

To this end, he said emergency consultations had been held with staff, covering those costs that had been prioritised for rationalisation, which included the outsourcing of staff transport, cleaning services and freeze on recruitment. He added that others included discretionary overtime, rationalisation of on-call allowances, reorganisation of wards to optimise service provision and other measures.  However, it is worth highlighting that the issue of on-call allowances is still pending before the Ministry of Labour and Social Security. The administration proposed that the payment of on-call allowances should be capped at 108 hours per month and if they had worked more than that, they would take the extra hours as days off. Another option that was put on the table was that if they did not sign for the proposal and worked over 108 on-call hours, they would get 50 per cent of the total claim. All along, they were paid for all hours worked. The medical staff challenged the proposal and approached the Ministry of Labour and Social Security for its intervention. “Other costs targeted for rationalisation include electricity, water, telephone and non-critical maintenance, among others,” Dr Bitchong said.


He added that optimisation of the benefits and savings from the Solar Energy Project also marked a key component of the targeted savings. After that, he said in order to achieve break even, the funds generated from cost savings would have to be backed-up by an estimated 90 per cent increase in the combined contribution generated from the income stream (patient fees, recoveries and other sources). He explained that while every effort was made to minimise the impact, their patients and the public were advised that the fees payable for services at the RFM Hospital and the 20 ENHI community clinics around the country, would be readjusted, effective from August 1, 2023.

SWADNU, MAWU frown upon proposal

MANZINI - The Swaziland Democratic Nurses Union (SWADNU) and Medical and Allied Workers Union (MAWU) have frowned upon ENHI’s proposal.

SWADNU Secretary General (SG) Mayibongwe Masangane said, according to their analysis, the management of ENHI seemed to be ready to steal from the poor in their quest to purportedly enrich themselves. He said government was subventing this entity using taxpayers’ money and if it was (allegedly) used to enrich a few, it meant stealing from the poor. “Paying for medication, mainly for non-communicable diseases as they trouble the elderly who have been paying taxes for a long time, is not right,” the unionist said.

In that regard, he said this was part of the capitalist agenda of privatising the health care system. On the same note, sources within MAWU said they believed that the ENHI, as an institution that was receiving a subvention from government, was supposed to be taking care of the poorest.