The Luke Commission into land acquisition while crying poverty

The Luke Commission into land acquisition while crying poverty

By Zwelethu Dlamini and Vuyisile Hlatshwayo

For the past three months, The Luke Commission (TLC), a faith-based health service provider, has been facing significant challenges. It recently announced a reduction in its operations, including scaling back from 24/7 service, and the layoff of over 160 employees. In response, TLC has been seeking relief funding from the government and international donors who have always supported their work, the minister of finance a former board member, has allocated approximately E30 million to assist the private health facility.

However, questions have been raised regarding TLC’s eligibility for this funding, as some critics suggest that the organization appeared to be doing well, offering transport reimbursement to some patients and expanding its departments. Additionally, over the past five years, TLC has reportedly purchased farms worth close to E10 million on Nkonyeni farms, totalling 101,0732 hectares in the Manzini District.

Critics of the relief funding process have labelled TLC’s financial challenges as self-made and accuse the organization of attempting to pressurise the cash-strapped eSwatini government to finance TLC to maintain its provision of free healthcare services and enriching its founders. An investigation by the Inhlase Centre for Investigative Journalism has highlighted these concerns. TLC was incorporated as a not-for-profit organization under Section 17 of the Eswatini Companies Act 2009.

The Ministry of Health has stated that it has a general Memorandum of Understanding (MoU) with TLC, which includes sharing medical drugs. This means the government offers TLC access to the Central Medical Store (CMS) whenever they are available, and TLC can share some with the government.

In several media statements and an interview with Inhlase, TLC has expressed a crisis due to financial constraints impacting its ability to provide vital healthcare. The organization stated that shortages in public health facilities have made TLC essential, but financial challenges have forced a significant reduction in services, leading to layoffs and turning away patients. This has deeply worried those reliant on TLC, prompting pleas for government intervention.

Despite facing financial struggles due to a gap between demand and available resources, inadequate external funding, and the emotional toll of downsizing on patients and staff, TLC maintains a commitment to patients by offering free healthcare and says it keeps transparent financial practices.

The organization’s accumulated debt during crises like the COVID-19 pandemic further complicates the situation, accentuating the need for urgent government collaboration, data-driven decisions, and efficient resource allocation.

TLC’s executive director, Echo VanderWal, emphasized the organization’s need to live within its means while appealing for collaboration with the government to ensure continuous healthcare. Former health minister Lizzie Nkosi criticized TLC’s management, stating that it was unprecedented for a healthcare provider to demand financial support from the government instead of continuing to offer healthcare services. She highlighted other healthcare providers, such as the Nazarenes and the Catholics at Good Shepherd Hospital, who have worked with the government for decades without resorting to similar actions. 

Sen. Nkosi dismissed TLC’s financial challenges as self-created and criticized the organization for paying patients to use its hospital, which she believes distorts people’s health behaviour.

During the visit to the state-of-the art TLC Miracle Campus, Inhlase was shown the vast land acquired by The Luke Commission in the past few years. Inhlase was also shown the ATM used by the facility to reimburse some “selected” patients. Additionally, Inhlase was shown the warehouses full of medicines and drugs that would last the hospital for at least three months. They were also shown various departments, including carpentry, drones, agricultural farms, mechanical, as well as the fleet of transport used for the outreach programme, to name a few. The oxygen plant and the Luvelo management system were also among the achievements showcased by the facility.

Nkosi found it strange that amid the dire financial situation, the TLC management had continued with the construction of new buildings and training institutions. Yet, they were crying out for money to cater for the ever-increasing number of patients. Inhlase’s investigation showed that The Luke Commission Swaziland Trust has been buying a lot of land. In 2018, they bought three large pieces of land from Nkonyeni Farms (Proprietary) Limited in the Manzini District. These purchases included Portion 7 of Portion 4 of Farm Nkonyeni III No. 523, which is 59.9165 hectares and cost E4,250,000. They also bought Portion 22 of Portion 8 of Farm Nkonyeni III No. 523, which is 1.5044 hectares and cost E100,000. Additionally, they purchased Portion 55 of Portion 1 of Farm Nkonyeni III No. 523, which is 22.1773 hectares and cost E1,550,000. These purchases were made from Johan Jacob Rudolf, the director of Nkonyeni Farms (Proprietary) Limited.

In 2019, Kevin Michael Millan Ward, a trustee of The Luke Commission Swaziland Trust, signed a certificate of consolidated title. Another trustee, Harry Ralph VanderWal, who is also the Chief Medical Officer, signed three certificates of registered title. These certificates serve the same purpose as deeds of transfer to prove land ownership. The additional portions of land were mortgaged for E3,000,000 and an additional amount not exceeding E600,000. In total, TLC invested E9.5 million in six farm portions measuring 101.0732 hectares. 

However, attempts to get clarity on the land acquisition from the TLC management were unsuccessful as a questionnaire sent to the TLC management was fobbed off with the communications officer claiming the questionnaire “focuses on matters of internal and classified to the institution as well as matters and others entities.”

In addition to the state-of-the-art Miracle Campus Hospital, TLC also invested in the construction of the Training and Leadership Centre of Excellence (TLCE). This centre is well-equipped with modern technology and facilities for various events but the management did not explain how these investments affected TLC’s finances.

The executive director blamed its ‘dire financial situation’ on lack of financial support from the health ministry. She complained bitterly about the exclusion of TLC by the Lizzy Nkosi-led health ministry administration from funding opportunities offered by the international partners such as the Global Fund and World Bank. TLC, she claimed, served 300,000 people, but only received less than 2% of eSwatini’s allocated healthcare resources. She pointed out that TLC continued to get support from donors, but demand had outpaced revenue. TLC is funded, among others, by the United States government through the President’s Plan for Aids Relief (PEPFAR), United States Agency for International Development (USAID) and the Free Wheelchair Mission. 

“Despite TLC caring for 90% of the nation’s severe and critical COVID-19 cases, building Eswatini’s first-ever oxygen production plant, and building the digital system to track the COVID vaccine, neither acknowledgment nor support from MOH was forthcoming. TLC was glaringly omitted from international partners’ proposals such as Global Fund and World Bank. As has been acknowledged by several international health funding experts, funding was not allocated to TLC in proportion to the services TLC provided,” VanderWal said.

TLC Executive Director Echo VanderWal chatting with King Mswati III

She told Inhlase that to keep afloat, TLC had used a credit line monthly for two years. Run as a family business, the VanderWal couple (Harry and Echo VanderWal) mortgaged their personal home, and emptied their retirement accounts. She put the institution’s debt over E25 million which resulted from response to patient demand over the last three years. Now the debt has since shot up to E60 million according to the proposed bailout recently submitted to the health ministry. 

The executive director suggested an emergency relief funding of at least E10 million a month to return to 24/7/365 care for very important patients (VIPs) while working with government to find a sustainable, scalable, and lasting financial solution. She blamed the TLC challenges on the ever-increasing number of patients and inadequate financial resources. 

Khanya Mabuza, who is principal secretary in the health ministry, emphasised the TLC’s complementary role rather than competition with the public healthcare facilities. He revealed a general Memorandum of Understanding (MoU) existing between government and TLC relating to the sharing of drugs. Importantly, the MOU enables TLC to access drugs at the government’s Central Medical Stores (CMS) riddled with corruption.

He, however, disputed that people were flocking to TLC and avoiding the government hospitals because of the collapsed health system. He said if that was the case, why was the government expected to then channel public resources to TLC instead of rescuing or ensuring that the public health facilities were functional.

“One should ask oneself the question of what is drawing the people to TLC, and chasing them away from the government hospitals. We’re not competing with anybody. The ministry provides health services where possible and our services are nationally recognised. If you go to our health facilities, you will still find patients who choose to go there. First and foremost, ours is to make sure that the health system is working and the partners continue playing the complementary role. We’re committed to rebuilding the facilities,” he said.

Mabuza also quashed the TLC’s complaint of exclusion from international funding proposals submitted to the Global Fund and World Bank. He pointed out that the government had no influence. He said such funds were managed by the Country Coordinating Mechanism (CCM) responsible for grant allocation. He said the health ministry was also a recipient. He advised the TLC management to apply for the Global Fund to the CMC Committee housed by the Coordinating Assembly of Non-Governmental Organisations (CANGO). 

CANGO executive director, Thembinkosi Dlamini told Inhlase that TLC had not made any application to CMC to access funding from Global Fund since he took over the reins. 

The TLC executive director  rejected the proposal from some quarters that TLC should become a parastatal organization in order to qualify for a government subvention. She argued that it would violate the TLC constitution and hinder its role as Eswatini’s innovation and digital solutions hub. She said the parastatal/subvention models were no longer seen as the best practice. She preferred the performance-based, fee-for-service and/or public-private partnership models.

“Following the recommendation of the World Bank and other international health agencies, we believe that the new funding from the Government to any health institution should move away from traditional subvention to performance-based, fee-for-service and/or public-private partnership models. These models are designed to produce cost-effective, patient-centred services,” VanderWal said.  

A liSwati financial adviser, who prefers anonymity, warned the TLC to stop dictating terms to government but put the cards on the table to enable the two parties to find a lasting solution to its financial woes. He pointed out that government learnt a lesson when the late missionary-cum-medical practitioner, Dr Samuel Hynd of the Nazarenes siphoned off emergency relief funds allocated to the Raleigh Fitkin Memorial Hospital. In the 1990s, he unashamedly diverted the public funds to the Nazarene Mission in the United States of America meant to rescue RFM from a dire financial situation.

As the government is mandated to provide healthcare to citizens, it did not ditch RFM but set up a financial control mechanism aligned to its own public finance system. This had become a standard measure used by government in the provision of subvention to all private healthcare providers including RFM Hospital and Good Shepherd Hospital. He cautioned government against pumping in money that would keep on increasing. He insisted on the need for the two parties to sit down and discuss the terms and conditions of the government financial assistance. 

“You cannot jump to put money unless an agreement has been reached on the sticky issues. Parliament is not permitted to allocate a national budget to a private entity that government does not have any control over. That’s criminal. Through an MOU, TLC must avail itself to Auditor General who audits institutions of the land,” he said.

Against this background, Finance Minister Neil Rijkenberg put aside E30m towards the bailout of TLC in the national budget. It came as no surprise because TLC’s proximity to him and royalty is paying off. The minister is a past trustee of The Luke Commission Swaziland Trust and he resigned in March 2019.  

The TLC management has found itself in the spotlight over the controversial decision bordering on unprofessional conduct. Retrenched workers were up in arms about unfair labour practice. They reported TLC management to the ministry of labour and social security for the violation of the workers’ rights in breach of the Employment Act of 1980. The TLC management allegedly dismissed the workers without following due process.

Section 32 of the Act states that the employees should have been given a three-month notice, a notice pay and settlement agreement fee. 

“The labour office didn’t get a letter from Luke Commission asking for the retrenchment. The Luke Commission didn’t follow the laid down procedure as per the law of the country. So in order to go ahead with this we tried to deliver a petition but we’re blocked by the police. Luke Commission is afraid because they must call us back to work and write the letter to Labour. The retrenchment letter must be signed and approved by the Labour Commissioner before retrenching us. Labour must help with calculation of the exit packages. We don’t even know the criterion used because one worker’s contract was ending in August 2024. He has been working there for 7 years on a contract. No one is hired permanently and I don’t know why. I’ve been working there for more than 2 years on contract,” said the aggrieved retrenched worker.

TLC is no stranger to controversy. During the Covid-19 vaccination campaign, it hit the headlines for rumours of using untrained people to vaccinate the people and not storing vaccines in good condition. Interviewed former Secretary of the Swaziland Democratic Nurses Union (SWADNU) Bheki Mamba could neither deny nor confirm the violation of workers’ rights due to uncooperative and untouchable attitude of the management.     

“As a union we asked for an investigation in the wake of Covid-19 rumours about vaccines stored in the not-so-good condition. Vaccination of patients by not qualified nurses. That investigation wasn’t successful because our investigation team found it difficult to investigate the Luke Commission because of its proximity to royalty. Even the PS in the Ministry of Health accused us of trying to abuse the government’s partners,” he said. 

Similarly, the current secretary general of the nurses’ union Mayibongwe Masangane expressed the frustration of the TLC workers who feared joining unions. He said this stemmed from job scarcity in the country, hence the majority of TLC workers were not unionised. He revealed that this opened the workers to exploitation. The TLC workers were treated more as volunteers than professionals under the guise of compassion. He pointed out that the workers’ rights were not respected left, right and centre. 

“At first, Luke Commission was like a charity organisation and employees were commanded not to work as a team. There is no room for discussion. They treat the staff as volunteers, even if you are qualified. It happens that you can be given a task to do of which you are not qualified to do,” he said, adding: “For example, you can be told to go and collect eggs from the farm. Sometimes, we advise the staff to come and complain about unpaid overtime. We can encourage them to go to unions directly in their departments. This can help us as unions to show others who do the same as Luke Commission that there is law in the country,” Masangane said.

Seeking a lasting solution to the TLC financial woes, the health ministry has set up a 20-member rescue committee drawn from the ministry of health and the TLC healthcare provider. 

“We’ve established a committee that will look into the details to find at least a more sustainable way to assist each other. As a ministry, we believe that this cannot be a thumb suck,” PS Mabuza concluded.

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