WHO COUNTRY COOPERATION STRATEGY 2014-2019 swazi land
W H O C O U N T R Y S wa z i l an d AFRO Library Cataloguing-in-Publication Data WHO Country Cooperation Strategy 2012-2015 Ethiopia 1. Health planning 2. Health plan Implementation 3. Health Priorities 4. International cooperation I. World Health Organization. Regional Office for Africa ISBN: 978 92 9 023207 0 (NLM Classification: WA 540 HE8)
© WHO Regional Office for Africa, 2014
Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: afrobooks@afro.who.int). Requests for permission to reproduce or translate this publication, whether for sale or for non-commercial distribution, should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use.
Designed and Printed in the WHO Regional Office for Africa, Republic of Congo
ii
Contents: MAP OF SWAZILAND...…………………………………………………………...v ABBREVIATIONS..………………………………………………………………..vii PREFACE…………………………………………………………………………..xi EXECUTIVE SUMMARY…………………………………………………………xiii SECTION 1: INTRODUCTION ………………………………………..……..…1
SECTION 2: HEALTH AND DEVELOPMENT CHALLENGES POLICY AND STRATEGIC PLAN ............................................3 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Macroeconomic, political and social context ………………………................3 Major determinants of health ………………………………………….................5 Health status ............................……………………………………….........….....6 National responses to health challenges ……....................…..........................8 Health systems and services ...................……………………….........…...........9 Medicines and health technologies.………………………..……….........…..... 10 Healthcare financing ………………………………………………..........……....11 Contribution of the global health agenda …........................…….........….......11
SECTION 3: DEVELOPMENT COOPERATION AND PARTNERSHIP........13 3.1 3.2 3.3 3.4 3.5 Available resources...........................………………………………................. 13 Stakeholder analysis ……………………………………………………............ 13 Aid coordination and effectiveness………………...................................…… 15 UNDAF in Swaziland........................…………………………………..........…..15 Summary …………………………………………………………..........……… 16
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
iii
W H O C O U N T R Y S wa z i l an d
SECTION 4: REVIEW OF PAST COUNTRY COOPERATION STRATEGY CYCLE......................................................................................17 4.1 External Review...…………………………………………................................. 17 4.2 Internal Review....…………………………………………................................. 22 4.3 Summary..…………………………………………............................................ 23
SECTION 5: STRATEGIC AGENDA FOR WHO COOPERATION.............. 25 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Defining the agenda…………………………………...………………............25 Strategic Agenda 1: Communicable diseases............................................26 Strategic Agenda 2: Noncommunicable diseases ......................................28 Strategic Agenda 3: Promoting health through the life course...................29 Strategic Agenda 4: Health systems..........................................................31 Strategic Agenda 5: Preparedness, surveillance and response.................33 Enabling functions of the strategic agenda.................................................35 Validation of the Country Cooperation Strategy.........................................42
SECTION 6: IMPLEMENTING THE STRATEGIC AGENDA....................... 47 6.1 6.2 6.3 6.4 Government commitment to health............................................................47 The role and presence of WHO.................................................................47 Using the CCS document...........................................................................48 Monitoring and evaluation..........................................................................49
REFERENCES..............................................................................................51 ANNEXES 1. 2. 3. 4. Health workers per 1000 population in Swaziland compared with international benchmarks............................................................................55 Face-to-face interviews...............................................................................56 Multidisciplinary Core Team........................................................................66 Achievements of past Country Cooperation Strategy (2008–2013)............67
iv
Map of Swaziland
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
v
W H O C O U N T R Y S wa z i l an d
vi
Abbreviations: ACMS AFP AIDS AGOA ART CARMMA CCS CCM CMYP CoIA COMESA DOTS EHCP EIMC EMONC EPI EU FLAS GAVI GBV GDF GDP GFATM GPW GVAP HEART HDI HIMS HIV Aid Coordination and Management Section Acute flaccid paralysis Acquired immunodeficiency syndrome Africa Growth and Opportunity Act Antiretroviral therapy Campaign on Accelerated Reduction of Maternal Mortality in Africa Country Cooperation Strategy Country Coordination Mechanism Comprehensive multi-year plan Commission on Information and Accountability (MCH health) Common Market for Eastern and Southern Africa Directly-observed treatment short-course Essential Health Care Package Early Infant Male Circumcision Emergency obstetrics and neonatal care Expanded Programme on Immunization European Union Family Life Association of Swaziland Global Alliance for Vaccines and Immunization (since 2008, the GAVI Alliance) Gender-based violence Global TB Drug Facility GDP Gross domestic product Global Fund to fight AIDS, Tuberculosis and Malaria General Programme of Work Global Vaccine Action Plan Health Equity Assessment and Response Tool Human Development Index Health Information Management System Human immunodeficiency virus
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 vii
W H O C O U N T R Y S wa z i l an d
HTC IDSR IHR IMCI INFOSAN IST JICA MAF MDG M&E MDR-TB MEPD MMR MOH MRA MSF NDS NCD NGO NHP NHSSP NPJA ODA OVC PBC PEI PEPFAR PLHIV PMTCT PRSAP RDT RED
HIV Testing and Counseling Integrated Disease Surveillance and Response International Health Regulations Integrated Management of Childhood Illness International Food Safety Authorities Network Intercountry Support Team Japan International Cooperation Agency MDG Acceleration Framework Millennium development goal Monitoring and evaluation Multidrug-resistant tuberculosis Ministry of Economic Planning and Development Maternal mortality ratio Ministry of Health Medicine Regulatory Authority
Médecins Sans Frontières (Doctors Without Borders) National Development Strategy Non-communicable disease Nongovernmental organization National Health Policy National Health Sector Strategic Plan National plans of joint action Official development assistance Orphans and vulnerable children Planning and Budget Committee Polio Eradication Initiative U.S. President's Emergency Plan for AIDS Relief People living with HIV Prevention of mother-to-child transmission (of HIV) Poverty Reduction Strategy and Action Plan Rapid diagnostic test Reaching Every District
viii
SACU SADC SDH SDHS SNAP SWAp TB TWT UN UNAIDS UNCT UNDAF UNDP UNFPA UNICEF USG VAC WCO WFP WHO XDR
Southern African Customs Union Southern African Development Community Social determinants of health Swaziland Demographic and Health Survey Swaziland National AIDS Programme Sector-wide approach Tuberculosis Technical Working Team United Nations Joint United Nations Programme on HIV/AIDS United Nations Country Team United Nations Development Assistance Framework United Nations Development Programme United Nations Population Fund United Nations Children’s Fund United States Government Vulnerability Assessment Committee WHO Country Office World Food Programme World Health Organization Extensively drug-resistant
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
ix
W H O C O U N T R Y S wa z i l an d
x
PREFACE: The WHO Third Generation Country Cooperation Strategy (CCS) crystallizes the major reform agenda adopted by the World Health Assembly with a view to strengthening WHO capacity and making its deliverables more responsive to country needs. It reflects the WHO Twelfth General Programme of Work at country level, aims at achieving greater relevance of WHO’s technical cooperation with Member States and focuses on identification of priorities and efficiency measures in the implementation of WHO Programme Budget. It takes into consideration the role of different partners including non-state State actors in providing support to governments and communities. The third Generation CCS draws on lessons from the implementation of the first and second generation CCS, the country’s focus strategy focus (policies, plans strategies and priorities), and the United Nations Development Assistance Framework. The CCSs are also in line with the new global health context and the move towards Universal Health Coverage, integrating the principles of alignment, harmonization, effectiveness, as formulated in the Rome (2003), Paris (2005), Accra (2008), and Busan (2011) declarations on Aid Effectiveness. Also taken into account are the principles underlying the “Harmonization for Health in Africa” (HHA) and “International Health Partnership Plus” (IHP+) initiatives, reflecting the policy of decentralization and enhancing the decision-making capacity of governments to improve the quality of public health programmes and interventions. The document has been developed in a consultative manner with key health stakeholders in the country and highlights the expectations of the work of the WHO Secretariat. In line with the renewed country focus strategy, the CCS is to be used to communicate WHO’s involvement in the country; formulate the WHO country workplan; advocate for and mobilize resources and coordinate with partners; and shape the health dimension of the UNDAF and other health partnership platforms in the country.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
xi
W H O C O U N T R Y S wa z i l an d
I commend the efficient and effective leadership role played by the Government in the conduct of this important exercise of developing the WHO’s Country Cooperation Strategy. I also request the entire WHO staff, particularly the WHO Country Representative to double their efforts to ensure effective implementation of the programmatic orientations of this document for improved health outcomes which in order to contribute to health and development in Africa.
Dr Luis G. Sambo WHO Regional Director for Africa
xii
Executive Summary: The Country Cooperation Strategy (CCS) as a medium-term vision for the World Health Organization (WHO) cooperation with Swaziland defines a strategic framework for working with the country. It also defines the Organization’s work in addressing national health priorities and contributes to national health development in harmony with other development partners. The process of developing the WHO Country Cooperation Strategy 2014– 2019 for Swaziland coincided with other development processes such as review of the National Development Strategy and development of the National Health Sector Strategic Plan 2014–2018. This CCS aims to contribute to disease prevention, management and control. Health systems development and strengthening also remain keys to the achievement of set health goals. The strategic agenda seeks to achieve its goals according to five of the strategic priorities identified in the WHO 12th General Programme of Work: communicable diseases; noncommunicable diseases; promoting health through the life course; health systems; and preparedness, surveillance and response. Likewise, this CCS is the instrument through which the six WHO leadership priorities identified in the 12th General Programme of Work (GPW) will be implemented at country level. These priorities are: universal health coverage; noncommunicable diseases (NCDs); Millennium Development Goals (MDGs); International Health Regulations; access to medical products; and social, economic and environmental determinants of health. The CCS was developed by a multidisciplinary technical working team (TWT) with leadership from the WHO Country Office and the Ministry of Health. The CCS formulation process was participative and consultative involving all key stakeholders in the health sector. The approach included data collection, review of literature, thematic group work for the drafting phase, stakeholder consensus-building meetings, reviews and consolidation. Data collection entailed face-to-face interviews with key stakeholders as well as focus group discussions.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 xiii
W H O C O U N T R Y S wa z i l an d
This document comprises six main sections: Section 1 sets out the principles underlying the CCS and presents it as a key component of the WHO country focus policy. Section 2 describes and explores the country’s health and development issues and challenges based on a comprehensive review of key national reference documents and country intelligence. Section 3 discusses the roles fulfilled by key development partners, the allocation of resources by these partners and the areas they support. Section 4 provides internal and external reviews of WHO cooperation with Swaziland over the past CCS cycle (2008¬–2013). Section 5 presents a set of strategic priorities for WHO cooperation with the country that are jointly agreed with national authorities and support the National Health Policy and National Health Sector Strategic Plan. The CCS is structured to follow the 12th GPW strategic directions and provides national priorities for Swaziland over the six-year period of the CCS. Section 6 concerns the implementation of the strategic agenda and its implications for the country and WHO. It also provides a monitoring and evaluation framework for the CCS.
xiv
SECTION 1: 1. INTRODUCTION The WHO Country Cooperation Strategy (CCS) is a medium-term vision for WHO technical cooperation with the Kingdom of Swaziland in support of the country’s National Health Policy and National Health Sector Strategic Plan. It defines a strategic framework for working with the country in improving the stewardship function of the health sector, reducing morbidity and mortality due to high disease burden and improving the responsiveness of the WHO Country Office. It is the key instrument for guiding WHO work in Swaziland and the main instrument for harmonizing WHO cooperation with that of other UN agencies and development partners. The formulation of the CCS is informed by the national context, national health priorities and the WHO General Programme of Work (GPW). The formulation of the CCS strategic agenda is the core of the CCS process. The strategic agenda consists of a set of medium-term strategic priorities for WHO cooperation with Swaziland that are jointly agreed with national authorities, and support the National Health Policy as well as the National Health Sector Strategic Plan. Each strategic priority also contains the identified main focus areas for WHO work as well as the strategic approaches that will be employed to deliver on these areas. This document covers the principles underlying the CCS. It describes and analyses the country’s health challenges and development issues as well as the roles fulfilled by key development partners in terms of resource allocation and the areas they support. Furthermore, it provides the findings of the internal and external reviews of the work of WHO in Swaziland over the past CCS cycle (2008–2013). In addition, it delineates the determined strategic priorities for WHO cooperation with Swaziland for the new CCS cycle (2014–2019). The document also provides details on implementation, monitoring and evaluation.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
1
W H O C O U N T R Y S wa z i l an d
2
SECTION 2: 2. Health and development challenges, policy and strategic plan This section gives an analysis of the country’s health and development issues and challenges. It describes national macroeconomic, political and social context; major determinants of health; and the health status of the population. The section also includes details of the national response to health challenges; Swaziland contributions to the global health agenda; and similarities with other countries.
2.1 Macroeconomic, political and social context Swaziland is a landlocked country in southern Africa, bordered to the north, south and west by South Africa, and to the east by Mozambique. It has a total land area of 17 364 square kilometres and is divided into four administrative regions namely Hhohho, Lubombo, Manzini and Shiselweni which vary in population, geographical size and socioeconomic factors. The population of Swaziland, estimated at 1 043 509 in 2009, is estimated to grow at a rate of 1.1% per annum. About 77% of the population live in rural areas. Estimated life expectancy in Swaziland is 54 years but is 55 years for females and 52 years for males. Swaziland has a youthful population with over 50% below the age of 18, of whom about one third are classified as orphans or vulnerable children. Swaziland is classified as a lower middle-income country. Revised estimates by the Central Bank and Ministry of Economic Planning and Development reflect that the economy grew by 1.7% in 2012 up from a 0.6% decline in 2011. By the end of the first quarter of 2013 the economy was still bruised by the general slowdown in global economic activity (Central Bank Annual Report April 2012-March 2013:16). The classification of the country as lower middleincome implies that it has limited access to concessional resources to address its many socioeconomic challenges such as high poverty levels and high HIV and AIDS prevalence rates.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
3
W H O C O U N T R Y S wa z i l an d
The Swazi economy is relatively diversified compared to other small economies, and economic growth has averaged 1.3% in the past five years against a national target of 5%. Nominal GDP was around US$ 3.6 billion in 2012, driven mainly by manufacturing, public administration, agriculture, and wholesale and retail trade. Supported by trade preferences, the country exports a wide range of products including sugar, textiles, soft drink concentrates, canned fruit and citrus fruits. Swaziland is integrated into the global economy and is a member of the Southern African Customs Union (SACU), Southern African Development Community (SADC) and Common Market for Eastern and Southern Africa (COMESA). The country is also a beneficiary of the Africa Growth and Opportunity Act (AGOA) promulgated by the United States, and the Cotonou Agreement signed with the European Union (EU). Despite the challenges of the global financial crisis, most notably the sharp deterioration in the fiscal outlook in recent years, the government still maintains health and education as priority sectors. The 2013 budget speech highlighted that the government had more than doubled the budget allocation for the Ministry of Health since 2008. For fiscal year 2013/14, the MOH received an additional 3.2% of the total budget totalling E1.2 billion which is 13% of the country’s E9.7 billion allocation for recurrent expenditure (goods and services) (see Fig. 1). Notably, per capita government expenditure on health has increased over the years from US$ 234 in 2007 to US$ 300 in 2011 (WHO. Global Health Observatory Data Repository: WHO African Region: Swaziland statistics summary (2002 - present). In 2002, general government expenditure on health as a percentage of total government expenditure was 9.9%; this gradually increased to 14.9% in 2011. Spending on medicines and medical supplies nearly tripled from 4% of total government spending on goods and services in 2008/09 to 13% in 2012/13. The increase is related to the response to the HIV and AIDS epidemic; the government so far procures all its antiretroviral drug requirements.
4
Figure 1: Budget allocation for recurrent budget, financial year 2013/14, Swaziland 2,500,000
Emalangeni ‘ 000
0
500,000
1,000,000
1,500,000
2,000,000
Deputy Prime Minister’sOffice Foreign affairs and Trade Defence
Public Service ICT EBC Health Justice & Contitutional Comm’n
Regional Dev’t & Youth Affairs Natural Resources & Energy Geological Survey & Mines Agriculture &Co-operatives Economic Planning & Development Housing & Urban Development
Private and Cabinet Offices Tourism, Comms & Environment
Commerce, Industry and Trade Education Finance Treasury & Stores
Correctional Services Home Affairs Swaziland National Tresury
Parliament
Internal Audit Labour & Social Security
Anticorruption Commission
Police
Government Ministry
The country had national elections in September of 2013 when members of parliament were elected and a new cabinet was constituted to run up to 2018. This resulted in changes in government structures including the ushering in of a new Minister of Health.
2.2 Major determinants of health Health is not created by health services provision alone but largely also by the determinants that together affect the health of individuals and communities. The social conditions in which people live greatly influence their chances of being healthy. Factors such as poverty, food insecurity, poor housing, unhealthy early childhood conditions and low occupational status are important determinants of most diseases, deaths and health inequalities between and within communities. Other factors such as education, biological and genetic
Sports, Culture and Youth Affairs Audit Central Transfers
Fire & Emergency Services
King’s Office Public Works & Transport
Judiciary
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
5
W H O C O U N T R Y S wa z i l an d
endowment, personal health practices and coping skills, gender and culture also determine the health of individuals. There is strong evidence indicating that factors outside the health-care system significantly affect health. In Swaziland, about 69% of the population live below the poverty line (The United Nations Development Assistance Framework 2012:9) with high ruralurban disparities in access to basic services. Poverty prevalence is 71% among the population in rural areas and 45% among the population in urban areas. There are differences in poverty prevalence among the four regions of the country, between rural and urban areas, and between the different ecological zones. Poverty is strongly related to social characteristics such as education and health standards, access to safe water and sanitation, and family size. The fundamental environmental factors affecting health, survival, growth and development are safe drinking water, sanitation and good hygiene. About 91% of the urban population have access to safe water as compared to only 37% of the rural population. The health burdens due to many of the common illnesses such as diarrhoea or from waterborne diseases such as roundworm, hookworm, schistosomiasis and trachoma can be reduced drastically if people have access to both safe drinking water and sanitation.
Poverty, adult literacy and unemployment are closely related determinants of health. In Swaziland the adult literacy rate is 90% in urban areas compared to 78.3% in rural areas. Swaziland is experiencing a growing problem of unemployment which is currently estimated at 23% of the economically active population and much higher among the youth. However, there has been an expansion of the informal employment sector which absorbs most of the school leavers, unskilled labour and disadvantaged members of the society.
2.3 Health status Swaziland is going through an epidemiological transition and experiencing a double burden of disease. While communicable diseases still remain a serious challenge, non-communicable diseases particularly hypertension, diabetes and cancers are growing problems. NCDs have not received adequate attention in the last few years. Communicable diseases contribute the largest share of the burden of disease in Swaziland. The country has one of the highest HIV prevalence in the world at 26% among the sexually active population. HIV infection is higher among women at 31% prevalence rate compared to men at 20%
6
prevalence (Swaziland Demographic Health Survey 2007:226-227). The HIV and AIDS epidemic has also given rise to a concurrent tuberculosis epidemic in the country: TB has become a major public health problem. The TB burden is estimated to be about 1380 incident cases per 100 000 occurring annually. The TB/HIV co-infection rate has remained around 80%. Fuelling the challenges in controlling the TB situation is the considerable MDR-TB burden of 7.7% prevalence among new cases and 33.9% among previously treated ones based on the 2009/10 nation-wide survey. In 2012, the National Referral Laboratory confirmed 220 MDR-TB cases and 2 XDR-TB cases (TB Program Annual Report 2012:26), levels never anticipated. Besides the HIV pandemic, the country faces other public health problems such as malaria. This is more prevalent in the Lubombo region where more than half of the cases occur. However, a significant reduction in the malaria incidence rate has been observed over the years. In 2010, 106 cases of malaria were reported, and 13 persons died of malaria (Atlas of malariaeliminating countries, 2011:157). Swaziland is one of the countries on track to eliminate malaria by the year 2015. Other diseases of public health importance are major neglected tropical diseases such as soil transmitted helminthiasis and schistosomiasis. The main NCDs in Swaziland are diabetes mellitus, cardiovascular diseases including hypertension and stroke, malignancies and chronic obstructive pulmonary diseases especially asthma. Other significant NCDs that contribute to the disease burden include psychiatric and neuropsychiatric ailments including substance abuse; trauma, violence and injuries; dental diseases; eye conditions; and musculoskeletal and connective tissue disorders. These diseases are related to social determinants of health, and the leading risk factors include sedentary lifestyles, unhealthy diet, excessive alcohol consumption, and tobacco use. Although there is a rise in diseases of affluence, malnutrition is a contributing factor in one out of three deaths in children under the age of five. The high HIV prevalence has had an impact on maternal and infant mortality. However, improvements have been observed over the last few years. Compared to the years 2008/09, the infant mortality rate has declined from 100 to 79 per 1000 live births and the under-five mortality rate has decreased from 146 to 104 per 1000 live births (Multiple Indicator Cluster Survey 2010:iv). Maternal mortality ratio was estimated at 390 in 2005 and now is estimated at 320 per 100 000 live births (Trends in Maternal Mortality 1990 to 2010:44).
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
7
W H O C O U N T R Y S wa z i l an d
2.4 National responses to health challenges In order to address the health challenges, the Government of the Kingdom of Swaziland, with support from WHO and other development partners, developed the National Health Sector Strategic Plan (2008–2013) to guide the health sector in the implementation of the National Health Policy (2007). The Strategic Plan focuses on three strategies: reform and enhancement of the institutional capacity of the Ministry of Health; universal access to essential, affordable and quality curative care; and provision of essential public health services. The Government of Swaziland adopted a sector-wide approach (SWAp) to planning and budgeting in 2008 as part of its strategy in implementing the Poverty Reduction Strategy and Action Programme (PRSAP) where health is one of the four pilot sectors among education, water, and agriculture and fisheries. According to the 2012 country assessment of SWAps, the health sector SWAp was the most advanced in its structures and functioning compared to the other three pilot sectors (The Sector Wide Approach: A Country Assessment 2012:35). Prior to the national assessment of SWAps, the Ministry of Health, with support from WHO, initiated a structured and consultative process to elicit views of different health sector stakeholders on their expectations concerning coordination in the health sector. An exercise for the enhancement of the health sector SWAp produced a SWAps strategy paper and a draft instrument for partnerships. Within the health sector SWAp, resource tracking has commenced with the collating of indicative budgets from development partners. This enforces the attempts to promote a health sector dialogue and planning for informed policy- and decision-making for health-care services. This yields coordinated and harmonized implementation of activities so that they are aligned with the National Health Sector Strategic Plan and the National Development Strategy. In an effort to combat the high burden of HIV and AIDS, the government decentralized HIV testing and counselling (HTC), PMTCT and antiretroviral therapy (ART) services. The ART programme has been strengthened through the introduction of structured pre-ART and ART services with the aim of encouraging people living with HIV (PLHIV) to monitor and improve their
8
health and to prevent opportunistic infections. These efforts have resulted in 91.1% ART coverage of the population in need (National ART programme annual report 2012:7). Uptake of PMTCT services is high with more than 98% of pregnant women getting HIV testing and 92% of HIV positive mothers receive ART or prophylaxis. To improve health-care service delivery, the Ministry of Health embarked on the development of the Essential Health Care Package (EHCP) that defines health services at the different levels of the health-care system. To enhance the prevention of vaccine preventable diseases the country developed the comprehensive multiyear plan (CMYP) for the Expanded Programme on Immunization (EPI) which is aligned to the NHSSP. The country adopted the Reaching Every District (RED) strategy to improve EPI coverage. In an effort to address the burden of TB including MDR-TB the country introduced the molecular diagnostic procedure Gene Xpert. For improved case management the country procures TB drugs through the Global TB Drug Facility (GDF) and has adopted the intensified DOTS strategy. As a way of strengthening the regulation of health service delivery, the following bills have been submitted to parliament: the Public Health Bill, Pharmacy Bill, and Nursing Bills. In 2013, the Tobacco Products and Control Bill became an Act of Parliament.
2.5 Health systems and services The country’s health-care system consists of the informal and formal sectors. The informal sector consists of traditional health practitioners and other unregulated service providers. The health service that is based on western medicine is considered to be formal and consists of public and private health services. The formal health sector is based on the concepts of primary health care and decentralization. Its infrastructure is made up of government, mission and private health facilities. These health facilities consist of hospitals, health centres, public health units, clinics and outreach sites. Access to health-care facilities is generally good. According to the National Health Policy (2007: 4), up to 85% of the population lives within a radius of 8 kilometres from a health facility. However, the quality and availability of
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 – 2 0 1 9
9
W H O C O U N T R Y S wa z i l an d
health services is affected by the distribution of resources. There is evidence to suggest that the distribution of health resources tends to favour urban over rural populations. All the hospitals are situated in urban areas and thus most health workers also serve in urban areas. Swaziland faces challenges related to human resources for health, depending on expatriate health workers for medical and specialized services. According to a situation analysis of the health workforce conducted in 2004, the ratio of doctors and nurses to the population was 1:5953 and 1:356, respectively (see Annex 1). Generally, health professionals across all cadres are in short supply. There is need to improve leadership and governance capacity across the health system to ensure the stewardship roles in decision-making, planning, development and management of human resources for health. Through the strategic information department, the Ministry of Health aims to improve the availability of information and research for policy- and decision-making. The Health Research Policy and Health Research Strategic Plan have been developed and aim at providing structures for coordination and improvement of health research activities.
2.6 Contributions to the global health agenda Swaziland as a WHO Member State participates in the World Health Assembly and the Regional Committee for Africa as well as the African Union. Swaziland joins other countries in discussing and setting the global health agenda. As a member of SADC, Swaziland participates in discussions on health issues affecting the regional bloc, for example, TB in the mining sector as well as HIV and AIDS prevention and control in most-at-risk populations (sex workers and long-distance truck drivers). Lesotho, South Africa and Swaziland have formed an inter-country certification committee to discuss activities in the Polio Eradication Initiative (PEI). Swaziland played a key advocacy role for accelerating action towards attainment of MDG 6 in SADC. The country is also advocating for a malaria elimination strategy through a cross-border initiative with Mozambique and South Africa. As part of the East, Central and Southern Africa health community (ECSA), Swaziland participated in the establishment of the Human Resources for Health Observatory. The country is also part of the Maputo Plan of Action for improving maternal health; in 2009, Swaziland launched the Campaign on Accelerated Reduction of
10
Maternal Mortality in Africa (CARMMA) joining eight other African countries. Through this participation the country was able to share experiences and technical expertise with other African countries.
2.7 Similarities with other countries Swaziland is a small middle-income country in southern Africa with a very high HIV burden. In this regard, Swaziland is similar to Botswana, Lesotho and Namibia, other countries within the southern African region. These countries also face serious challenges in human resources for health due to staff migrations mostly to their economically strong neighbour, South Africa. Despite their middle-income status these countries also experience high levels of poverty and health inequalities. In Swaziland, the health and social indicators are similar to those of countries classified as low-income. Due to the middle-income status, Swaziland receives minimal aid from international development partners and does not benefit from initiatives such as the Global Alliance (GAVI). There are thus limited opportunities for local resource mobilization to supplement national efforts.
2.8 Summary Swaziland is a lower-middle-income country in southern Africa; the country’s disease patterns and response to such are similar to those of other countries in the sub-region. The country’s macroeconomic, political and social context as well as other major determinants of health greatly affect the disease burden. The country has a high burden of communicable diseases, mainly HIV, AIDS and tuberculosis, and there is a rising burden of NCDs. The heath system is based on the primary care health concept. Service delivery is guided by the NHSSP for 2008–2013 and other programmespecific strategic plans of action. Health system strengthening is one of the major focuses of the health sector.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 11
W H O C O U N T R Y S wa z i l an d
12
SECTION 3: 3. Development, cooperation and partnership This section analyses the roles fulfilled by development partners, the allocation of resources by these partners and the areas they support.
3.1 Available resources The Aid Coordination and Management Section (ACMS) in the Ministry of Economic Planning and Development is the designated authority for the mobilization, coordination, monitoring and evaluation of all official development assistance (ODA) received by Swaziland. This support is in the form of grants within the framework of the Swaziland Aid Policy of 1997, and the Ministry of Finance is the custodian of loans. According to the Ministry of Economic Planning and Development report (Status of official development assistance in Swaziland 2011/12, 2013:25), health is the leading sector receiving external aid. In fiscal year 2011/12, approximately US$ 55 million (E410 million), out of approximately US$ 132.9 million (E1 billion), was received by health, that is 41.4% of total ODA.
3.2 Stakeholder analysis There are a number of key health development partners providing aid in the country.These include UN agencies, bilateral and multilateral agencies, global health partnerships and initiatives, development banks and international financial institutions. The aid is mainly in the form of technical and financial support. Figure 2 shows a summary of expected partner support for the financial year 2013/14. Other stakeholders active in health include civil society and NGOs, community groups, academic institutions and collaborating centres.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 13
W H O C O U N T R Y S wa z i l an d
Figure 2: Resource allocation according to health operational objectives Graph Presentation of Allocation According to Health Operational Objectives: FY 2013/14
The Republic of China on Taiwan has a bilateral agreement with Swaziland, the Swaziland-Taiwan Cooperation which focuses on a number of areas including health care. The Japan International Cooperation Agency (JICA) through a bilateral agreement provides support for health system strengthening. The World Bank supports the health system through the project on HIV, AIDS and TB; the main objectives are improving access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and increasing social safety net access for orphans and vulnerable children (OVC). The European Union provides support for improving health in Swaziland by addressing HIV and AIDS, tuberculosis, and maternal and child health. United Nations (UN) cooperation is focused mainly on basic social services which include health, education, poverty reduction, HIV/AIDS and gender issues. Assistance is channelled through the key UN agencies operating in Swaziland: United Nations Development Programme (UNDP); United Nations Children’s Fund (UNICEF); United Nations Population Fund (UNFPA); World Health Organization (WHO); Joint United Nations Programme on HIV/AIDS (UNAIDS). The GFATM also contributes considerable amounts of financial resources to support TB, HIV, AIDS and malaria programmes in the country. PEPFAR is another major contributor to health especially in HIV, TB and health systems. 14
Other global health partnerships such as the Bill & Melinda Gates Foundation, Clinton Health Access Initiative (CHAI), and Médecins Sans Frontières (MSF) continue to support various health programmes.
3.3 Aid coordination and effectiveness In order to play its leading role, the government through the Planning and Budget Committee (PBC) took the decision to establish sector working groups as part of the institutional framework for planning and budgeting in the country. More specifically, PBC circular no. 1 of 2008 for budget preparation directs that a sector-wide approach (SWAp) in planning and budgeting be adopted to be phased in over time, starting with education, health, water, and agriculture and fisheries. SWAp actors include government agencies, parastatals, NGOs, private institutions and development partners that contribute financial and technical resources to the sector. This is in line with the 2005 Paris Declaration on Aid Effectiveness. The Paris Declaration reinforces the health sector’s own attempts to promote a sector-wide working group to oversee implementation and improve aid effectiveness in support of the National Health Sector Strategic Plan. In recent years, the Ministry of Health has used SWAp for strengthening aid effectiveness in the health sector. In national development, SWAp brings together government, development partners and other stakeholders within the health sector to support national priorities. The Health Partners Coordination Consortium, chaired by the Principal Secretary for Health, was established to provide a forum for partner coordination and engagement. SWAp coordinates and harmonizes partner activities within the health sector and aligns them with the National Health Sector Strategic Plan 2008–2013.
3.4 UNDAF in Swaziland The United Nations Development Assistance Framework (UNDAF) is the vehicle for strategic partnership and resource planning which drives the programmes under which the UN system supports Swaziland in the realization of its development goals. UNDAF is fully aligned with national priorities and the Poverty Reduction Strategy and Action Plan (PRSAP), National Development Strategy (NDS) and the government’s Ten-Point Action Programme 2009–2015. Current UNDAF assistance covers the period 2010–2015.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 15
W H O C O U N T R Y S wa z i l an d
Country support to Swaziland is based on the UNDAF pillars of HIV and AIDS; poverty and sustainable livelihoods; human development and basic social services; and governance. UNDAF provides a strong basis for strengthening the long and stronger partnership between the government and the UN system. In an effort to deliver as one and coordinate UNDAF implementation, the UN formed a number of technical working groups and committees all of which WHO is a member. These include a programmes support group, a UN communications group, and an operations and management team. UNDAF has two health-related objectives. The first objective is to contribute to reducing new HIV infections and improving the quality of life of persons infected and affected by HIV. The second objective is to increase access to and utilization of quality basic social services especially for women, children and disadvantaged groups. These objectives support MDGs 4, 5 and 6. The national response to the challenges brought about by HIV and AIDS is very well-organized. It is conducted through the Joint UN Programme of Support on HIV and AIDS 2009–2015 (JUNPS, of UNAIDS), the operational plan for the UNDAF pillar on HIV and AIDS.
3.5 Summary Health is the main sector receiving external aid in Swaziland. Aid is mainly in the form of financial and technical assistance and is provided by a number of key health development partners including UN agencies, bilateral and multilateral agencies, global health partnerships and initiatives, development banks and international financial institutions, civil society and NGOs, community groups, academic institutions and collaborating centres. UNDAF is the vehicle for strategic partnership and resource planning which drives the programmes under which the UN supports Swaziland in the realization of its development goals. The ACMS in the Ministry of Economic Planning and Development is the designated authority for the mobilization, coordination, monitoring and evaluation of all ODA received by Swaziland in the form of grants within the framework of the Swaziland Aid Policy of 1997.
16
SECTION 4: 4. REVIEW OF PAST COUNTRY COOPERATION STRATEGY CYCLE The review of the WHO cooperation over the past CCS was done through an external review as well as an assessment of the internal WHO environment. The methodology and findings of these reviews are described below.
4.1 External review The review of WHO’s cooperation over the period of the second generation Country Cooperation Strategy 2008–2013 was undertaken jointly by the Ministry of Health under the leadership of the Principal Secretary and the WHO Country Office under the WHO Representative. The framework for collecting and analysing data was based on WHO guidance for review of CCSs. Data were collected through focus group discussions and face-to-face interviews in order to provide an understanding of WHO’s contributions to enhancing national ownership; alignment with national health priorities; limitations; and role as a member of the UNCT and as a broker for health among partners and across sectors. The findings of the review were summarized according to the structure of UNDAF. The key findings are presented below. 4.1.1 Enhancing national ownership
The stakeholders acknowledged that WHO helped the country to lead the development of the National Health Sector Strategic Plan 2008–2013 which become the major document that guided all partners in their work in the health sector. The National Health Sector Partners Coordination Consortium, chaired by the Principal Secretary of Health and the WHO Representative, was formed with support from WHO. The Consortium rallies stakeholders around the NHSSP and helps ensure MOH leadership in guiding the health sector.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 17
W H O C O U N T R Y S wa z i l an d
It was noted that WHO provided consistent leadership in the implementation of the priorities of the NHP and NHSSP. However, the support was mostly limited to the Ministry of Health; not much support was provided to other stakeholders such as NGOs and the private sector, nor to decentralized levels of government. WHO supported the mid-term review of the NHSSP and provided strategic guidance in the process. The external review recommended that the monitoring framework of the NHSSP needed strengthening with a focus on fewer indicators. It was further recommended that WHO provide more support for continuous monitoring of NHSSP implementation and its various programme operational plans. 4.1.2 Alignment with national health policies
WHO developed the CCS 2008–2013 priorities in consultation with government and other stakeholders. The development of the CCS was also informed by the priorities that emerged in the development of the NHSSP 2008–2013. In operationalizing the CCS, WHO developed biennial work plans in consultation with the Ministry of Health. Thus, while the biennial work plans contained the health sector priorities as defined in the NHSSP, they were also informed by emerging priorities through engagement with the MOH. One of the main focus of WHO’s work during the CCS 2008–2013 was to support the country to accelerate actions towards attainment of healthrelated MDG targets. Though national progress towards achieving the MDGs has been slow, WHO provided considerable support to the national efforts. In an effort to reduce child mortality rates, WHO supported the Ministry of Health to develop the comprehensive National Child Survival Strategy 2012–2015. The goal of the Strategy is to accelerate the reduction of under-five mortality in Swaziland and thus meet MDG 4 targets. WHO also provided technical and financial support for the development of Integrated Management of Childhood Illness (IMCI) guidelines and tools, and increased the capacity of health workers on IMCI strategy implementation. In addition, WHO supported the country in strengthening routine immunization using the Reaching Every District (RED) strategy as well as introducing Haemophilus influenza type B vaccine into the immunization programme. WHO supported intensified immunization activities such as child health days, commemoration of African Vaccination Week (AVW) and integrated measles campaigns. 18
With WHO financial and technical support focusing on critical EPI activities, there is an observable reduction of morbidity and mortality due to vaccine preventable diseases such as polio, measles and neonatal tetanus. On MDG 5, WHO provided technical support for building national capacity for the implementation of evidence-based interventions taking into account global and regional resolutions such as the Maputo Plan of Action, CARMMA and the development of the road map for the Commission on Information and Accountability on maternal and child health (CoIA). These initiatives supported advocacy and coordination for the adaptation and implementation of proven effective interventions, saving lives of mothers and babies. The WHO Country Office in collaboration with other UN agencies and partners supported development of strategic documents on both nutrition and sexual and reproductive health; and adaptation of evidence-based guidelines and management protocols for improving maternal health. WHO supported the initiation of the national maternal death audits and supported implementation of recommendations for the improvement of maternal and newborn health. On MDG 6, WHO assisted the country to ensure that HIV prevention is scaled up by the necessary policies, guidelines and tools in the health sector. WHO also supported the development of guidelines for PMTCT and ART as well as strengthening planning, monitoring and evaluation of HIV interventions. WHO supported country efforts for decentralization of HTC and ART services to increase availability and thus contributed to increased ART coverage which was 91.1% in 2012. For tuberculosis control, WHO supported the adoption of the 3Is strategy (intensive case finding, infection control and isoniazid preventative therapy) to effectively manage TB/HIV co-infected patients and further encourage integration and decentralization of these services. WHO advocated for more political support and visibility for TB that culminated in the declaration of TB as an emergency in 2011. Support also combated the TB epidemic through the Stop TB Strategy which ensures high-quality DOTS expansion and enhancement. WHO supported the development of guidelines to address TB, TB/HIV and MDR-TB. Concerning malaria, WHO supported the Malaria Programme Review and development of the Malaria Elimination Strategic Plan. In addition, WHO through various international workshops built national capacity to support the malaria elimination goal. Support goes to the following focus
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 19
W H O C O U N T R Y S wa z i l an d
areas: effective case management through definitive diagnosis using rapid diagnostic tests (RDTs) and proper case management including the use of artemether-lumefantrine (AL); integrated vector management particularly in the combined use of indoor residual spraying and long-lasting insecticidetreated nets; a strong epidemiological and entomological surveillance system; and a comprehensive information, education and communication campaign. Swaziland is on track for achieving the malaria elimination goal. In spite of the commendable contributions in the past CCS, WHO will continue to prioritize support to accelerate actions toward attainment of health-related MDGs by 2015 and beyond. Through the implementation of the CCS 2008–2013, WHO provided considerable technical support and contributed to a number of achievements in the NHSSP. These achievements are highlighted in Annex 2. Additionally, WHO supported the implementation of activities in eye care and dental programmes and the commemoration of the World Sight Day, even though these activities were not part of the CCS 2008–2013. 4.1.3 Limitations
Within the period of the CCS 2008–2013, WHO did not harmonize its procedures in terms of procurement and financial management with those of the country. This is likely to remain the case for the foreseeable future. It was also noted that there were areas where WHO support was required but was insufficient. Stakeholders reported that more WHO technical support was required than was provided in the areas of multi-sectorial engagement in addressing NCDs including mental health; strengthening laboratory services; and ensuring uninterrupted supply of quality affordable medical products. Further, it was observed that WHO focused on public health programmes and did not provide adequate support for strengthening the delivery of clinical services. It was also felt that WHO should interact with and provide more direct support to NGOs and the private sector. 4.1.4 The United Nations Country Team
WHO collaborated very well with other UN agencies to implement priorities within the NHSSP. WHO contributed to the development of UNDAF objectives in particular the HIV/AIDS and basic social services pillars, both of which were informed to a large extent by the CCS 2008–2013. WHO provided strong 20
leadership in the implementation and review of the UNDAF HIV and AIDS pillar. The work of WHO was seen as complementary and not duplicating that of other partners, and reflected cross-cutting issues such as gender equality and human rights mainstreaming. WHO has also participated well in various UN technical working groups and joint programmes in the spirit of “Delivering as One”. However, the limited number of staff in the WCO has hampered full and consistent participation in some of the many UNCT activities. 4.1.5 Partnerships
There are very few international partners in Swaziland; however, of the few partners present most are in health. These include the UN family (UNICEF, UNFPA, UNAIDS), PEPFAR, EU, World Bank and GFATM. Through co-chairing the National Health Partnership Coordination Consortium, WHO has helped to foster partnerships in health. WHO has chaired an ad hoc meeting between partners and the Ministry of Health to address specific issues such as medicine availability and task shifting in health-care delivery. WHO leads in HIV/AIDS and health matters in the monthly UNCT meetings and in meetings with USAID and PEPFAR. As a representative of the UNCT in the Country Coordination Mechanism (CCM), WHO ensures the continued partnership of UNCT with GFATM and the country. Through the CCM, WHO supported resource mobilization for health programmes in HIV and AIDS, TB and malaria for proposal development; grant negotiations; and implementing, monitoring and evaluating grants. 4.1.6 Areas for future WHO focus
The stakeholders suggested that WHO should continue to focus on the following: (a) (b) (c) (d) Provide leadership and use its knowledge, expertise, efficiency and earned respect to promote initiatives in the health sector. Partner and coordinate (especially international organizations) for maximum realization of health outcomes. Expand the WHO mandate towards a multi-sectorial approach. Continue to avail a pool of technical experts in different areas and promote the utilization of those with local knowledge and expertise. C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 21
W H O C O U N T R Y S wa z i l an d
4.2 Internal review The assessment of the internal environment was informed by the inputs from the external review where stakeholders also provided perceptions related to the internal environment. This was accomplished through review of various WCO documents such as quarterly reports, annual reports and biennial evaluation reports, all of which touch on the internal environment. The findings of the internal review are summarized below. The internal assessment indicated that one of the main issues is inadequacy of staff numbers in the WHO Country Office, especially from the year 2011. Due to financial constraints, the WCO had to cut staffing drastically from 24 staff members in 2011 to 16 staff members. This included all the internationally recruited professional staff who were responsible for the areas of HIV and TB (the major health challenges of the country) as well as epidemic preparedness and response including NCDs. Activity associated with these critical health priorities therefore slowed down in the last two years of the CCS. Stakeholders have also iterated the importance of a strong WCO to ensure effective WHO technical leadership. Throughout the CCS 2008–2013, the WCO has had inadequate and unpredictable funding. Of the total expected funding, only 61% was actually received in the country. This hampered the timely implementation of various CCS priorities. Also, the budget was not allocated according to priorities in the CCS. For example, HIV/AIDS and TB, both of which are top priorities in the CCS as well as the NHSSP, received some of the lowest budgetary allocations. It is hoped that with the ongoing reforms in WHO such misalignments will be addressed. However, it is important to note that WHO was able to draw on its technical expertise at regional and headquarter levels to support the country efforts. Within the CCS period, a considerable number and type of missions were undertaken to Swaziland to support work in various strategic objectives: HIV and AIDS, EPI, TB, SRH, child health, health systems, malaria, health promotion, medicines and technologies, administration. The ability of the Organization to draw expertise from various levels contributed greatly to the implementation of the many CCS priorities. The Inter-country Support Team rapidly deployed required technical support to the country.
22
The period of the CCS also saw improvement in connectivity in WCO which made communication with other levels more efficient. A video conferencing facility was installed allowing for more virtual and long distance provision of technical support thereby cutting costs. The GSM system was installed and this has improved both financial and administrative functions in the Country Office and indeed the whole Organization.
4.3 Summary The external and internal reviews highlighted a number of critical areas to be considered in the strategic agenda for CCS 2014–2019. These include but are not limited to the following: extending WHO engagement and support to non-traditional partners such as NGOs and the private sector; strengthening monitoring and evaluation of the national health sector policy and strategic plan; strengthening WHO support to clinical health service delivery; continuing support efforts for accelerating progress towards the MDGs; and strengthening WCO capacity to provide high quality technical support and guidance.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 23
W H O C O U N T R Y S wa z i l an d
24
SECTION 5: 5. STRATEGIC AGENDA FOR WHO COOPERATION This section discusses the strategic priorities for WHO cooperation with the Kingdom of Swaziland for the period 2014–2019.
5.1 Defining the agenda The strategic agenda priorities are based on the situation analysis conducted as part of the CCS development process as well as the situation analysis and priority setting for the National Health Sector Strategic Plan 2014–2018. It has taken into account the recommendations from stakeholders, country health challenges and socioeconomic environment, and the development assistance and partnership framework in the country. The development of the strategic agenda is also informed by the findings of the UNDAF midterm review 2011–2015. The strategic agenda is the vehicle through which WHO in Swaziland will implement its leadership priorities of universal health coverage; addressing the unfinished business of the MDGs; implementing the International Health Regulations; increasing access to high quality medical products; addressing the environmental and social determinants of health; and addressing NCDs as defined in the 12th General Programme of Work. The strategic agenda for WHO cooperation for the period 2014–2019 is based on the priorities identified in the WHO 12th General Programme of Work and Programme Budget 2014–2015. While Swaziland adopted the strategic priorities identified in the GPW, the country defined key areas of focus within these priorities that are unique to the needs of Swaziland and in line with the NHSSP. It is envisaged that this will ensure closer alignment of the CCS, GPW, programme budgets and biennial work plans by which the CCS will be operationalized. Strategic approaches were derived from national consultations that involved government as well as local and international partners. Strategies were prioritized according to their contribution to the achievement of targeted health outcomes and their ability to assist in closing the current gaps in the achievement of universal health coverage.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 25
W H O C O U N T R Y S wa z i l an d
5.2 Strategic Agenda 1: Communicable diseases Swaziland is experiencing a serious burden of HIV/AIDS and tuberculosis which is made worse by the close relationship between the two conditions. Other communicable diseases such as malaria, neglected tropical diseases and vaccine-preventable diseases are also a challenge; hence, the prevention and control of communicable diseases is a priority for this CCS cycle. 5.2.1 HIV and AIDS
This CCS focuses on programme strengthening of implementation, monitoring and evaluation of the health sector response to HIV and AIDS. Emphasis will be placed on the combination HIV prevention package including male circumcision, HTC and condom promotion. WHO will also support, where feasible, the introduction of treatment as prevention. Technical support will also be provided toward the implementation of the new consolidated HIV and AIDS guidelines in order to provide more comprehensive quality treatment and care for PLHIV including children and adolescents. WHO will also support the strengthening of strategic information for the health sector response including M&E, assessment of the trend of the epidemic and surveillance for HIV drug resistance. 5.2.2 Tuberculosis
To tackle TB control challenges WHO will support the country to improve and strengthen the management of all TB cases for adults and children. The focus will be on strengthening the DOTS strategy including community DOTS and addressing the increasing problem of drug-resistant TB; in doing this, WHO will work to strengthen TB diagnosis and TB partnerships including public private partnerships in the national response to TB. WHO will also support the implementation of the 3Is strategy: intensive case finding, infection control and isoniazid preventive therapy. 5.2.3 Malaria
As a low malaria transmission country, Swaziland is pursuing the goal of eliminating malaria by 2015 which means reducing the number of indigenous malaria cases to zero. To achieve this WHO will support the country in reviewing the elimination strategy as well as its implementation. WHO will support capacity-building among health workers in terms of case management
26
and integrated vector management including use of insecticide-treated nets and residual indoor spraying. WHO will also support the strengthening of the surveillance system for malaria, monitoring and evaluation, and development and implementation of a communication strategy to enhance community mobilization for malaria prevention services. 5.2.4 Neglected tropical diseases
In Swaziland the major neglected tropical diseases are soil-transmitted helminthiasis and schistosomiasis. WHO has developed a clear global policy for the control of soil-transmitted helminthiasis and schistosomiasis. Guided by this policy, WHO will support the country to conduct baseline surveys on NTDs to estimate the present status and the need for intervention as well as to produce essential data for guiding the development of national control programmes including school-based chemoprophylaxis. Follow-up surveys will be used to monitor the impact of the control programme. WHO will support the strengthening of the surveillance system for soil-transmitted helminthiasis and schistosomiasis in the country. 5.2.5 Vaccine-preventable diseases
Children under the age of five years die from vaccine-preventable diseases. Immunization is one of the most successful and cost-effective public health interventions. The priority given to current and future vaccine-preventable diseases is reflected in the Decade of Vaccines (2011–2020) and WHO’s associated Global Vaccine Action Plan (GVAP). Guided by this action plan, WHO will support the development of a national plan to implement strategies to reach the immunization coverage of 90% at national level and at least 80% coverage in every region. A special focus will be on reaching all the underserved populations. In addition, WHO will support the strengthening of a surveillance system for vaccine-preventable diseases. Efforts will also be intensified towards the elimination of measles and rubella. New vaccines are becoming available, and routine immunization is being extended from the focus on infants and pregnant women as the sole target groups to the inclusion of adolescents and adults. By scaling up the use of existing vaccines and the introduction of more licensed vaccines WHO will support planning and introduction of new vaccines in the country.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 27
W H O C O U N T R Y S wa z i l an d
5.3 Strategic Agenda 2: Noncommunicable diseases Swaziland is experiencing a rise in the burden of noncommunicable diseases, especially cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes mellitus. Mental health, substance abuse, violence, injury, nutrition, disability and rehabilitation are other areas that will be focused on during this CCS cycle. 5.3.1 Major noncommunicable diseases
The strategies and actions identified in this CCS align with the national priorities for NCDs prevention and control as reflected in national strategic documents. The main strategy will be developing a strong surveillance system for NCDs; strengthening the monitoring and evaluation framework; and focusing on operational research for evidence-based decision-making. Another priority area is supporting the integration of NCDs into the primary health care system, other communicable disease programmes and the sexual reproductive health programme. The control of NCDs involves risk reduction; thus, guidelines will be produced by adapting and implementing global risk reduction strategies such as the Global Strategy on diet, physical activity and health and the Global Strategy to reduce the harmful use of alcohol. In this regard, WHO will collaborate with other sectors. The country will be supported in the implementation of the provisions of the Framework Convention on Tobacco Control through policy and legislation development under the Tobacco Products Control Act of 2013. 5.3.2 Mental health and substance abuse
Mental health is increasingly acknowledged as an important public health concern in Swaziland. However, WHO has provided limited support to mental health. During the timeframe of this CCS, WHO will support the review and development of guiding and normative documents which include the mental health policy, strategic plan, treatment guidelines, and standard operating procedures including the development of strategies and programmes to address substance abuse in the country. Support will also be extended for integrating mental health services with the general health-care system and for decentralizing services. Efforts will be made to build capacity of health workers in managing mental health cases and to strengthen community care and rehabilitation services. The M&E systems for mental health including operations research will be strengthened.
28
5.3.3 Violence and injury
Violence and injury are major killers of adults, children and adolescents in Swaziland. These deaths are preventable. WHO will work closely with various partners such as the Road Safety Alliance; support strengthening of the surveillance system for violence and injuries; and encourage research on post-crash responses in the country. WHO will also support capacitybuilding of health workers in the management of trauma cases pre-hospital, in hospital and during rehabilitation. 5.3.4 Disability and rehabilitation
Strengthening the programming and coordination of rehabilitation services in the country has been identified as one of the priorities in the NHSSP 2. In this regard WHO will support the development of guiding documents for rehabilitation in the country including the policy and the strategic plan. 5.3.5 Nutrition
In the area of nutrition WHO will support the updating of the Comprehensive Nutrition Policy as well as conducting a national survey on the nutritional status of the population. Support will also be provided for the development of a strategy to address acute and chronic malnutrition including stunting and obesity as well as infant and young child feeding.
5.4 Strategic Agenda 3: Promoting health through the life course In this area, the WHO Country Office will support the Ministry of Health to implement interventions that will reduce morbidity and mortality and improve health during key stages of life including pregnancy, childbirth, the neonatal period, childhood and adolescence. In addition, emphasis will be on improving sexual and reproductive health and promoting active and healthy ageing for all individuals, using a life-course approach in addressing equity gaps. 5.4.1 Reproductive, maternal, newborn, child and adolescent health
Reproductive health continues to be a challenge especially in the area of maternal and newborn health; the HIV and AIDS pandemic has compounded this problem. Complications of pregnancy are not always predictable and C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 29
W H O C O U N T R Y S wa z i l an d
can occur even if a woman has had good quality antenatal care. Access to quality maternity services with emergency obstetrics and neonatal care (EMONC) is critical in saving the lives of mothers and babies especially after delivery and during the first day of life. WHO will support the efforts of the Ministry of Health for reduction of maternal, newborn, infant and child morbidity and mortality through strengthening implementation of the frameworks for accelerating the reduction of maternal and neonatal mortality (CARMMA, MAF). WHO will furthermore contribute to improving the quality of care through implementation of the Commission on Information and Accountability (CoIA) road map with special reference to the health of women and children. This will include advocacy for increased access to maternal and child health services and strengthened capacity to achieve universal access to priority health interventions and support initiatives for improving access, demand and quality family planning (FP) services, especially the use of long-term contraceptive methods. WHO will also provide support in scaling up EMONC, monitoring of maternal and neonatal deaths through surveillance and response (MNDSR) and strengthening capacities of communities in the prevention of morbidity and mortality in maternal, newborn and child health (MNCH). This will include support for implementation and monitoring of interventions defined in the child survival strategic plan and other cost-effective interventions that are evidence-based. 5.4.2 Aging and health
The WHO Country Office will support the development of policies and strategies that foster healthy and active ageing and provide technical guidance in promoting innovations that identify and address health needs of older people for improved care. 5.4.3 Gender, equity and human rights
As a result of gender imbalance, women experience health hazards such as physical and sexual violence, sexually transmitted infections, HIV, AIDS and other health problems. Most of their problems are related to limited equity and integration of gender in health programmes.
30
WCO will support the Ministry of Health in the integration of gender, equity and human rights with national policies and programmes and the provision of gender-sensitive health-care services. In the area of gender-based violence (GBV), WHO support will focus on effective management of survivors to complement the work of other stakeholders in GBV prevention. 5.4.4 Social determinants of health
Concerted and coordinated action on the social determinants of health (SDH) requires strong political leadership and ambition. Multi-sectorial and government actions are needed to tackle the social determinants of health. WHO will support the strengthening of multi-sectorial collaboration to address the SDH and implementation of health in all policies. Health promotion is part of the efforts to address SDH. WHO will support strengthening national institutional and technical capacity for health promotion and the establishment of sustainable mechanisms for innovative financing of health promotion to ensure adequate funding of interventions across programmes. 5.4.5 Health and environment
Environmental hazards influence many communicable and noncommunicable diseases including injuries. Addressing environmental hazards goes a long way in disease prevention. WHO will support the implementation of the Libreville Declaration through National Plans of Joint Action (NPJA). Support will also be given towards the development of occupational health and safety policy, strategies and guidelines as well as implementation of the WHO safe workplaces programme. Improving where people stay is a key to disease prevention and control, and WHO will assist the country through the use of Urban Health Equity Assessment and Response Tool (HEART).
5.5 Strategic Agenda 4: Health systems The country has made some strides in improving health service delivery following the introduction of health sector reforms and implementation of the National Health Sector Strategic Plan 2008–2013 (NHSSP). The NHSSP has also led to the development of management documents and guidelines which contribute to progress towards universal health coverage as highlighted in the National Health Policy (NHP).
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 31
W H O C O U N T R Y S wa z i l an d
5.5.1 National health policies, strategies and plans
During this Country Cooperative Strategy the WHO Country Office (WCO) will support the country in the implementation of the Essential Health Care Package (EHCP); the Essential Medicines List (EML) and Standard Treatment Guidelines (STG); and the Human Resources for Health Strategic Plan. The country will also be supported to review the current National Health Policy and finalize the second National Health Sector Strategic Plan. Within the Ministry of Health the NHSSP will be implemented through annual operational plans at national, regional, programme, unit and health facility level. The WCO will support the programmes, units and facilities with limited capacity for developing plans. WHO will also support the strengthening of the stewardship and partner coordination roles of the Ministry of Health to ensure alignment with the priorities identified in the NHP and the NHSSP. Furthermore, WHO will support the country in the development of the road map for the achievement of universal health coverage. 5.5.2 Integrated people-centred health services
The WHO Country Office will support the sector to operationalize the Framework for the implementation of the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa. This will include rolling out the Essential Health Care Package (EHCP) and Standard Treatment Guidelines (STGs) and giving consideration to the contributions of community health workers in health care delivery and strengthening referrals and linkages. WHO will also support the strengthening of eye, ears-nose-throat (ENT) and dental services. During this CCS the other important areas of focus will be supporting the health sector to implement the National Human Resources for Health Strategic Plan and strengthen the capacity of the MOH HRH unit. In the area of health financing, WHO will support the development and implementation of both a policy and strategy for health financing. 5.5.3 Access to medicines and health technologies
Leadership, governance and regulatory mechanisms require strengthening. This strategic priority area will focus on supporting the Ministry of Health to strengthen capacity to lead the sector and assume its stewardship role. 32
The professional regulatory bodies will be supported to strengthen their role in regulating and monitoring professional conduct to ensure the safety of consumers of health services. During the CCS 2008-2013 WHO provided technical support for an assessment for the establishment of a medicines regulatory authority. WHO will advocate for the finalization and adoption of the pharmacy and related substances bill which provided for the establishment of the Medicine Regulatory Authority (MRA). The country will be supported to improve rational use of medicines and ensure uninterrupted supply of quality medicines and diagnostics. The implications and contribution of complementary medicine and traditional medicine will be taken into consideration during this CCS. 5.5.4 Health systems information and evidence
The Ministry of Health established the Health Research Technical Working Group to form the Health Research Unit. The WCO will support the MOH to develop capacity to implement the provisions of the National Health Research Policy and Strategic Plan. The use of evidence in planning will be promoted and WHO will support the strengthening of the Health Management Information System (HMIS). In addition, WHO will support the development of both a policy and a plan for e-Health.
5.6 Strategic Agenda 5: Preparedness, surveillance and response Another strategic priority focuses on preparedness, surveillance and response to public health events of international and national concern. In addition, it addresses humanitarian response to emergencies and disasters as well as issues of food safety. Preparedness, surveillance and response focuses on four main areas: alert and response capacities; epidemic and pandemic prone diseases; emergency risk and crisis management; and food safety. 5.6.1 Alert and response capacities
The focus area of alert and response looks at the implementation of the International Health Regulations (IHR 2005) in Swaziland. Swaziland is one of the countries still to build the required capacities for implementing the IHR 2005. An assessment of the required capacity and plan for capacitybuilding has been done; the national focal point has been established and
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 33
W H O C O U N T R Y S wa z i l an d
the strengthening of disease surveillance at ports of entry has been initiated. To ensure that the country remains on course to meet the requisite capacities for implementing IHR 2005 by June 2014, WHO will provide technical support for capacity-building in the health sector and other relevant sectors. Technical support will include training, surveillance, and risk assessment and communication. In addition, WHO will support continuous advocacy for multi-sectorial action in the implementation of the IHR 2005. 5.6.2 Epidemic and pandemic prone diseases
In this area, the focus is on strengthening Integrated Disease Surveillance and Response (IDSR) in the country. This will also augment the work on the implementation of the IHR 2005. The Ministry of Health has developed and approved national IDSR guidelines in preparation for implementation of IDSR. WHO will provide on-going technical support for capacity-building for the implementation and monitoring of IDSR, including the development of training materials and the training of all relevant officials and stakeholders at all levels. 5.6.3 Emergency risk and crisis management
This area focuses on national response to emergencies that have public health consequences and polio eradication. Swaziland occasionally experiences droughts, floods, hail storms and wild fires. The Ministry of Health has established an emergency preparedness and response unit which is responsible for providing emergency medical services countrywide. At national level the Disaster Management Authority has been established to coordinate all disaster response activities. In addressing emergencies and disasters that may arise in the CCS period, WHO will provide support to implement the Disaster Risk Management Strategy for Africa, including the development of a national Swaziland disaster risk management plan of action based on assessments of capacities and risks. WHO will also build capacity in MOH staff and other relevant stakeholders for the implementation of a national disaster risk management plan which could include disaster response planning and training. WHO will also strengthen the readiness of the WHO Country Office and staff for implementing the WHO emergency response framework in acute emergencies with public health consequences.
34
On 26 May 2012, the World Health Assembly declared ending polio a “programmatic emergency for global public health”. Swaziland presented its poliofree certification documentation which was duly accepted by the Africa Regional Certification Commission (ARCC) in 2005. Thereafter, it has been important that the country maintain its polio-free status. WHO will therefore support the country to maintain this status through the strengthening of AFP surveillance and polio outbreak preparedness. Further, routine polio immunization will be strengthened. The Polio Eradication and Endgame Strategic Plan 2013–2018 was developed to end the disease of polio. In this regard, WHO will provide support for capacitybuilding for implementation of interventions of the polio endgame strategy as it pertains to Swaziland. 5.6.4 Food safety
In the area of food safety, the focus during the period of the CCS will be on minimizing food-borne infections and controlling zoonotic diseases through capacity-building of all relevant stakeholders as well as promotion of intersectorial linkages and action, especially between the health and agricultural sectors. WHO will provide technical support for an assessment to establish the magnitude of the problem of foodborne diseases and support capacity-building for controlling foodborne diseases including risk communication. In addition, WHO will provide guidance and support the strengthening of surveillance of foodborne and zoonotic diseases through collaboration with the International Food Safety Authorities Network (INFOSAN) and in the context of the IHR.
5.7 Enabling functions of the strategic agenda Within the context of this CCS, WHO will implement some broad functions to support the country in addressing national health priorities as well as participate more effectively in the global health agenda (see Table 1). In this regard WHO will support and contribute to partnership strengthening through such forums as the CCM and support national resource mobilization efforts. WHO will work towards strengthening the capacity of the country to participate in meetings of governing bodies such as the World Health Assembly and the Regional Committee for Africa through regular briefings of the delegation and other stakeholders on the agenda of the meetings. Furthermore, WHO will support the debriefing and follow-up on implementation of resolutions and recommendations emanating from these governing bodies.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 35
W H O C O U N T R Y S wa z i l an d
Table 1: Strategic priorities and approaches of the WHO Country Cooperation Strategy 2014-2019, Swaziland
Strategic priorities 1. Communicable diseases
Main areas of focus 1.1 HIV/AIDS 1.1.1
Strategic approaches Strengthen HIV prevention in the health sector focusing on combination HIV prevention and scaling up male circumcision especially Early Infant Male Circumcision (EIMC)
1.1.2 Expand HIV surveillance to include incidence, prevalence measurement and HIV drug resistance 1.1.3 Support implementation of WHO HIV treatment guidelines and promote integration of HIV treatment with other services as well as improve adherence to ART through strengthening communities (schools, outreach, mobile clinics, adherence clubs) Improve management of all TB cases including MDR/XDR, rifampicin-resistant cases
1.2 TB
1.2.1
1.2.2 Strengthen diagnosis and management of TB in children 1.2.3 1.3 Malaria 1.3.1 Improve patient support and community linkages as part of DOTS strategy Strengthen malaria surveillance as part of elimination
1.3.2 Strengthen community education on malaria in order to create demand for services (ITNs, prophylaxis, ACT, indoor residual spray) 1.4 Neglected tropical diseases 1.4.1 Strengthen the development of strategic documents for NTD programme 1.4.2 1.4.3 Strengthen the surveillance system for NTDs in the country Support the Implementation of the deworming programme in schools
36
Strategic priorities
Main areas of focus 1.5 Vaccinepreventable diseases 1.5.1
Strategic approaches Introduce new life-saving vaccines for under-fives, adolescents and adults
1.5.2. Strengthen routine immunization activities by implementing RED and other innovative strategies 1.5.3 Strengthen surveillance 1.5.4 Intensify efforts to eliminate measles and rubella, and prevent Hep B
2. Noncommunicable 2.1 NCDs diseases
2.1.1
Support the development of a strong surveillance system for NCDs and strengthen M&E as well as research
2.1.2 Support integration of NCDs into PHC as well as CD and SRH programme 2.1.3 Adapt and implement global risk reduction strategies 2.2 Mental health and substance abuse 2.2.1 Support the review and development of guiding and normative documents to address substance abuse in the country 2.2.2 Support the integration of mental health services into the general health care system and decentralization of services; train health workers to manage mental health cases; strengthen community care and rehabilitation services 2.2.3 Support the strengthening of M&E systems for mental health including operations research 2.3 Violence and injury 2.3.1 Support the strengthening of surveillance system for violence and injuries and research on post-crash response 2.3.2 Support capacity-building of health workers on the management of trauma cases: pre-hospital, in hospital, rehabilitation
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 37
W H O C O U N T R Y S wa z i l an d
Strategic priorities
Main areas of focus 2.4 Disability and rehabilitation 2.4.1
Strategic approaches Strengthen the programming and coordination of rehabilitation services
2.4.2 Develop a policy and strategic plan for rehabilitation 2.5 Nutrition 2.5.1 Update the Comprehensive Nutrition Policy
2.5.2 National survey on nutritional status of the population 2.5.3 Develop a strategy to address acute/ chronic malnutrition including stunting, obesity, infant and young child feeding Promote implementation and monitoring of evidence-based interventions to reduce mortality through the life course by supporting implementation and monitoring of interventions on FP, prevention and management of abortions, STIs, cancers of the reproductive organs, and adaptation and implementation of guidelines for SRH Support capacity-building for improving health information on maternal and perinatal health including implementing the road map for the CoIA, maternal and perinatal death surveillance and response Support expansion of high-quality evidence-based interventions to improve child health and end preventable child deaths including pneumonia and diarrhoea
3. Health promotion through the life course
3.1 Reproductive, maternal, newborn, child and adolescent health
3.1.1
3.1.2
3.1.3
3.2 Ageing and health
3.2.1 Support the development of policies and strategies that foster healthy and active ageing 3.2.2 Provide technical guidance in promoting innovations that identify and address the needs of older people for improved health care
38
Strategic priorities
Main areas of focus 3.3 Gender, equity and human rights mainstreaming 3.3.1
Strategic approaches Support integration of gender, equity and human rights into national policies and programmes Promoting good health at key stages of life, taking into account the need to address SDH along with gender, equity and human rights
3.3.2
3.4 Environmental 3.4.1 Support implementation of the Libreville health Declaration through NPJA 3.4.2 Support development of occupational health and safety policy, strategies, guidelines; implement the WHO safe workplaces programme 3.5.3 Support the improvement of where people live using Urban HEART 3.5 Social determinants of health 3.5.1 Revive and strengthen multi-sectorial collaboration on addressing SDH and implementation of Health in all Policies 3.5.2 Strengthen national institutional and technical capacity for health promotion 3.5.3 Establish sustainable mechanisms for innovative financing of health promotion to ensure adequate funding of interventions across programmes
4. Health systems strengthening
4.1 National health policies, strategies and plans
4.1.1 Support the review and development of comprehensive national health policies, strategies and plans 4.1.2 Increase capacity to develop and implement legislative, regulatory and financial frameworks Support the development of the road map to universal health coverage
4.1.3
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 39
W H O C O U N T R Y S wa z i l an d
Strategic priorities
Main areas of focus 4.2 Integrated people-centred health services
Strategic approaches 4.2.1 Strengthen country capacity to develop tools for equitable people-centred integrated service delivery and public health approaches including implementation of the Ouagadougou PHC Framework; strengthen leadership and management capacity in the health sector 4.2.2 Support the development and implementation of customer care and safety standards guidelines
4.2.3 Support country capacity to implement the national HRH policy and strategy 4.2.4 Strengthen capacity of the MOH HRH Unit
4.2.5 Strengthen eye, ENT and dental services 4.2.6 Support development and implementation of a policy and strategy for health financing 4.2.7 Strengthen health service delivery through implementation and periodic review of the EHCP, EML and STG 4.3 Access to medicines and health technologies 4.3.1 Support establishment of national regulatory mechanisms, norms, standards, guidelines for medical products and health technologies Support the establishment of a quality assurance system for pharmaceuticals and biological Support the adaptation and implementation of new diagnostic technologies Facilitate electronic management medicines and medical supplies of
4.3.2
4.3.3 4.3.4
40
Strategic priorities
Main areas of focus 4.4 Health systems information and evidence
Strategic approaches 4.4.1. Provide technical support for policy, tools, guidelines for health information, research and M&E 4.4.2 Advocate for the allocation of 2% of national health expenditure and 5% of project and programme aid for research and technical support to conduct research on health systems Provide technical support to build human capacity for e-Health: diagnosis and management of patients, infrastructure and services
4.4.3
5. Preparedness, surveillance and response
5.1 Alert and response
5.1.1 Support national capacity-building for health and other relevant sectors for the implementation of IHR including training, surveillance, risk assessment and communication 5.1.2 Continuously advocate for multi-sectorial implementation of IHR
5.2 Epidemic and pandemic prone diseases 5.3 Emergency risks and crisis management
5.2.1
Support capacity-building to implement national IDSR
5.3.1 Implement the Disaster Risk Management Strategy for Africa including capacity assessment, planning and capacity development 5.3.2 Develop WCO readiness; implement the WHO emergency response framework in acute emergencies with public health consequences Build capacity and support the implementation of National Polio Endgame Strategy
5.3.3
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 41
W H O C O U N T R Y S wa z i l an d
Strategic priorities
Main areas of focus 5.4 Food safety 5.4.1 5.4.2
Strategic approaches Support capacity-building in food safety including risk communication Strengthen cross-sector linkage and action in food safety including surveillance of foodborne and zoonotic diseases in the context of the IHR
6. Enabling functions
1.1 Leadership and governance
6.1.1 Build capacity and support national participation in governing bodies meetings 6.1.2 6.1.3 Foster partnership and collaboration within the country Support national resource mobilization for the health sector
5.8 Validation of the Country Cooperation Strategy 5.8.1 Validating the Country Cooperation Strategy with the National Health Policy and National Health Sector Strategic Plan
The CCS strategic agenda is aligned to the national priorities identified in the National Health Policy and the National Health Sector Strategic Plan. This is illustrated in Table 2. Both the CCS and NHSSP prioritize the prevention and control of communicable diseases. Communicable diseases including vaccine-preventable diseases are a huge burden on the country. Prevention and control of non-communicable diseases and their risk factors are also prioritized in both documents. The CCS, NHP and NHSSP emphasize universal health coverage, primary health care and health systems strengthening. The CCS includes ageing, gender, equity and human rights which are also included in the NHSSP.
42
Table 2: Validation of Country Cooperation Strategy agenda with the National Health Policy and National Health Sector Strategic Plan priorities
CCS agenda 1. Communicable diseases (a) HIV/AIDS (b) Tuberculosis (c) Malaria (d) Neglected tropical diseases (e) Vaccine-preventable diseases 2. Noncommunicable diseases (a) Major NCDs (b) Mental health and substance abuse (c) Violence and Injury (d) Disability and rehabilitation (e) Nutrition 3. Promoting health through the life course (a) Reproductive health, MNC health and adolescent health (b) Ageing and health (c) Gender, equity and human rights mainstreaming (d) Environmental health (e) Social determinants of health 4. Health systems strengthening (a) National health policies, strategies and plans (b) Integrated people-centred health services
NHP and NHSSP priorities (a) Prevention, control and management of communicable diseases (b) Prevention, control and management of HIV and AIDS, TB, malaria and STIs
(a) Prevention, control and management of NCDs
(a) Family health including reproductive health, maternal health, child health and nutrition (b) Health promotion including health education, environmental health, school health, substance abuse prevention and control
(a) Enhancing health system capacity and performance (b) Strengthening the governance and management capacity of MOH (c) Strengthening financial management and administrative support systems
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 43
W H O C O U N T R Y S wa z i l an d
CCS agenda (c) Access to medicines and health technologies (d) Health systems information and evidence
NHP and NHSSP priorities (d) Strengthening systems for HR development and management (e) Emphasizing decentralization and strengthening regional and community-based health systems (f) Strengthening health sector partnerships, coordination and SWAps (g) Strengthening policy, planning, monitoring and evaluation systems (h) Strengthening regulatory standards and quality assurance systems (i) Strengthening health research and knowledge management systems
5. Preparedness, surveillance and response (a) Alert and response (b) Epidemic and pandemic prone diseases (c) Emergency risks and crisis management (d) Food safety (e) Polio eradication
(a) Strengthen emergency, epidemic and disaster prevention, preparedness and response (b) Capacity-building for implementation of the IHRs
5.8.2 Validating the Country Cooperation Strategy agenda with the United Nations Development Assistance Framework
UNDAF has two health-related objectives and that focus mainly on HIV/AIDS and the health of mothers, newborns and children. These areas are also prioritized in the Country Cooperation Strategy.
44
Table 3: Validation of the CCS strategic agenda with UNDAF objectives CCS strategic agenda 1. Communicable diseases (a) HIV/AIDS (b) Tuberculosis (c) Malaria (d) Neglected tropical diseases (e) Vaccine-preventable diseases 2. Noncommunicable diseases (a) Major NCDs (b) Mental health and substance abuse (c) Violence and injury (d) Disability and rehabilitation (e) Nutrition 3. Promoting health through the life course (a) Reproductive health, MNC health and adolescent health (b) Ageing and health (c) Gender, equity and human rights mainstreaming (d) Environmental health (e) Social determinants of health 4. Health systems strengthening (a) National health policies, strategies and plans (b) Integrated people-centred health services (c) Access to medicines and health technologies (d) Health systems information and evidence 5. Preparedness, surveillance and response (a) Alert and response (b) Epidemic and pandemic prone diseases (c) Emergency risks and crisis management (d) Food safety (e) Polio eradication 2. Human development and basic social services (a) To increase access to and utilization of quality basic social services especially for women, children and disadvantaged groups by 2015 · Effective and efficient social services delivery (particularly in health, education, water and sanitation) in place · Basic social services to vulnerable groups including women and children, equitably accessed · Government capacity to establish decentralized structures for disaster management improved UNDAF objectives and outcomes 1. HIV and AIDS (a) To contribute to reduced new HIV infections and improved quality of life of persons infected and affected by HIV by 2015 · · · · · Risky behaviour for prevention of HIV reduced Access to comprehensive HIV treatment, care and support increased Impact mitigation services for vulnerable children Services for PLHIV and the elderly scaled up HIV and AIDS response effectively managed at all levels
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 45
W H O C O U N T R Y S wa z i l an d
46
SECTION 6: 6. IMPLEMENTING THE STRATEGIC AGENDA 6.1 Government commitment to health Swaziland is classified as a lower-middle-income country; therefore, it does not attract many development partners including bilateral and multilateral agencies, international institutions or international NGOs. This is in spite of the fact that over 63% of the population live in poverty and the health profile of the country is similar to that of least developed countries. There is strong government commitment to the health sector. The government contributes over 80% of the total health expenditures and has prioritized the health sector in its budgetary allocations. The bulk of the support from development partners goes to accelerating actions on health-related MDGs, especially responses to HIV/AIDS and TB. Other critical areas of health remain relatively unsupported including health systems strengthening; ensuring access to affordable medical products; combating NCDs; building capacity for implementing the IHR 2005; and addressing the environmental and social determinants of health.
6.2 The role and presence of WHO The WHO plays a critical role in providing the necessary technical support and guidance for implementation of the current CCS, national health policies and national health plans for improved health outcomes in Swaziland. In addition, WHO and indeed the whole UN family have important roles to play in advocating for more international support for health for Swaziland. The strategic agenda of this CCS describes the roles of WHO as providing technical advice, advocating and building capacity across all priority areas in the health sector. These roles allow WHO to effectively and comprehensively support the health sector within the dictates of its own mandate and resource availability.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 47
W H O C O U N T R Y S wa z i l an d
The implication of these WHO roles and presence is the need for Country Office staff with competencies to provide high level policy advice and guidance in all the critical areas of the health sector in Swaziland. The areas are health systems strengthening; communicable diseases especially HIV, AIDS and TB; NCDs control; health promotion including addressing environmental and social determinants of health; and epidemic preparedness and response. Implementation the strategic agenda will require that professional staff of the WCO be regularly reviewed and re-profiled to ensure alignment with the CCS. Therefore, WHO should ensure the mobilization and allocation of adequate resources for the requisite technical team in the WCO in Swaziland. Given the limited capacities in the WCO, it is very important that WHO intensify and coordinate the technical backstopping from other levels of the Organization, i.e. the Intercountry Support Team, Regional Office and Headquarters, in order to complement Country Office efforts. Further support should be obtained from WCOs having the expertise required for the strategic agenda priorities. WHO is the main, if not only, partner of government in a number of health areas. The implication of this is that the Organization should allocate adequate funding to support implementation of key actions in the health priorities identified in the CCS, especially in the least supported areas. To fully implement the strategic agenda, the WHO should explore innovative ways of mobilizing additional resources for Swaziland, given its middle-income classification and limited number of development partners. To ensure that the results of the CCS fully complement the work of other partners and the government in meeting national health goals, WHO will need to work closely with all the available partners both bilaterally and through the National Health Partnership Forum. In addition, WHO will need to continue to collaborate closely with other UN agencies in implementing the CCS to ensure continued alignment with the UNDAF and in the context of “Delivering as One”.
6.3 Using the CCS document During the review of the Country Cooperation Strategy 2008–2013 most stakeholders, especially those at subnational level, indicated that they did not know much about the CCS, and yet it is a key document driving the cooperation between a Member State and WHO. Therefore the WCO will organize a national launch and dissemination of the CCS to various key stakeholders at national and subnational levels. This will also help to enhance understanding of the roles and functions of WHO.
48
Swaziland has just initiated the process of developing the National Health Sector Strategic Plan for the period 2014–2018 (NHSSP 2). This third generation CCS in addition to the valuable information gathered during the review of the second generation CCS will help guide or inform the development of the NHSSP 2. Further, the WCO should ensure that this CCS is used in all planning processes in the health sector, particularly in the preparation of biennial and operational workplans. Swaziland is currently implementing the UNDAF 2011–2015 which is undergoing a mid-term review. The WCO should ensure that the CCS informs the adjustment of the UNDAF post mid-term review. Further, the CCS will inform the next UNDAF for the period 2016–2020. Finally, the WCO and other levels of the Organization should use the CCS to advocate and mobilize more resources for the work of WHO in Swaziland.
6.4 Monitoring and evaluation A monitoring framework for this CCS has been developed (see Annex 4). The monitoring of the CCS will be done periodically at six-month intervals in line with the monitoring of biennial operational plans. Semi-annual, annual and end-ofbiennium evaluation done collaboratively with the MOH will form the basis of CCS monitoring. Further, mid- and end-term reviews of the CCS will be conducted as part of the monitoring and evaluation of this CCS.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 49
W H O C O U N T R Y S wa z i l an d
50
REFERENCES : African Development Bank 2011. Kingdom of Swaziland country strategy paper, 2009–2013 mid-term review. African Development Bank. Central Bank of Swaziland 2013. Annual Report, April 2012-March 2013. Central Bank of Swaziland. Mbabane: Kingdom of Swaziland. Central Statistical Office 2008. Swaziland Demographic Health Survey 2006-07. Macro International Inc. Calverton, Maryland: USA. Central Statistical Office and UNICEF. Multiple Indicators Cluster Survey 2010: Final Report. Mbabane: Kingdom of Swaziland. Central Statistics Office 1999. Swaziland population projections 2007–2030: changing shape of the population pyramid. Mbabane: The Government of the Kingdom of Swaziland, 2007. Central Statistics Office 2011. Poverty profile report 2009/2010. Swaziland household income and expenditure survey: poverty in a decade of slow economic growth. Mbabane: Kingdom of Swaziland. Government of Swaziland. National development strategy. Mbabane: Kingdom of Swaziland. Ministry of Economic Planning and Development (Swaziland) 2006. Poverty reduction strategy and strategic plan. Mbabane: Kingdom of Swaziland. Ministry of Economic Planning and Development (Swaziland) 2012. The sector wide approach: the country assessment. Mbabane: Kingdom of Swaziland. Ministry of Economic Planning and Development (Swaziland) 2013. Status of Official Development Assistance in Swaziland 2011/12. Mbabane: Kingdom of Swaziland. Ministry of Economic Planning and Development (Swaziland) 2013. Status of Official Development Assistance in Swaziland 2011/12. Mbabane: Kingdom of Swaziland.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 51
W H O C O U N T R Y S wa z i l an d
Ministry of Economic Planning and Development (Swaziland) July 2013. Economic indicators for Swaziland. Mbabane: Kingdom of Swaziland. Ministry of Economic Planning and Development (Swaziland) October 2012. International Conference on Population and Development (ICPD) at 2014 and Beyond. Mbabane: Kingdom of Swaziland. Ministry of Finance 2013. Estimates for the years from 1st April 2013 to 31st March 2016. Mbabane: Kingdom of Swaziland. Ministry of Finance. Budget speech 2013 (online). Mbabane: Government of the Kingdom of Swaziland, 2011. Available from: http://www.gov.sz/images/ stories/finance/budget%20and%20monetary%20affairs/Final%20BUDGET%20 SPEECH%202013.pdf (accessed 2 October 2013). Ministry of Finance. Fiscal adjustment roadmap 2010/1–2014/15 (online). Mbabane: Government of the Kingdom of Swaziland, 2011. Available from: http://www. gov.sz/images/stories/FAR.pdf (accessed 2 October 2013). Ministry of Health 2007. National Health Policy. Mbabane: Kingdom of Swaziland. Ministry of Health. ART Programme Annual Report 2012. Mbabane: Kingdom of Swaziland. Ministry of Health. Swaziland Annual Statistics Report 2010. Mbabane: Kingdom of Swaziland. Ministry of Health. Swaziland Annual Statistics Report 2010. Mbabane: Kingdom of Swaziland. The Global Health Group and the Malaria Atlas Project (2011). Atlas of MalariaEliminating Countries, 2011. San Francisco. The Global Health Group, Global Health Sciences, University of California, San Francisco: USA. United Nations Development Program 2000. Swaziland Human Development Report: economic growth with equity. Mbabane: Kingdom of Swaziland. United Nations System in Swaziland. The United Nations Development Assistance Framework for the Kingdom of Swaziland 2011-2015. Mbabane: Kingdom of Swaziland.
52
WHO, UNICEF, UNFPA and The World Bank estimates. Trends in Maternal Mortality: 1990 to 2010: WHO Document Production Services, Geneva: Switzerland. WHO. Global Health Observatory Data Repository: WHO African Region: Swaziland Statistics Summary (2002 - present) (online). Available from: http://apps.who. int/gho/data/?theme=country&vid=18900 (accessed 02 October 2013) World Bank. World Bank Working Paper No. 214. African Human Development Series: The Human Resources for Health Crisis in Zambia (online). Available from: http://issuu.com/world.bank.publications/docs/9780821387610/31(accessed 02 October 2013)
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 53
W H O C O U N T R Y S wa z i l an d
54
ANNEXES Annex 1: Health workers per 1000 population in Swaziland Health worker per 1000 persons 0.126 (2.1 including for profit private sector) 1.5 (1.9 including for profit private sector) 0.071 0.122 0.029 0.114 0.224 0.047 0.035 0.077 0.078 0.060 0.030 0.011 0.003 1.2
Cadre Medical
Total number 126
Benchmark to achieve MDGs (per 1000 persons) 0.55 (Scheffler et al 2008 in the World Bank Working Paper) 1.73 (Scheffler et al 2008 in the World Bank Working Paper )
Nursing
1,505
Dental Environmental health Health education Laboratory Administration Medical imaging Biomedical engineering Nutrition Other paramedical Pharmaceutical Physiotherapy Psychology Social welfare Support staff
71 122 29 114 224 47 35 77 78 60 30 11 3 1,152
Grand Total
3,684
3.68
4.1 WHO Benchmark
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 55
W H O C O U N T R Y S wa z i l an d Annex 2: Face-to-face interviews Face-to-face interviews: Development partners and parastatal employees Name 1. 2. Mr Karibu Nasidi
Designation Deputy Resident Representative
Organization UNDP UNDP
Ms Senelisiwe Ntshangase Programme Analyst— Governance and HIV/ AIDS Dr Kwame Ampomah Ms Margherita Coco Dr Florence NaluyindaKitabire Mr Makhosini Mamba Country Coordinator Head of Programmes HIV/AIDS Specialist Health Specialist— PMTCT & Paediatric AIDS Representative
3. 4. 5. 6.
UNAIDS WFP UNICEF UNICEF
7. 8. 9. 10. 11. 12. 13.
Dr H. Mohtashami Ms Marjorie Mavuso Mr Emmanuel Tofoatsi Ms SanelisiweTsela Ms Thamary Silindza Mr BonganiDlamini Ms Rachel ShongweMasuku Ms Happiness Mkhatshwa Ms Lucille Bonaventure Mr Patrick Mduduzi Dlamini Dr Peter Ehrenkranz
UNFPA
Assistant Representative UNFPA Technical Advisor Technical Specialist— SRH/HIV Programme Analyst— Maternal Health Programme Analyst— SRH/ HIV Linkages Programme Analyst— Population & Development Programme Analyst— SRH Country Coordinator Deputy Country Coordinator CDC Country Director UNFPA UNFPA UNFPA UNFPA UNFPA
14. 15. 16. 17.
UNFPA PEPFAR PEPFAR PEPFAR
56
Face-to-face interviews: Development partners and parastatal employees 18. 19. 20. Mr Elias Pavlopoulos Dr Bernhard Kerschberger Ms Thembi Gama Head of Mission Deputy Medical Coordinator Head of Response Planning MSF/Swiss & Ned MSF/Swiss & Ned National Response Council on HIV/AIDS
FGDs: NGOs 21. 22. Ms Victoria Masuku Dr Hailu Alida Director— HIV Systems Strengthening Executive Director Population Services International (PSI) Swaziland Baylor-Bristol-Myers Squibb Children's Clinical Center of Excellence Save the Children Fund mothers2 mothers Red Cross Swaziland National Nutrition Council and Nutrition Programme Southern Africa HIV/AIDS Information Dissemination Service International Baby Food Action Network (IBFAN)-Africa Swaziland Infant Nutrition Action Network (SINAN) World Vision & CCM SOS Children Villages The AIDS Information and Support Centre (TASC) Cheshire Homes
23. 24. 25. 26. 27.
Ms Senelile Khumalo Ms Sibongile Maseko Ms Jabu Mthethwa Ms Danisile Vilakati Mrs Margaret ThwalaTembe Ms Joyce Chanetsa Mr Percy Chipepera Rev Senzo Hlatshwayo Ms Phumelele DlaminiNjoya Ms Thandi NHlengethwa Ms Makhosazana Hlatswayo
Information Officer Country Director Matron-in-charge of clinics Director Country Representative
28. 29. 30. 31. 32. 33.
Regional Coordinator Programme Manager Team Leader—Health Services National Fundraiser Executive Director Director
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 57
W H O C O U N T R Y S wa z i l an d
Face-to-face interviews: Development partners and parastatal employees 34. 35. Mr Markton Gumede Ms Joanne Chesson Nursing Sister Monitoring and Evaluation Officer Catholic Church Swaziland Breast & Cervical Cancer Network
FGD: Institutions of Higher Learning 36. 37. Dr Winnie Nhlengethwa Ms Zanele Mhlongo Principal Vice Chancellor Good Shepherd College Southern Africa Nazarene College (SANU)
FGD: Support groups 38. 39. 40. 41. 42. 43. 44. Ms. Dumsile Mavuso Ms. Siphiwe Nxumalo Ms. Kelley Gorsuch Ms. Nomsa Msibi Mr. Eric M. Dlamini Ms. Nozipho Sibandze Ms. Nolwazi Mabanga Director Member Member Member Member Member Member Diabetes Swaziland Diabetes Swaziland Diabetes Swaziland CANASWA TACS Health Institution Swaziland AIDS Support Organisation Swaziland Positive Living (SWAPOL)
FGDs: MOH Senior management 45. 46. 47. 48. 49. 50. Dr Steven V. Shongwe Ms Constance T. Vilakati Dr Simon Zwane Mrs Rejoice Nkambule Mrs Thembisile Khumalo Matron Phumelele Dlamini Principal Secretary Under Secretary— Technical Director of Health Services Deputy Director Health Services—Public Health Chief Nursing Officer Acting Deputy Chief Nursing Officer MOH MOH MOH MOH MOH MOH
58
Face-to-face interviews: Development partners and parastatal employees 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. Mr Vuyile Dlamini Ms Dudu Mbuli Mr Edmund Dlamini Dr John Kunene Dr Rosemary Mukasa Dr Velephi Okello Mr Musah Dlamini Ms Thabsile Simelane Ms Sibongile Mndzebele Ms Zanela Simelane Ms Danicia Phiri Ms Futhie Nkambule Ms Lombuso Dlamini Mr Dumisani Shongwe Ms Gcinile Buthelezi Ms Violet Buluma Legal Advisor Senior Health Administrator Chief Environmental Health National Medical Coordinator MOH MOH MOH MOH
Senior Medical Officer— MOH Public Heath Senior Medical Officer— MOH SNAP Acting Financial Controller Principal Human Resources Officer Manager—M&E Manager —HMIS MOH MOH MOH MOH
Senior Computer Analyst MOH Senior Planning Officer Ministerial Communication Project Coordinator— Health, HIV/AIDS and TB MOH MOH MOH
65. 66.
Coordinator—MOH/CDC MOH Cooperative Agreement Coordinator—EHCP MOH
FGD: MOH Regional Management Teams 67. Mr Nhlanhla Minisi Regional Health Administrator, Hhohho MOH
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 59
W H O C O U N T R Y S wa z i l an d
Face-to-face interviews: Development partners and parastatal employees 68. 69. Ms Cebile Dlamini Ms Neliswa Mabaso Administrator, Mbabane MOH Government Hospital Administrator, Mkhuzweni Health Centre MOH
FGD: MOH Public Health Managers 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. Ms Phumzile Mabuza Ms Precious Dlamini Mr Simon Kunene Ms Mildred Xaba Mrs Thandi Mndzebele Ms Nok’thula Mahlalela Mr Masitsela Mhlanga Ms Xolisile Dlamini Ms Sibongile Mndzebele Ms Zanela Simelane Dr Velephi Okello Mr Sibusiso Lushaba Programme Manager, SRH Programme Manager, Bilharzia Programme Manager, Malaria Programme Manager, School Health Programme Manager, Rural Health Motivators MOH MOH MOH MOH MOH
Health Promotion Officer MOH Programme Manager, EPR Epidemiologist Monitoring and Evaluation Manager Manager—HMIS MOH MOH MOH MOH
Senior Medical Officer— MOH SNAP National Quality Assurance Programme Officer Research Officer Quality Assurance Officer— MOH/CDC Cooperative Agreement MOH
82. 83.
Ms Babazile Shongwe Ms Gugu Masinga
MOH MOH
60
Face-to-face interviews: Development partners and parastatal employees 84. Ms Bongiwe Maphalala Activity Officer —MOH/ CDC Cooperative Agreement MOH
FGD: MOH Clinical managers 85. 86. Dr Samuel Magagula Dr Mahaliyana Deputy Director Health Services—Clinical Senior Medical Officer, Mbabane Government Hospital MOH MOH
87.
Dr Makhosazana A Dlamini Senior Medical Officer, Mbabane Government Hospital Dr Casper Senior Medical Officer, Matsanjeni Health Centre Senior Medical Officer, Nhlangano Health Centre Senior Medical Officer, Dvokolwako Health Centre Senior Medical Officer, Mkhuzweni Health Centre Senior Dental Officer, Oral Health Matron II, Nhlangano Hospital Acting Chief Technologist, National Clinical Laboratory Services Quality Assurance Manager, Swaziland National Blood Transfusion Services
MOH
88.
MOH
89.
Dr Ndakit
MOH
90.
Dr Lawal
MOH
91.
Dr Mapfeka
MOH
92. 93. 94.
Dr Happiness Mabuza Matron Phindile Mavuso Ms Gugu Maphalala
MOH MOH MOH
95.
Dr Stanley Mtimeri
MOH
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 61
W H O C O U N T R Y S wa z i l an d
Face-to-face interviews: Development partners and parastatal employees 96. 97. 98. Sister Joyce Mdluli Sister Happy Nkhambule Dr Shili Kundhunda Anaesthetist, Hlathikhulu MOH Government Hospital Anaesthetist, Mbabane Government Hospital Medical Officer, Dvokolwako Health Centre MOH MOH
FGDs: Nurse managers 99. Mrs Thembisile Khumalo Chief Nursing Officer Acting Deputy Chief Nursing Officer MOH MOH MOH MOH
100. Matron Phumelele Dlamini
101. Matron Tholakele Mkhonta Matron II, Mbabane Government Hospital 102. Matron Sisana Khumalo 103. Sister Nokthula Kunene 104. Sister Sabelo S Dlamini 105. Sister Lindiwe L Dlamini 106. Sister Rhoda Mkhabela 107. Sister Elizabeth Dlamini 108. Sister Lungile Dlamini 109. Sister Ncamsile Magongo 110. Sister Siphiwe C Dlamini 111. Sister Busisiwe Ngwenya Matron II, Mbabane Government Hospital
Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital
62
Face-to-face interviews: Development partners and parastatal employees 112. Sister Sphiwe Matse 113. Sister Raynett Dlamini 114. Sister Makhosazana Dlamini 115. Matron Thembi P Dlamini 116. Sister Martha B Dlamini Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Nursing Sister, Mbabane MOH Government Hospital Matron II, Mankayane Government Hospital MOH
MOH Nursing Sister, Mankayane Government Hospital Nursing Sister, Hlathikhulu Government Hospital Nursing Sister, Piggs Peak Government Hospital Nursing Sister, Piggs Peak Government Hospital Nursing Sister, Piggs Peak Government Hospital Matron I, National TB Hospital Nursing Sister, National TB Hospital Nursing Sister, National TB Hospital Nursing Sister, National TB Hospital Nursing Sister, National TB Hospital Nursing Sister, National Psychiatric Hospital MOH
117. Sister Eunice B Mdlovu
118. Sister Thabitha Makhanya
MOH
119. Sister Simangele Mamba
MOH
120. Sister Nomvula Pereira
MOH
121. Matron Elizabeth Nxumalo 122. Sister Dorcas Nxumalo 123. Sister Elijah Mabuza 124. Sister Thandi Zikalala 125. Sister Eldah Nsibandze 126. Sister Hellen Vilakazi
MOH MOH MOH MOH MOH MOH
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 63
W H O C O U N T R Y S wa z i l an d
Face-to-face interviews: Development partners and parastatal employees 127. Matron Eunice S Hhalaza 128. Sister Zakhele Nsoko 129. Sister Thokozani Dlamini 130. Sister Nomcebo Dlamini 131. Sister Nkosingphile Shongwe 132. Sister Betrinah Hlophe Maron, Good Shepherd Hospital Nursing Sister, Good Shepherd Hospital Nursing Sister, Good Shepherd Hospital Nursing Sister, Good Shepherd Hospital Nursing Sister, Good Shepherd Hospital Nursing Sister, Matsanjeni Health Centre MOH MOH MOH MOH MOH MOH
133. Sister Tsakasile Maphalala Nursing Sister, Matsanjeni Health Centre 134. Sister Nelly F Nxumalo Nursing Sister, Nhlangano Health Centre Nursing Sister, Nhlangano Health Centre Matron I, Sithobela Health Centre
MOH
MOH
135. Sister Dudu Dlamini
MOH
136. Matron Marylyn M Msibi 137. Sister Nomphumelelo Nkambule 138. Sister Bonsile T Dlamini 139. Sister Chubby Harris 140. Sister Tiny Dlamini
MOH
Nursing Sister, Sithobela MOH Health Centre Nursing Sister, Sithobela MOH Health Centre Nursing Sister, Sithobela MOH Health Centre Nursing Sister, Dvokolwako Health Centre MOH
64
Face-to-face interviews: Development partners and parastatal employees 141. Matron Nomsa J Makhanya 142. Sister Lilly Simelane 143. Sister Gillian Zwane 144. Sister Thulsile Nkambule 145. Sister Dumsile Nxumalo Matron II, Manzana Clinic & Hhohho Region MOH
Nursing Sister, Lubombo MOH Region Nursing Sister, Manzini Region Nursing Sister, Manzini Region Nursing Sister, Manzini Region MOH MOH MOH MOH MOH
146. Matron Thandie Maphalala Matron II, Shiselweni Region 147. Ms Bongiwe Maphalala Activity Officer, MOH/ CDC Cooperative Agreement
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 65
W H O C O U N T R Y S wa z i l an d
Annex 3: Multidisciplinary Core Team Name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. Dr Owen Kaluwa Ms Rejoice Nkambule Ms Khosi Mthethwa Dr Kevin Makadzange Dr Sithembile Dlamini Ms Dudu Dlamini Ms Lonkululeko Khumalo Ms Hlelisile Dlamini Mr Thamsanqa Dlamini Ms Precious Nxumalo Feziwe Hlatshwayo Ms Thembisile Khumalo Ms Dudu Mbuli Dr Velephi Okello Ms Gcinile Buthelezi Mr Tsini Mkhatshwa Ms Ntombifuthi Nkambule Mr Anafi Mataka Ms Fortunate Fakudze Ms Sibongile Mdzebele Dr A.S. Shabangu Dr Bongiwe Malinga Mr. Dumsani Shongwe Designation WHO Representative CCS Chairperson MPN Officer HPR Officer HIV/TUB Officer FHP Officer EPI Officer Administration Officer IT Officer Logistics Assistant SWAp Coordinator Chief Nursing Officer Senior Health Administrator Senior Medical Officer CDC MOH Cooperative Agreement Programme Officer Senior Health Planner Laboratory Officer Pharmacist Monitoring and Evaluation Officer Senior Medical Officer Senior Medical Officer Project Manager Organization WHO MOH WHO WHO WHO WHO WHO WHO WHO WHO MOH MOH MOH MOH PEPFAR CANGO MOH MOH/NCLS MOH MOH MOH MOH World Bank
66
Annex 4: Achievements of past Country Cooperation Strategy (2008–2013) Strategic direction Strategic objective Activities Achievement status Not Partially achieved achieved Fully achieved
Comments
1. Stewardship 1.2. To support and governance efforts to rationalize and improve responsiveness of the management structure and organization of the health sector
1.2.1 Sharing best practices with the sector on structures and organization of health services; 1.2.2 Providing technical support to the process for developing a new and decentralized structure 1.2.3 Providing advocacy support to the process for adopting the new structure by government 1.2.4 Contributing to development and implementation of an accreditation system for health facilities ü
ü
Process led by other partner with minimal involvement of WHO
ü
ü
Approved by Cabinet, but Ministry Finance required budget line from MOH for implementation An assessment and benchmarking with other countries was done; the process to commence in the next CCS ü
1.3.To assist the country in improving effectiveness of sector leadership
1.3.1 Supporting ongoing leadership capacity development activities 1.3.2 Promoting a culture of strong demand and practice of good corporate governance principles 1.3.3 Contributing to development of modern corporate governance structures and guidelines at all levels ü
ü
1.4. To support efforts to increase investment in the health sector
1.4.1 Advocating for increased government budgetary allocation to the health sector 1.4.2 Supporting the efforts of the sector to introduce a social health insurance scheme 1.4.3 Contributing to efforts of the sector to introduce sector-wide action planning
ü
ü
ü
SWAp coordinator employed through partnersupport; a lot done in establishing structures for partner coordination Partners support to the sector coordinated through NHSPCC
1.4.4 Mobilizing development partners in the country to support sector-wide action planning
ü
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 67
W H O C O U N T R Y S wa z i l an d
Strategic direction
Strategic objective
Activities
Achievement status Not Partially achieved achieved Fully achieved
Comments
2. Reduce excess mortality due to high disease burden
2.1 To contribute to the reduction of mortality due to HIV and AIDS
2.1.2 Supporting actions to improve patient tracking and improving treatment compliance 2.1.3 Advocating for free access to medicines for managing opportunistic infections as part of comprehensive clinical management of AIDS 2.1.4 Supporting implementation of universal access to prevention, care and treatment in the health sector 2.1.5 Supporting implementation of evidence-based and costeffective interventions in the HIV/AIDS response
ü
ü
ü
ü
2.2 To contribute to the reduction of mortality due to TB and other communicable diseases prevalent in the country
2.2.1 Supporting the implementation of the national plan to scale up DOTS 2.2.2 Supporting the response to the MDR/ XDR threat 2.2.3 Supporting interventions aimed at coordinating TB/HIV/AIDS activities 2.2.4 Supporting the strengthening of IDRS 2.2.5 Supporting the MOH, especially the IHR focal point, to implement the IHR in the country 2.2.6 Supporting the strengthening of control measures against communi-cable diseases of public health importance, including malaria ü ü
ü
ü
ü
ü
68
Strategic direction
Strategic objective
Activities
Achievement status Not Partially achieved achieved Fully achieved
Comments
2.3 To contribute to the reduction of mortality that is due to childhood conditions
2.3.1 Continuing to support EPI 2.3.2 Supporting the scaling up of PMTCT 2.3.3 Supporting efforts to increase access to ART by children, especially OVC 2.3.4 Contributing to efforts for improving management of paediatric AIDS 2.3.5 Supporting the scaling up of IMCI 2.3.6 Improving capacity for management of nutrition-related problems ü
ü ü
ü
ü ü
2.4 To contribute to reducing mortality related to childbirth and other problems related to reproductive functions
2.4.1 Supporting the country to improve access and quality of maternal and newborn health-care services 2.4.2 Promoting and strengthening establishment of appropriate youth-friendly health services 2.4.3 Strengthening the scaling up of PMTCT services including expansion of a more efficacious regimen
ü
ü
ü
2.4 To contribute to reducing mortality related to childbirth and other problems related to reproductive functions
2.4.4 Supporting the country’s efforts to ensure that all deliveries are conducted by skilled personnel with competencies in management of EMONC and complications 2.4.5 Repositioning FP in light of HIV/AIDS to ensure improved access and quality of services 2.4.6 Supporting the establishment of services for prevention, screening and management of cancers of the reproductive organs
ü
ü
ü
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 69
W H O C O U N T R Y S wa z i l an d
Strategic direction
Strategic objective
Activities
Achievement status Not Partially achieved achieved Fully achieved
Comments
2.4.7 Supporting the surveillance of SRH-related morbidity and mortality 2.5 To contribute to the promotion of healthy life styles and reduction of risky behaviours including the reduction of mortality due to chronic NCDs 2.5.1 Advocating for increased investment in the prevention and management of NCDs 2.5.2 Supporting assessment of disease burden from NCDs through STEPS surveys 2.5.3 Supporting health promotion aimed at encouraging healthy lifestyles: diet and physical activity 2.5.4 Supporting appropriate and costeffective interventions such as screening for cervical and breast cancer, diabetes, hypertension, etc 2.5.5 Supporting efforts to establish and manage a national cancer registry 2.5.6 Supporting capacity building to prevent and manage NCDs 2.5.7 Supporting health promotion initiatives 2.5.8 Advocating and supporting activities aimed at reducing tobacco use and substance abuse 3. Strengthen health systems to improve health outcomes 3.1To assist efforts of the health sector to generate and effectively manage HRH 3.1.1 Supporting the establishment of an HR management system that streamlines employment procedures, thus reducing high vacancy rates and promoting retention of health workers
ü
ü
70
Strategic direction
Strategic objective
Activities
Achievement status Not Partially achieved achieved Fully achieved
Comments
3. Strengthen health systems to improve health outcomes
3.1 To assist efforts of the health sector to generate and effectively manage HRH
3.1.2 Contributing to the finalization and implementation of an HR management policy that includes a development plan 3.1.3 Providing fellowships in work areas that are targeted by this strategic agenda where feasible 3.1.4 Supporting efforts to develop a systematic continuing education programme for the health sector 3.1.5 Supporting efforts to establish registration of councils for allied health professionals 3.1.6 Supporting efforts to establish standard staffing patterns and their adoption by the Ministry of Public Service and Information. ü ü
ü
ü
ü
3.2 To support efforts for the constant availability of quality pharmaceutical and laboratory supplies
3.2.1 Improving the procurement, quantification and distribution of pharmaceutical and laboratory supplies to all health facilities 3.2.2 Supporting mechanisms for guaranteeing the supply of quality assured medicine and laboratory reagents 3.2.3 Supporting measures to promote rational use of medicines
ü
ü
ü
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 71
W H O C O U N T R Y S wa z i l an d
Strategic direction
Strategic objective
Activities
Achievement status Not Partially achieved achieved Fully achieved
Comments
3.3 To contribute to efforts to improve the collection, management and use of health data for planning, budgeting and M&E purposes
3.3.1 Advocating for increased investment in HIMS, M&E and health research by government and partners 3.3.2 Supporting the development of a policy for HIMS, M&E, health research and knowledge management 3.3.3 Supporting the development and implementation of a national framework for health-related HIMS, M&E, health research and knowledge management 3.3.4 Support research activities in the work areas that are targeted by the strategic agenda ü
ü
ü
ü
3.4 To support the development of periodic national health information sharing and dissemination frameworks
3.4.1 Developing a framework for joint WHO/ MOH press conferences on topical issues 3.4.2 Supporting the development and implementation of a framework for hosting periodic national health and social welfare conferences 3.4.3 Contributing to strengthening the health sector website
ü
ü
ü
72
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 – 2 0 1 9 73