eSwatini (formerly Swaziland) is a landlocked country in Southern Africa between South Africa and Mozambique, covering a surface area of 17,364 square kilometers. eSwatini is severely affected by HIV/AIDS. It is divided into four administrative regions (Hhohho, Lubombo, Manzini and Shiselweni) with 55 tinkhundla (districts) and 366 chiefdoms. According to the 2016 population census estimates, the population of eSwatini
is 1,297,378, and about 77% of the population live in rural areas. Women of reproductive age (15 to 49 years) make up 26% of the population, while over half (53% of all Swazis are female. An estimated 5% of the population is aged 60 or over, and 60% is under 30 years old. The total population under the age of 15 , which shows the young age structure of the country. The total fertility rate is estimated at an average of 3.3 births in a woman’s life compared to 6.4 births in 1986. The life expectancy at birth has drastically declined from 56 years in 1986, to 48.85 years in 2012. This dramatic drop in life expectancy is mainly attributed to the impact of the HIV/AIDS epidemic. The health sector in eSwatini operates in a complex socio-cultural and political environment that presents both opportunities and challenges for its goal of achieving universal access to quality healthcare in all levels of service delivery.
PSI/eSwatini is fully committed to measurable health impacts. It measures its effect on disease and death, in the same way a business measures its profits. PSI works in cooperation with government and partners in the public and private sector to deliver high-quality health programs, reaching all populations in need. PSI/eSwatini has been serving priority populations in eSwatini with comprehensive evidence-based public health interventions, including HIV prevention and reproductive health programs, for over a decade. Using highly efficient private sector techniques, PSI/eSwatini promotes products, services and healthy behaviors that enable Swazis to lead healthier, more productive lives.
- Innovation, creativity and risk taking.
- Evidence based decisions for measurable health impact.
- Long-term commitment to the people we serve.
- Making markets work for the people.
- Leadership through inspiration.
- Talented and passionate team.
PSI/eSwatini sees a future where the Swazi nation will be empowered to adopt positive and healthy behavior, will have access to comprehensive health services, and will be able to adapt to a changing environment.
To provide relevant, quality health products and services to the Swazi nation through evidence based social marketing strategies intended to maximize the quality of life.
PSI/eSwatini estimates that in 2015, its products and services helped avert 670,630 DALYs, including, by health area:
- 643,090 HIV DALYs
- 27,539 DALYs
PSI/eSwatini’s family planning programs also provided 111,833 couple-years of protection.
These statistics include the impact of sales and distribution of condoms by PSI/South Africa, PSI’s regional commercial entity in Southern Africa.
Though antiretroviral treatment (ART) services have been available in eSwatini since 2004, linkages to prevention, care and treatment services have been weak in the country. A recent survey found that less than 60% of people did not know their HIV status.
PSI/eSwatini addresses HIV through the following interventions:
HIV Testing Services
Community-based HIV testing and counseling services (HTS) are an essential component of public health efforts to reduce HIV incidence, and to improve access to HIV care and treatment. PSI is supported by the President’s Emergency Plan For AIDS Relief (PEPFAR) and works in close cooperation with the government of the Kingdom of eSwatini, and partners in the public and private sector. PSI provides HTS through networks of directly and indirectly managed sites throughout the country. Service delivery models include stand-alone sites, partner sites, sites integrated into public and private health facilities, innovative forms of outreach (such as dip tanks outreach targeting men who take their cattle for weekly fumigation by the veterinary unit), as well as community-based HTS. PSI/eSwatini provides standard training, protocols and quality assurance to all sites within the network. Some of PSI’s sites are also linked by the New Start (Calakabusha Namuhla) brand, positioned as a symbol of hope and quality to help create awareness and generate demand for this service. In addition to branded advertising, PSI/eSwatini uses non-branded behavior change communication campaigns to motivate people to learn their HIV status. Culturally appropriate, targeted mass media and interpersonal communication strategies also aim to reduce stigma associated with HIV testing. To ensure that HTS reach everyone, PSI/eSwatini has taken this service to people’s homesteads by providing door-to-door HTS in communities, under the leadership of the Ministry of Health and with the support of PEPFAR. Our services are managed by expert counselors and controlled with the strictest level of confidentiality and quality.
PSI/eSwatini, under the HTS program, has increased the number of people who know their HIV status over the years and currently is responsible for about 45% of HTS nationwide. HTS are also offered as part of the voluntary medical male circumcision (VMMC) package, and 90% of all VMMC clients opt for the service. PSI/eSwatini is working towards achieving 90-90-90 goals set by UNAIDS. In 2016 alone, over 6,000 people were identified to be HIV positive and linked to HIV care in health facilities. PSI has started offering ART services in the central part of eSwatini and is hopeful to extend the services to communities through mobile units.
Voluntary Medical Male Circumcision
Clinical trials in Kenya, Uganda and South Africa have shown that male circumcision can reduce the risk of female-to-male sexual transmission of HIV by up to 60%. Inspired by these findings, and with generous support from PEPFAR through USAID, PSI/eSwatini has been providing high quality, cost-effective male circumcision services in eSwatini since mid-2009 at our flagship clinic, Litsemba Letfu Men’s Clinic. VMMC services are also offered by PSI at clinics and health facilities in the different regions of the country.
PSI/eSwatini currently performs VMMC under a sub-award to the Center for HIV and AIDS prevention (CHAPS), a regional South African organization funded by PEPFAR through USAID. Demand-creation efforts rely on community-based communication agents and counselors. Young people aged 15 to 29 are targeted for the intervention, which usually happens in clinics and hospitals.
Condom Education and Distribution
PSI/eSwatini distributes non-branded, free-issue condoms, and educates the public on their use through various platforms such as community dialogues, one-on-one sessions and tertiary institution peer educators. PSI/eSwatini is the country’s largest distributor of free condoms at community level and has over 1,800 condom outlets. These are established to serve as distribution points for different segments of the population including youth, key populations and the general public. PSI/eSwatini is in the second year of its youth condom campaign, Got it? Get it., which promotes condom use to youth, as well as ensures availability at youth-friendly outlets. PSI/eSwatini’s targeted condom distribution has increased dramatically over the years, distributing over 11 million male and 136,000 female condoms in 2016.
Overall, a Swazi woman gives birth to 3.3 children during her entire reproductive lifespan, while for men this occurs at 19.
The contraceptive prevalence is 66.1 % among all women. The most frequently used contraceptive methods are male condoms (used by 23.9%), injectables (21.9%) and pills (10.5%). The total unmet need is 15.2%. This is the proportion of women who are not using any method of contraception but who wish to postpone the next birth, or who wish to stop childbearing altogether. .
PSI/eSwatini offers short acting family planning methods and long acting reversible family planning methods to women aged 15 to 24 years under the DREAMS Project. Beneficiaries of family planning are targeted in communities where they reside. Mobile units staffed with community educators and nurses visit areas where young women can access these services and family planning is offered as part of an integrated package with HIV services.
Behavior Change Communication
PSI/eSwatini communicates to different sectors of the public about the importance of taking informed decisions. These topics include delayed sexual debut, risks associated with multiple and concurrent sexual partners, and adopting healthy lifestyle choices. Risk assessment is conducted for all beneficiaries of PSI/eSwatini services. PSI/eSwatini developed a toolkit called Am I at Risk?, which helps to engage beneficiaries to discuss risks for contracting HIV, and what to do when testing HIV-negative.
PSI/eSwatini has integrated gender messages into all the HIV programs and communication messages for specific target audiences. PSI gender mainstreaming efforts address social norms that increase uptake of VMMC and condoms, as well as addressing gender-based violence and its impact on HIV transmission.
- U.S. Centers for Disease Control and Prevention (CDC)
- U.S. Agency for International Development (USAID)
- Government of Swaziland/Ministry of Health
- Government of Swaziland/Deputy Prime Ministers Office
- The National Emergency Response Council on HIV/AIDS (NERCHA)
- United Nations Children’s Fund (UNICEF)
- The Joint United Nations Programme on HIV/AIDS (UNAIDS)
- United Nations Population Fund (UNFPA)
- World Health Organization (WHO)
- Coordinating Assembly for NGO (CANGO)
- Swaziland National Youth Council (SNYC – Youth Centres)
- Swaziland Network of People Living with HIV&AIDS (SWANNEPHA)
- Family Life Association of Swaziland (FLAS)
- The Luke Commission (TLC)
- International Center for AIDS Care and Treatment Programs (ICAP)
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
- University Research Cooperation (URC)
- Cabrini Ministries
- Raleigh Fitkim Memorial Hospital
- Good Shepherd Hospital
- Medecins Sans Frontiers (MSF)
- Management Sciences for Health (MSH)
- Institute for Health Measurement (IHM)
- Human Resources Alliance for Africa (HRAA)
- Clinton Health Access Initiative (CHAI)
- Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS)
- Adventist Development Relief Agency (ADRA)
- Swaziland Migrant Mineworkers Association (SWAMMIWA)
- Lutsango LwakaNgwane
- Khulisa Umntfwana
- University of Swaziland (UNISWA)
- Swaziland College of Technology (SCOT)
- Ngwane Teacher Training College
- The Nazarene University
- Peace Corps Volunteers (Community trainings, community meeting for VCT)
- World Vision International
- Health Communication, Collaboration and capacity JHU (HC3)
- Gone Rural Bomake (handicrafts organization)
- Rapid ART Initiation and Index Client Testing Outcomes of Commlink: A Community-Based, HIV Testing, Mobile HIV Care, and Peer-Delivered, Linkage Case Management Program – Swaziland, 2017 (THAC0401)
Few persons diagnosed in community settings receive antiretroviral therapy within seven days of diagnosis (rapid ART) in accordance with World Health Organization recommendations. To improve rapid ART for clients diagnosed in community settings in Swaziland, we implemented CommLink, an integrated community-based HIV testing (CBHTS), mobile HIV care, and peer-delivered linkage case management (LCM) program.
- Scaling Up Early Infant Male Circumcision: Lessons From the Kingdom of Swaziland
Swaziland is the first country to introduce national early infant male circumcision (EIMC) into voluntary medical male circumcision (VMMC) programming for HIV prevention. With more than 5,000 EIMCs performed between 2010 and 2014, Swaziland learned that EIMC requires inclusion of stakeholders within and outside of HIV prevention bodies; robust support at the facility, regional, and national levels; and informed demand. Expansion of EIMC and VMMC has the potential to avert more than 56,000 HIV infections in Swaziland over the next 20 years.
- AEA 2014: Serving the Poor and Sustaining Condom Markets – An Evaluation of Six African Countries
The Total Market Approach is a system in which all sectors – public, social marketing, and commercial – work together to deliver health choices for all population segments. The goal is to ensure that the poorest communities receive free products, those with slightly greater resources benefit from partially subsidized products, and those with a greater ability to pay purchase products from the commercial sector. The objective of this evaluation is to determine if actions taken by all three market sectors over the last five to seven years have increased condom use in an equitable and sustainable way in six African countries.
- Total Market Approach in Six African countries
The Total Market Approach (TMA) is a system in which all sectors – public, subsidized and commercial – work together to deliver health choices for all population segments. In 2013, PSI completed six TMA case studies describing the condom markets in Botswana, Lesotho, Mali, South Africa, Swaziland and Uganda. These case studies also propose a set of recommendations for improving the effectiveness, efficiency and sustainability of condom markets.
- Total Market Approach: Swaziland
This case study describes the market for male condoms in Swaziland, and the roles of the public, social marketing, and commercial sectors in the market.
- How to Use the Inner Condom
Animated video on how to use the female condom or inner condom. Brought to you by Lovers+ and PSI/South Africa.
- PSI’s Southern Africa Regional Platform Condom Social Marketing
PSI has a new regional condom brand in Southern Africa. Check out this video describing how the new program works.
- Love Test — Swaziland
The Love Test is an annual campaign in Swaziland, aimed at encouraging couples to recognize the month of February as Couples Month and make a commitment to test together for HIV.
- 2012 Mid Year Region and Country Dashboards, Southern Africa
Mid-year Southern Africa region and country impact dashboards for 2012
- Using GIS to Support Public Health Interventions
Many of PSI's country offices now actively use GIS to support a range of public health interventions, including STI and HIV testing, prevention, and treatment, reproductive health service provision, prevention and treatment of malaria and TB, maternal and child health, and safe water systems.
Inside are just a few examples of how international non-profit organizations such as PSI can benefit from maps and GIS technology, be it for resource allocation, monitoring and reporting of interventions at the national level, or targeting and planning field activities in communities.