Sustainability Indicators for Swaziland

indicators | social | economic | natural resources | institutional

SOCIAL ASPECTS OF SUSTAINABLE DEVELOPMENT IN SWAZILAND

Poverty | Demographics | Health | Education | Human Settlements

HEALTH

Background

The Ministry of Health is the government arm which provides, promotes and co-ordinates the provision of health facilities and care in the country. The Ministry is committed to the World Health Organisation goal of "Health For All By The Year 2000". The Ministry's strategy to achieve this goal is through the mobilization of all for health in the development of a Comprehensive Primary Health Care System. The main objective is "to improve the health status of the Swazi people by providing preventative, promotive, rehabilitative and curative health services which are relevant and accessible to all".

In order to accomplish its mission of health for all by the year 2000, the Ministry is trying to reach everyone by establishing health facilities all over the country, encouraging community participation in the provision of health facilities and care, co-ordinating the efforts by private sector and church organisations to provide health facilities and care, as well as incorporating the traditional health care with modern methods.

Health facilities are classified according to the following hierarchy;

General Hospitals
Specialty Hospitals
Health Centres
Public Health Units
Clinics
Outreach Clinics/Sites

Swaziland adopted a primary health care strategy in 1983. Prior to this the health care system was largely urban based and curatively biased. As a result it catered for a small population. Since the introduction of the primary health care strategy, the provision of preventative and promotive services has received much attention and is strongly encouraged in rural areas, which were largely neglected by the curative strategy. Consequently, the Ministry of Health has come up with the comprehensive health facilities hierarchy which is being implemented throughout the country.

Level of Provision of Health Facilities and Services in 1994

INDICATOR	HHOHHO	LUBOMBO	MANZINI	SHISELWENI
Population per Hospital	116 000	198 197	124 000	201 497
Population per Health Centre	77 000	50 000	248 330	100 748
Population per Clinic	6601	5829	4685	10 605
Population per Outreach Clinic	7453	4719	3820	8396
Population per Hospital Bed	378	906	475	855
Population per Medical Officer	6397	11 300	4812	16 242
Population per Nurse	808	1444	835	1402

Curative and Preventative Services

Curative facilities are urban based. As a result Lubombo and Shiselweni are poorly served by in-patient facilities, where population per bed figures are high in these regions. The same applies to population per nurse and population per medical officer.

Preventative Services are designed to prevent disease and illness before they occur thus reducing the need for curative services. To achieve the preventative strategy the Ministry of Health has devised a number of projects which are now being implemented. The Health Education Unit and the Rural Health Motivators (i.e. Village Health Workers) are the main agents for achieving the Preventative Services Strategy. The Rural Health Motivators are community based health care providers and there is one per 25 to 30 households. Health Education covers the following;

Environmental Health
Immunisation
Control of Diarrhoeal Diseases
Acute Respiratory Infection Control
Maternal Health and Family Planning
Promotion of Young Child Feeding and Growth Monitoring
AIDS Prevention and Control
Tuberculosis Control Programme, and
Other Public Health Programmes

However, despite the two-pronged approach to curative and preventative services the incidence of disease is still disturbing. The maternal mortality rate is still high at 100 - 110 per thousand births. Malaria has a high incidence rate in the Lubombo region, while bilharzia has a high incidence rate in the Lubombo, Hhohho and Shiselweni regions. In light of the potential for increased population settlement in the Lowveld, the MOH's malaria control programme will play an important role in the future. An Entomology Unit was established in Big Bend in 1992 and a second unit is proposed for Simunye.

Antenatal attendances and family planning are still very low in the Shiselweni region where the population is largely rural. Furthermore, underweight children under 5 years is still high in the Shiselweni and Lubombo regions, showing nutritional problems in these regions.

Across the whole country rural water supply and sanitation need to be improved, building on the government programme which was initiated in 1983. Only 42 percent of the rural population use pit latrines and about 50 percent have access to potable water. This scenario calls for the strengthening of primary health care and education in rural areas, as well as encouraging the community and non-governmental organisations to fund rural water supply and sanitation programmes.

However, Swaziland has made great achievements in immunizing children between 12 and 24 months. The immunization rate is 83 percent.

On the whole, although there are problems in trying to achieve "Health For All By The Year 2000", the Ministry of Health has adopted an appropriate approach. In rural areas, especially Shiselweni region, there is a need to strengthen the primary health care and education. In urban areas the low-income and peri-urban households need attention in terms of primary health care and education.

AIDS Prevention and Control

The Ministry of Health has an objective to control the spread of Human Immuno Deficiency Virus (HIV) infection and Acquired Immuno Deficiency Syndrome (AIDS) as part of an overall programme for the prevention and control of sexually transmitted diseases (STDs).

The Swaziland National AIDS Programme (SNAP), Schools HIV/AIDS Partnership Education (SHAPE), The Family Life Association of Swaziland (FLAS) and the Mass Media are the major sources of information on the fatal disease. The first HIV Sentinel Surveillance, carried out in 1992, revealed that the overall HIV prevalence rate was about 11 percent for STD patients, 19 percent for TB patients and 9 percent for blood donors. The Sentinel Surveillance in the country in 1993 indicated 22 percent prevalence of HIV among ante-natal clinic attenders and 27 percent for STD patients.

In December 1994 the Ministry of Health revealed that approximately 1 out of 3 pregnant mothers was aged between 10 and 19 years. Of these teenage mothers 1 out of 4 was infected with the AIDS virus. All these figures show a rapid increase of AIDS cases and a high prevalence rate. Studies which have been carried out project that there will be 115,090 orphans by the year 2006 and the cost of these children's schooling will be in the region of E 56 million per annum in 2006 (at present day prices). Also, it is projected that the cost of replacing affected manpower will be high. The high risk age-group has been identified as the 15 to 29 year olds.

The high incidence of AIDS has led the Ministry of Health through SNAP, SHAPE, FLAS and mass media to undertake a massive AIDS awareness education programme. This has been done through training the health motivators, traditional healers and church leaders on AIDS, so that they can educate the community on the disease. SNAP working with the Tinkhundla office has formed AIDS committees in rural areas. In 1995, SNAP has plans to develop stickers which will be placed in buses, government vehicles and road signs as a way of educating the community. The non government organisations are primarily involved in the education of the community.

However, little is being done on the provision of facilities for AIDS victims or the orphans. There is a need to promote a home based AIDS programme and the monitoring of the need for facilities which will cater for orphans and the elderly, who are left with no breadwinners but have the burden of looking after the orphans. The impact of AIDS on the country's manpower, especially the skilled, needs to be assessed and continuously monitored.

Because of the dearth of information on AIDS it has not been possible to undertake a regional analysis to determine which regions are most severely affected.

It is important to note that traditional healers (Tinyanga) still play a very important role in the country, studies show that on average the Inyanga/population ratio is 1:100. Therefore for the AIDS prevention and control programme to be successful, it is essential that the Tinyanga are educated. The other important group are the traditional midwives, their inclusion in AIDS education is vital for those who give birth at home under the midwives' supervision.

This page was last updated on 03 February 2004