The Kingdom of Eswatini is a small country with a population of just over 1 million. Fortunately the country has not experienced any large-scale emergencies recently. However the government of Eswatini volunteered to undertake the Joint External Evaluation (JEE) to identify its gaps in emergency preparedness, detection and response and improve on its strengths. This is highly commendable. The JEE process started in February and was concluded in April 2018. The evaluation was completed in two stages. There was an initial self-evaluation conducted by the country using the JEE tool followed by an in-country evaluation conducted by an external evaluation team of subject matter experts, done in close collaboration with the country.

A team of 30 national experts representing different sectors in line with the 19 technical areas of International Health Regulations (IHR) 2005 worked tirelessly to complete the self-evaluation report. The sectors included Ministries of Health, Agriculture, Environment, Justice as well as the National Disaster Management Agency (NDMA), Swaziland Environment Authority (SEA) and Swaziland Civil Aviation Authority (SWACAA). The findings highlighted in the report were then validated through an external peer-to-peer review conducted from 9 to 13 April 2018 by a team of 16 international experts.

Eswatini was found to have various strengths including the implementation of IHR through the Integrated Disease Surveillance and Response (IDSR), a good sample transport system with dedicated vehicles driven by people trained in specimen referral and laboratory testing systems for priority diseases. One of the best practices identified during field visits was the national Immediate Disease Notification System (IDNS) for reporting notifiable and priority diseases through the toll-free telephone number 977. The hotline is managed by extremely well trained and organised staff, utilising an electronic system for data management. Eswatini has nationwide mobile telephone coverage hence health staff from all parts of the country can report cases (e.g. cholera), which activates communication with all appropriate stakeholders to mount a response. 

A lot of work has been done in the area of developing plans and strategies which were shared during the peer-to-peer review. Many of these documents however were in draft form, and had not yet received formal endorsement or enactment by ministers or parliament. This impacted negatively on the scores in the JEE tool. Documentation of protocols and standard operating procedures was found to be lacking in a number of the technical areas assessed. This however did not mean the capacity of the country was necessarily absent or lacking. Using IHR coordination as an example, it was clear that strong relationships existed between staff of the Ministries of Health and Agriculture; however there were no formal standard operating procedures outlining coordination mechanisms among all key sectors.  

Eswatini needs to ensure the provision of adequate resources to address the gaps identified in each technical area by investing in building the necessary skills and competencies. For example it was found during the visit to the Point of Entry (PoE) ground crossing that staff were not sensitised on the IHR requirements and requested further training to adequately perform their duties. Additional resources are needed to bring the PoE to the level that fulfils the requirements outlined by IHR. 

The findings of the JEE were disseminated to senior government officials through a breakfast meeting held on the 13th of April. Dr Sally-Ann Ohene who was the team leader gave a summary of the findings highlighting that a full report was going to be written and widely disseminated. There were technical areas that required a lot of work. These included medical countermeasures and personnel deployment, biosafety and biosecurity, chemical events and radiation emergencies.

Reacting to the findings of the JEE, Dr Vusi Magagula, the Director of Health Services who was representing the Principal Secretary in the Ministry of Health assured the team that all the  recommendations would be discussed at higher level and prioritised for implementation. “Following this evaluation the Swaziland Government will be developing an implementation plan in May 2018, we are hopeful that development partners will support this initiative. However we also request the collaboration that has been created between local and international experts to be maintained,” he said.   

The WHO Country Representative Dr Tigest Ketsela Mengestu commended the government of Eswatini for taking this voluntary, collaborative, multisectoral initiative to evaluate the country’s capacity to prevent, detect and rapidly respond to natural, deliberate, or accidental public health threats. She also expressed gratitude to the team of internal and external experts for completing the JEE process in the spirit of one health approach and a multi-hazard dimension.

Dr Mengestu noted that the findings of the evaluation indicated the beginning of the work towards developing the core capacities for IHR implementation. “The findings should actually motivate the country to work towards improving national public health security”. She said there was need to develop a plan of action towards strengthening the core capacities to prevent, detect and rapidly respond to emergencies.