OPIOIDS ON THE SHELVES · PART 2 OF 3
The Director of Health Services says inspections have found pharmacies that should be closed, medicines dispensed by people who are not pharmacists, and ‘highly scheduled’ drugs on open display. Small pharmacy owners say the problem starts at the wholesaler.
By Inhlase Reporter
Inhlase Centre for Investigative Journalism
WHAT TO KNOW
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In July, an Inhlase reporter bought 13 bottles of codeine-containing cough syrup in four towns between 20 and 23 July without once being asked for a prescription or a reason (Part 1). He then took the bottles to the Ministry of Health. This part of the series asks the regulator, the new Medicines Regulatory Authority and the pharmacy trade why the law on scheduled medicines is not being enforced.
Ministry of Health speaks
After making the test purchases, this reporter returned to the Ministry of Health with the 13 bottles of syrup in hand to present the findings.
Confronted with the evidence in an interview on Friday 24 July 2026, Dr Okello said she remembered the initial article about codeine syrup abuse, but that it was difficult for government to regulate retail pharmacies because some operated as commercial entities.
“I understand that your focus is on codeine-based cough syrups, but it is important to note that codeine is an important medication that, when used correctly, aids patients,” she said.
Okello added that government had found pharmacies failing to comply with regulations on multiple occasions during random inspections held by the Ministry of Health and the Royal Eswatini Police Service (REPS).
“Government agrees that some pharmacies, especially the smaller ones, don’t follow regulations that govern the industry,” she said.
Okello added that in some pharmacies, some highly scheduled medicines were not supposed to be openly displayed and should only be supplied with a prescription, but this was not happening.
“We have seen some pharmacies display multiple highly scheduled medications openly, so we have to strengthen our monitoring of local pharmacies,” she added.
Okello said the youth misused a lot of medications.
She told this reporter that young people had previously misused cough syrups containing the ingredient DPH, prompting government to stop ordering the medication for government hospitals in 2013.
“You can no longer find DPH based cough syrups at government hospitals, but that does not mean you cannot find them at local pharmacies,” she said.
According to Okello, the problem demonstrated the difficulty of monitoring medicines sold through private pharmacies.
“Currently the safeguards for the sale of medications by private pharmacies are easy to circumvent.” — Dr Velephi Okello, Director of Health Services
“Currently the safeguards for the sale of medications by private pharmacies are easy to circumvent,” she said.
Okello added that government could not simply stop allowing codeine imports into the kingdom because the medicine had legitimate medical uses.
“It is easy for you to assume that we can just stop importing, but most medications are important,” she said.
According to Okello, the Ministry has moved to operationalise the Medicines Regulatory Authority (MRA), the body established by the 2016 Act, to strengthen the regulation of medicines and pharmacies.
“We upgraded the Medicines Regulatory Board to an agency to give it teeth so that it can work with local law enforcement to help the further regulation of pharmacies,” she said.
According to an official statement delivered by Minister of Health Mduduzi Matsebula on January 8, 2026, the Ministry launched the Medicines Regulatory Authority (MRA) Board to replace the interim Medicines Regulatory Unit (MRU) and strengthen medicine oversight. The 2016 Act had established the Authority on paper almost a decade earlier.
An Inhlase report on the establishment of the Eswatini Medicines Regulatory Authority (EMRA) board also highlighted a gap in the country’s medicines-control system: the regulator had no laboratory to draw on for testing medicines. The report, drawing on the Funduzi forensic review and recommendations from health experts, called for the establishment of a national drug-testing facility, with accredited laboratories outside the country used for interim testing until such a facility is available.
The laboratory gap referred to in that article pointed to a broader challenge facing medicines regulation: while government was working to strengthen the institutional framework for oversight, some of the technical capacity needed to independently verify medicines was also still being developed.
That wider regulatory challenge was also reflected in Okello’s account of the difficulties government faced in monitoring local pharmacies.
Okello concluded by saying government had worked with law enforcement to inspect pharmacies during the previous year.
“For your investigation you can use codeine as your baseline but other medications [are] being misused. Pharmacies are the ones that sell these medications, so you need to speak to them and find out how the medication is ending up in the hands of the youth,” she said.
The enforcement bottleneck
To find out whether Eswatini has gazetted its own medicine schedules under the Medicines and Related Substances Control Act, 2016 — and which schedule these syrups fall under in Eswatini law — this reporter tried to reach the MRA through the Ministry of Health’s pharmaceutical department.
The ministry’s receptionist instead set up a second interview with Dr Okello, on Wednesday 23 September, saying she was currently the only person allowed to speak to the media.
In this second interview Okello addressed administrative and regulatory bottlenecks, as well as medicine schedules.
“I see the evidence of the actual medication bottles that you have brought. Your medication scheduling question, although complex, falls under the jurisdiction of the MRA, not the Ministry of Health. I am not sure who the spokesperson at the MRA is because they are still setting up. However, let me phone Siphesihle Nhlabatsi, who works there, for extra information as well as the schedules,” she said.
During the call, Nhlabatsi told Okello that the authority was still waiting for the appointment of a chief executive officer before a spokesperson could be named, so Okello continued the interview with Nhlabatsi on the phone.
Okello said that because Eswatini does not manufacture medicines and lacks a national drug-testing facility, the kingdom relies on the manufacturer’s own scheduling, as printed on the packaging.
“When it comes to importing medication and medication schedules in Eswatini, the kingdom relies on the manufacturer’s scheduling of the medication, because in order to provide a national medication schedule you need a national drug-testing facility, which we currently lack. You must remember that Eswatini has agreements with South Africa and India when it comes to importing medication, so we often align with their scheduling of the medication as they are the medication manufacturer. But these syrups are more complicated because they contain another active ingredient, promethazine; this combination gives these syrups a high propensity for addiction. Hence the syrups fall under Schedules 2 to 3 based on the preparation,” she explained.
Okello said that during random inspections a lot of pharmacies had been found to be ignorant of the medicine schedules, and that this was a bigger issue.
Nhlabatsi added that, under the Pharmacy Act, 1929 (Act 38 of 1929), the MRA had drafted regulations and amendments, and that amended medicine schedules were incorporated in those drafts.
But Nhlabatsi admitted that the MRA was not sure what stage of execution and endorsement those drafts had reached — which would guide enforcement of the Act, codeine addiction being a reported problem.
He explained that there are fines in the principal Act, but that a lack of entities to actually enforce them had produced inaction, leaving pharmacies to take advantage of the loopholes.
Nhlabatsi recalled a presentation to the Ministry of Health directorate on pharmacy compliance in which it was recommended that a majority of local pharmacies be closed. After the presentation, no pharmacies were closed; instead, one government official, whom Nhlabatsi would not name, was arrested.
He said the lack of enforcement also involved the office of the Director of Public Prosecutions (DPP), which, for reasons unknown to him, had yet to sign the letters allowing the closure of some pharmacies — an administrative bottleneck that exposes the gap between identifying pharmacies for enforcement action and actually carrying it out.
According to Nhlabatsi, the MRA regulates medicines and pharmacies, while the DPP deals with criminal prosecution.
Okello, who recalled the presentation but not its date, said there were categories of penalties: some pharmacies were found to need closing, others were to be given warnings for a period and then re-checked, and others were to be fined.
Speaking on the test purchases, Okello said other violations had occurred for which an individual could be charged.
“There is a section (section 51(1)) that says the Medicines Regulatory Authority may suspend or revoke a licence on specified grounds, including breaches of licence conditions or acts considered undesirable on grounds of harm to human health,” she said.
“We can use painkillers like Panado as an example: you can only give an individual enough painkillers for one month; you can’t give them more. In this case they exceeded the dosage by selling you more medication than you needed. They were harming your health and they can have their licence revoked,” she said.
“Doctors usually give you enough medication to last only a certain period of time, so it’s a violation that a person can be allowed to purchase more than one bottle of syrup at one go, and it’s a violation that that same person can come back to purchase more syrup in less than a month,” she said.
“On these syrups I see Panado as a predominant ingredient. In a local pharmacy they see Panado and assume that they can just sell it,” she added.
Okello said the ministry had assumed that whoever dispensed medication at a pharmacy understood the science of dispensing it, but that in many smaller pharmacies the person dispensing might not be a pharmacist at all — another violation.
“Also, the law says the MRA should look at who works in these pharmacies, because we have seen a lot of problems at smaller pharmacies where pharmacists get other jobs elsewhere and leave their family members to work in the pharmacy instead. So you find the person dispensing the medication is not the same person written on the certificate in the pharmacy. That is why the random inspections are so important to reduce these things,” she said.
At some pharmacies, she added, the pharmacist might be on a break or outside, so a teller or assistant dispenses the medication instead — but the law states that only a pharmacist may dispense.
“The reality is there are many gaps in the pharmacy chain and our regulator currently has its hands tied due to administrative bottlenecks.” — Dr Velephi Okello
“According to your account, are you sure that an actual pharmacist dispensed the medication, or was it one of the shop assistants, in the case of the test purchases? And from the empty bottles taken from Sandile, another violation was evident — that of ethics under pharmacovigilance,” she said.
Okello said that, in her training as a medical practitioner, one never dispenses above the doctor’s recommended dose, even for Panado.
“I should never give you an excessive dose, because that Panado will cause you liver damage in the future. Sandile, if checked, might have cirrhosis of the liver. I can disclose that because you said that it’s not his real name and he has been using the medication for years,” she said.
If a patient walks back into a pharmacy to buy the same medication again after a short time, she added, that medication is not helping the patient.
“A real pharmacist would never allow a patient to keep purchasing the same medication multiple times without trying to alter the treatment. There is a serious lack of education here,” she added.
Okello concluded that a large number of local pharmacies, especially the smaller ones, needed to be closed.
“During multiple random inspections we found a lot of smaller pharmacies needed to be closed and the pharmacists’ licences revoked, meaning they can never practise pharmacy in Eswatini. In a few cases smaller pharmacies even claim that the bigger pharmacies get all the stock, hence they might misdiagnose a patient. The reality is there are many gaps in the pharmacy chain and our regulator currently has its hands tied due to administrative bottlenecks. We are still waiting for more developments at the MRA, as this abuse will continue,” she said.
DPH syrups are still on the shelves
After speaking to Okello, this reporter visited two pharmacies in Mbabane on Saturday 5 September — Mphandlana Pharmacy and Greencross Pharmacy — to ask whether they had cough syrups containing DPH for sale.
Both pharmacies confirmed that they sold bottles for as little as E40.
On a second visit on 23 September, the pharmacist at Mphandlana, Noma, said DPH also came in a cheaper option known as Clear Cough, for as little as E20, and could be bought over the counter without a consultation.
At Greencross Pharmacy, the pharmacist, who asked that his name be withheld, said DPH had gone out of stock since the previous visit but could be bought over the counter once back in stock, as it had no issues.
The pharmacies’ side
Following the two interviews with Dr Okello, this reporter spoke to smaller local pharmacy operators about the industry in Eswatini.
Both operators spoke from the perspective of smaller pharmacy businesses, and raised concerns about the advantages they said larger pharmacies have in lower operational costs and in accessing and distributing stock. Their comments reflect their experience as smaller operators.
First to speak was the owner of Safe Health Pharmacy in Manzini, Joseph Lungu, who admitted that although pharmacies were selling codeine syrups to members of the public, government needed to limit the number of pharmacies in the Kingdom because business interests were taking centre stage.
“It’s easy to blame the pharmacies, but we feel government needs to strengthen regulations on who can operate a pharmacy in the Kingdom,” he said.
Lungu added that recent media reports published in the Times of Eswatini stated that residents of Manzini were shocked to see the ever-growing number of pharmacies mushrooming around the town.
“That is an important point because not all these pharmacies are correctly regulated, leading to some pharmacies operating purely for commercial purposes. The reality is most pharmacies due to competition are more motivated by business interests rather than actual healthcare,” he said.
“We are seeing pharmacy saturation, so obviously some pharmacies won’t follow the law. The question should be how pharmacies are obtaining stock, because so many medications are misused, even morphine. I agree codeine is being sold in large quantities to the public,” he concluded.
Next to speak was Medville Pharmacy employee Trevor Lawrence Mnisi in Mbabane, who agreed that government needs to strengthen pharmaceutical operational regulations.
“It’s up to government to monitor pharmacies because the medications are coming from somewhere and ending up in the hands of the consumer. You must be observant. Some pharmacies have different stock while other smaller pharmacies usually have the same-looking stock,” he said.
Mnisi explained that the reason for stock similarities was pharmacy owners in Eswatini only had two options when it came to stocking medication.
“When you open a pharmacy you can either order your stock directly from the manufacturer located in South Africa or India, or you can order your stock from pharmacy wholesalers located in the Kingdom,” he said.
Mnisi added that local pharmacy wholesalers were much easier to work with because smaller pharmacies don’t have the capital or the expensive import permits to order stock directly from the manufacturers.
“Most smaller pharmacies use pharmacy wholesalers to get stock hence the stock usually looks alike on these pharmacy shelves. The pharmacies that usually have the syrups are usually larger pharmacies with larger operational capacities,” he said.
Mnisi then named a few pharmacy wholesalers.
“Pharmacy wholesalers in Eswatini include SwaziPharm, OmniPharm, Best Comfort Pharmaceuticals, Avoma Pharma, Linkmed and other licensed pharmaceutical wholesale suppliers,” he said.
“Based on the size of your pharmacy, you get a quota from the ministry of health on what medications you can order from the wholesalers. All medication is classified under schedules, meaning you need to know what schedule a particular medication is before you can order it,” he said.
“Using your example, codeine in smaller concentrations can fall under schedules 2 or 3, meaning you can order it. But you are limited. However it is hard to order those cough syrups as they are popular at the wholesalers, often reserved for larger pharmacies that have multiple locations,” he added.
Mnisi explained that every time his pharmacy called various local wholesalers to place an order for codeine cough syrups, the wholesalers would say they were sold out.
“Those medications sell out quickly at the wholesalers due to their popularity. It is strange that some pharmacies have the syrups and sell them while other pharmacies don’t have the syrups. This is leading to a shortage of these medications for us smaller pharmacies, like the time when there was a shortage of scheduled medications,” he said.
Mnisi added that some pharmacies and pharmacy wholesalers were using medication abuse as an opportunity to make money.
“They told us at 8am that they had just received 1,000 bottles of Painagon syrup. By 2pm we called them with the money and they said the medication was sold out.” — Trevor Lawrence Mnisi, Medville Pharmacy, Mbabane
“Just last week Thursday we got a phone call from our pharmacy wholesaler in Matsapha who we won’t name,” he said.
“They told us at 8am that they had just received 1,000 bottles of Painagon syrup. We begged them to reserve 20 bottles for us as we needed to raise the money to buy the medication. By 2pm in the afternoon we called them with the money and they said the medication was sold out. I don’t know how many pharmacies bought the stock. All I know is it moves too quickly, and that wholesaler supplies many pharmacies,” he said.
Mnisi concluded by saying that smaller pharmacies will always lack high demand medications because certain pharmacies were operating as pharmacies in the front and pharmacy wholesalers in the back, leading to a business model known as vertical integration.
“Go to the industrial site in Mbabane and you will find a pharmacy which has pharmacy wholesalers in South Africa, Botswana, Lesotho and Eswatini,” he said.
“This pharmacy can order stock directly from the manufacturer in South Africa as a wholesaler and sell that stock at their own pharmacy here in Mbabane.”
“Because of their scale they can import most medications that we smaller pharmacies cannot, as we don’t have the financial capacity or size to order medication directly from the manufacturer,” he concluded.
Told of these claims in the second interview, Okello said that both Lungu and Mnisi were simply shifting blame to competitors.
The Ministry of Health’s 2024/25 annual report records that five new pharmaceutical wholesale establishments were registered as medicine importers in 2024.
The report added that all new retail pharmaceutical establishments must register with the MRU before commencing operations.
When approached for comment about the alleged vertical integration, an employee of the pharmacy at the industrial site who preferred to remain anonymous said that they were doing nothing illegal because government knew the number of all the medications that are being imported into the Kingdom.
“As a company, it is not illegal for us to operate as a pharmacy and as a pharmacy wholesaler. Also we sell stock to other local pharmacies. Government knows our operations as we are not the only ones doing this vertical integration,” she said.
The employee said a major supermarket chain did the same thing.
“Another supermarket chain from South Africa has the scale to order directly from the manufacturer and sell the medication in its own pharmacies, effectively operating as a wholesaler and as a pharmacy at the same time. It’s not market capture. It’s all about scale and whether or not you as a pharmacy have a good relationship with your wholesaler. If you don’t, you will lack certain medications,” she said.
“Ask government about the International Narcotics Control Board (INCB) as codeine is monitored there worldwide. Government should know how much codeine enters the Kingdom,” she concluded.
This reporter then sought comment from the pharmacy management at the industrial site in Mbabane.
The company stated that its Eswatini branch was not authorised to speak to the media as its head offices are in South Africa.
The company did, however, confirm that pharmaceutical wholesalers are not permitted to sell medicines directly to members of the public.
Can a wholesaler also be a pharmacy?
To establish whether a company can lawfully hold both a retail pharmacy licence and a pharmaceutical wholesale licence in Eswatini, this reporter approached the Ministry of Commerce, Industry and Trade’s communications officer, Andile Dlamini, but found her out of office.
The reporter was then referred to Sonto Hlophe, Chief Commercial Officer at the ministry, who said the matter was governed by the Trading Licences Order, 1975, and its amendments and regulations.
Hlophe said a wholesaler cannot operate a retail business, as a company is not allowed to dominate the entire value chain.
“You will have to double-check the licences that you saw at that company,” she said.
Hlophe added that such a business model also raised concerns for the Competition Commission.
Hlophe then referred the matter to the Competition Commission, which was approached with a questionnaire. No response had been received by the time this article was compiled.