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Swaziland – Factfile


Overview

Swaziland, officially the Kingdom of Swaziland is a landlocked country in Southern Africa, bordered to the north, south and west by South Africa, and to the east by Mozambique. The nation, as well as its people, are named after the 19th century king Mswati II. Swaziland became an independent kingdom in 1968, with His Majesty the King as the Head of State and the Prime Minister as the Head of Government. It is a small country, no more than 200 kilometres (120 mi) north to south and 130 kilometres (81 mi) east to west. The western half is mountainous, descending to a low veldt region to the east.

HIV prevalence in Swaziland is at 26% among 15- 49 years population and is reported to be the highest in the world. According to the Antenatal Care Surveillance Survey HIV prevalence among pregnant women stands at 41.1% (2010). This is the evidence of the high burden of the HIV and among pregnant women. In addition, access to family planning services is limited unmet need is reported to be at 24%, in the general population the unmet need is even higher at 67% for women living with HIV and this has contributed significantly to the high rate of teenage pregnancies and high maternal mortality. The Maternal Mortality ratio is estimated to be 589 deaths per 100 000 live births (2007) with HIV being the main contributor.

Integra Initiative

Integra research in Swaziland is investigating three different models of integrated HIV and SRH service provision in 15 facilities operated by the government and by the Family Life Association of Swaziland (FLAS), an affiliate member of the International Planned Parenthood Federation.

Model 2: Integrated HIV into PNC and Family Planning - Includes of family planning services, repeat HIV testing for mother, HIV testing for infant, and referral to HIV services for HIV positive women with PNC for mother and baby. The aim of the intervention is to deliver a comprehensive package of integrated post-natal care and HIV services within 48 hours of delivery, and for one week and six weeks after birth. This model is being studied at four intervention sites and six comparison sites, all of which are government-operated.

Model 3: Integrated HIV and SRH services - Includes family planning, maternal and child health services, HIV testing, HIV care, STI services, cervical cancer screening, and services for youth. This model is being studied at two intervention sites operated by FLAS.

Model 4: Comparison of integrated and stand-alone HIV service models – Comparison of facilities offering fully integrated SRH/HIV services with facilities offering stand-alone HIV services. This model is being studied at two fully integrated SRH/HIV sites (one of which is also in Model 3) and two stand-alone HIV sites operated by both the government and FLAS.

Model 2 and 3 intervention sites received support, training, equipment, and supplies to introduce the new services. For Model 2, clinics were also provided with additional support to strengthen their existing post-natal care services.

For Model 2, the study design involves comparing measurements of  primary research outcomes (including HIV risk behaviours, incidence of unintended pregnancies, uptake of SRH/HIV services, contraceptive use, HIV-related stigma, and costs) collected at baseline with those collected at the end of the study. For Model 3, various HIV and SRH integration indicators are being monitored over the course of the project at the two FLAS clinics. For Model 4, a comparative case study was conducted to investigate differences in the processes and outcomes of the different services. Data collection methods focus on three different study groups – facilities, clients, and populations – and a mix of qualitative and quantitative research is being conducted.

For information about the research findings to date, click here.

SRHR and HIV Linkages Project

The project – known locally as ‘Phila Uphephe’ – will focus on catalytic action in 5 selected pilot Model Centers of Excellence in Swaziland in order to learn lessons on how to practically integrate SRH and HIV services. The five Centres of Excellence are:

1)    Family Life Association of Swaziland
2)    Mbabane Public Health Unit
3)    Siphofaneni Clinic
4)    Matsanjeni Health Centre
5)    Mankayane Government Hospital

Lessons learned and experiences from working with these facilities will be used to scale up to other facilities within Swaziland as well as shared with the other countries where the project being implemented in the region.

Key Achievements to date

  • Technical Working Group has been formed and is led by the Deputy Director Public Health in the Ministry of Health constituted of Civil Society Organization’s [Family Life Association of Swaziland (FLAS) and Swaziland Network of People Living With HIV and AIDS (SWANNEPHA)] and Donor Agencies (PEPFAR, INTERGRA,UNAIDS and UNFPA).
  • 5 Model Pilot Centres of Excellence are in the process of strengthening their service provision in integrating SRH and HIV and HIV into SRH.
  • Orientation of Senior Managers at Facility level on SRH and HIV and has been undertaken.
  • Civil society has been sensitised and met to discuss their role and how they can support the Integration Agenda.
  • Procurement of Supplies, Equipment and commodities as part of support Centres of Excellence has been done.
  • High level Handover of equipment supplies was done by the Minister of Health, UNFPA Country Representative, EU-Representative (Charge d ’affairs) and other Ministry of Health High ranking officers.
  • Project visibility has been achieved through Local Media on the Presentation of Supplies, Equipment and commodities.
  • Baseline assessment has been completed for the Centres of Excellence to establish what works well and what needs to be strengthened.
  • Branding guidelines have been developed and approved by the EU.
  • Strategy to document   best practices has been developed and preliminary training for Project M&E working Group has been conducted.

 

Partners

To find out more about this project click here

 

Key Publications and Resources

Resources

Linking Sexual and Reproductive Health and HIV in Swaziland – Phila Uphephe
This presentation explores the benefits and meaning of linking SRH and HIV in Swaziland. It contains an overview of what integration means that the policy, systems, and service delivery level, as well as a list of Centres of Excellence, including the Siphofaneni Clinic.
(Download Presentation)

Best Practices in Linking HIV and Sexual Reproductive Health Rights
Year 2013 | Authors: UNAIDS, UNFPA, EU, Ministry of Health, Swaziland
The Swaziland Linking HIV and SRH Programme Best Practices Series. A model of integrated services integrating family planning into ART services: The case of the Siphofaneni Clinic.
(Download PDF)

National policy on sexual and reproductive health
Year 2013 | Authors MOH Swaziland, IPPF, UNAIDS, WHO, UNFPA
The policy takes cognizance of the existing policies, frameworks and guidelines, in
particular the National Population Policy which forms the basis for all population
related programmes. This document  has been developed by extensive consultations with key informants and stakeholders in government and NGOs as well as opinion leaders at both the national, regional, Inkhundla and chiefdom levels.
(Download PDF)

Rapid assessment of sexual and reproductive health and HIV linkages: Swaziland
Year 2011 | Authors MOH Swaziland, IPPF, UNAIDS, WHO, UNFPA
This summary highlights the experiences, results and actions from the implementation of the Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages in Swaziland.
(Download PDF)


Research

The Swaziland Network of People Living with HIV and AIDS (SWANNEPHA) (2011). Stigma and discrimination experienced by people living with HIV and AIDS in Swaziland.
In 2010, The People Living with HIV Stigma Index, which is a community-based research initiative measuring HIV-related stigma and discrimination, was implemented in Swaziland. The research involved interviews with over 1,200 people living with HIV (PLHIV). The aim of the study was to determine the experiences of stigma among PLHIV and to measure the impact of specific stigma-reduction programmes and interventions. The report provides details of the process, findings, conclusions, and recommendations of the study.


Other national research

Studies conducted in Swaziland are contributing to the growing body of research related to HIV/SRH integration. The following studies have been published in peer-reviewed journals from 2009 onward.

Bancheno, W., M., Mwanyumba, F., Mareverwa, J. (2010) ‘Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa.’ AIDS Care, 22 (9): pp1130-1135. This paper reports the outcomes of a service to prevent mother-to-child transmission of HIV in a referral hospital and its rollout to clinics in rural Swaziland.It concludes that the provision of such a service is possible but staff shortages, as well as socio-economic and service-related factors, make it challenging.

Mazia, G., Narayanan, I., Warren, C., Mahdi, M., Chibuye, P., Walligo, A., Mabuza, P., Shongwe, R., Hainsworth, M. (2009) ‘Integrating quality postnatal care into PMTCT in Swaziland.’ Global Public Health, 4(3): pp253-70. This paper reports the findings of a study that looked to improve the effectiveness of postnatal HIV services which typically find that postnatal visits are delayed, occurring at 4-6 weeks after birth. The evaluation of a training programme in seven health facilities in Swaziland is largely positive and included a large increase in the number of women visiting the clinic within three days after birth.

Root, R. (2010) ‘Situating experiences of HIV-related stigma in Swaziland.’ Global Public Health, 5(5): pp523-38. Using qualitative methods, this study, based in rural Swaziland, looks to identify patterns of stigma across three domains: verbal, physical, and social. The study found that stigma was extensive and that homesteads were often markedly stigmatising environments whilst health centres emerged as more supportive.

Contact

For further information about the SRHR and HIV linkages project in Swaziland, please contact

Ms Rejoice Nkambule – Deputy Director Public Health ( chair)
Ministry of Health
Phone: 2404 5554
Email: nkambulere@gov.sz

Mr Petros Dlamini – Coordinator UNFPA
UNFPA Country Office
Phone: 2404 2301 ext. 3
Email: pedlamini@unfpa.org

For further information about the Integra Initiative in Swaziland, please contact:
Zelda Nhlabatsi
Family Planning Association in Swaziland FLAS
Email: znhlabatsi@flas.org.sz

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