Mbabane, Swaziland 25 May - The Kingdom of Swaziland completed a two weeks long first ever joint review of four programmes; Human Immunodeficiency Virus (HIV), Tuberculosis (TB), Viral Hepatitis prevention and control as well as Prevention of Mother to Child Transmission of HIV(PMTCT). This is in line with the country’s plan to strengthen integration of the four programmes. Currently the programmes have separate strategic plans. For example: the HIV Health Sector Response Plan runs from 2014 – 2018 and the TB National Strategic Plan runs from 2015 – 2019. However all the strategic plans are aligned to the National Health Sector Strategic Plan (NHSSP 2013 – 2018).

The review process was commissioned by the Principal Secretary in the Ministry of Health Dr Simon Zwane and supported technically and financially by the Government of Swaziland, the World Health Organization (WHO) and other United Nations (UN) agencies, as well as other development partners. Over 25 experts from the region and beyond including senior staff in the Ministries of health of Botswana, Kenya, and Zimbabwe participated as external reviewers. The support by experts from other African countries demonstrated the spirit of South to South cooperation.

The main objectives of the process were to; review progress towards reaching national health sector targets for HIV, PMTCT and TB; review level of integration of management and services for HIV, TB, PMTCT, child, maternal, sexual and reproductive health; assess quality and effectiveness of HIV and TB services; assess capacities and challenges related to cross-cutting health system elements for service delivery, procurement and supply chain management, information systems, laboratory,  and health workforce; analyse current investments for HIV and TB control, and identify priority investment areas for the short and medium term as well as conduct baseline assessment of Viral Hepatitis burden and services to inform development of national plan.

Major achievements were identified in the different programmes. There is very high political will to tackle HIV/TB and Sexually transmitted diseases with good progress in managing HIV and reversing trends in TB. Of note is the fact that there is rapid initiation of patients including children on drug susceptible TB treatment (average 2 days) based on standardised regimens, in line with national guidelines and also consistent with international recommendations. There is also progressive increase in treatment success rate: 70% in 2012 to 79% in 2015 cohorts. For Drug Resistant TB (DR-TB), Treatment Success Rate (TSR) improved from 56% (2014) to 70% (2016). Swaziland introduced new drugs for DR-TB treatment including adoption of short course regimen. TB diagnosis and treatment is provided free of charge in all public health facilities. The country is also implementing an Active Case Finding (ACF) initiative country wide to pursue contact tracing for Drug Sensitive TB (DS-TB) and DR-TB patients, and conduct door to door screening within communities. As far as the HIV response is concerned, antiretroviral (ARV) initiation has been decentralised to Public Health Units (PHU), Health Centres and TB units with initiation threshold moving from CD4 count less than 500 to test and start.

 Routine viral load testing is also done as from 1 April 2017. A total of 26 290 adults were initiated on ART in 2016 and currently a total of 171 266 patients are on treatment. The retention on treatment at 12 months is 95% for both adults and children. Swaziland implements Lifelong ART among Pregnant and Lactating women (LLAPla) and same day initiation of treatment. The government procures all ARVs.The Viral Hepatitis prevention and control programme is not well established but there are opportunities for strengthening it with partners’ willingness to provide support. Of note, however, is that there is a policy in place on the vaccination in children at 6, 10 and 14 weeks but it is silent on birth dose. There are currently 100,000 doses of HBV vaccines and Penta vaccine at EPI Central Vaccine Store. Another strength for this programme was also that all donated blood is screened for HBV, HCV, HIV and Syphilis and a system is in place for notification, counselling and onward referral of donors if abnormalities are found.

As part of the recommendations, the Ministry of Health should establish a mechanism at national level to coordinate all levels of the response to HIV, TB, PMTCT and Viral hepatitis according to the 3 ones: one coordinating body, one strategic framework, one monitoring and evaluation (M&E) framework. A review of the overall human resources for health requirements and development of programme staffing norms and hiring guidelines in line with government guidelines was recommended as well as putting in place a staff performance-linked appraisal. Another issue raised was that though the laboratory infrastructure is in good condition there is need to improve the procurement and supply chain and management of laboratory reagents. There is adequate financial support for HIV, TB and PMTCT activities from both the government and partners. However due to unpredictability of cash flow from treasury, the programmes prefer utilising donor funds than government allocation.

The findings of the review were shared with stakeholders through a high level breakfast meeting held at Mountain Inn Hotel in Mbabane and a wider stakeholder meeting held at Royal Swazi Hotel in Ezulwini. The high level meeting was attended by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), United Nations AIDS Programme (UNAIDS), and other development partners representatives as well as senior Ministry of Health officials. The WHO Representative Dr Tigest Ketsela Mengestu stated that the sound recommendations made need to be implemented, monitored and evaluated for programme impact and contribution to the achievement of the 2030 Agenda for Sustainable Development. She referred  to Sustainable Development Goal (SDG) target 3.3 which talks about ending the epidemics of TB, AIDS, Viral Hepatitis as well as Malaria and Neglected Tropical Diseases and therefore ensuring healthy lives and promote well-being for all at all ages.

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Below :

01 - One of the External reviewers, Dr Buhle Ncube presenting the findings of the review during a high level meeting at Mountain Inn.

02 - WHO Representative Dr Tigest Ketsela Mengestu addressing the high level gathering.

03 - The external reviewers paid a courtesy call to WHO where they were welcomed by Officer in Charge Dr Khosi Mthethwa.