Swaziland is land locked country in Southern Africa between South Africa and Mozambique, covering a surface area of 17,364 square kilometres. Swaziland is severely affected by HIV/AIDS. It is divided into four administrative regions (Hhohho, Lubombo, Manzini and Shiselweni) with 55 Tinkhundla (districts) and 360 chiefdoms (communities). According to the 2007 population census, the population of Swaziland is 1,018,449, and about 77 percent of the population lives in rural areas. Women of childbearing age (15-49 years) make up 26.2 percent of the population, while over half (53 percent) of all Swazis are female. An estimated 4.6 percent of the population is 60 years of age or over, and 60 percent is under 30 years old. 39.6 percent of the total population is children under the age of 15 years, which shows the young age structure of the Swazi population. The total fertility rate is estimated at an average of 3.8 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 32.5 years in 2003. This dramatic drop in life expectancy is mainly attributed to the impact of the HIV/AIDS epidemic. The health sector in Swaziland operates in a complex socio-cultural and political environment that presents both opportunities and challenges for its goal of achieving universal access to quality health care in all levels of service delivery.
PSI/Swaziland is fully committed to measurable health impact. 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/Swaziland has been serving vulnerable communities in Swaziland 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/Swaziland 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/Swaziland 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/Swaziland 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/Swaziland’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.
Swaziland has the world’s highest HIV prevalence rate of 26 percent (31 percent women and 23 percent men) among people aged 15-49 years, and has a high estimated HIV incidence rate of 3 percent. This means that, of every 100 HIV-negative persons in Swaziland, 3 will become infected with HIV every year. In 2008, an estimated 44 HIV-negative adults were infected every day.
The number of people estimated to be living with HIV is expected to increase from approximately 190,000 to over 216,000 by 2015. Heterosexual sex accounts for 94 percent of HIV transmissions and it is projected that the majority of new HIV infections will occur in adults aged 25 years and above, many of whom are married or cohabitating with a steady partner. Furthermore, an estimated 62 percent of all new infections will occur in females.2 Though antiretroviral treatment (ART) services have been available since 2004, a recent survey found that less than 50 percent of people did not know their HIV status and that linkages to prevention, care and treatment services had been weak.
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 percent. Inspired by these findings, and with generous support from PEPFAR through USAID, PSI/Swaziland and partners have been providing high quality, cost effective male circumcision services in Swaziland since mid-2009 at our flagship clinic, Litsemba Letfu Men’s Clinic. Male circumcision services are also offered at clinics and health facilities in the different regions of the country. The PSI/Swaziland program offers both adult voluntary medical male circumcision (VMMC) and early infant male circumcision (EIMC).
PSI continues to lead MC service delivery on behalf of government and through the generous funding of PEPFAR through USAID. PSI leads national efforts to generate demand for VMMC services and also offers services directly and indirectly under the support of public and private sector partners. Demand creation efforts rely on community-based communication agents and MC champions. PSI has seen a steady increase in the number of boys and men circumcised as illustrated above. The VMMC coverage for adults and adolescents, as per the PSI 2012 mapping report stands at an average of 20.5, and this percentage is almost the same as the one of 21 percent reported by government in the Multiple Indicator Cluster Survey Report (MICS 2010). There is currently no national level data on EIMC coverage, but PSI has reached 3,673 infants with MC services since its inception in 2009.
PSI/Swaziland distributes non-branded condoms and educates the public on their use through various platforms such as community dialogues, one on one sessions and tertiary institution peer educators. Key populations are targeted with social and behavior change communication interventions, including community based group and individual education sessions aimed at reducing risk of HIV transmission and acquisition as well as condom and lubricant distribution with a focus on increasing availability and access. PSI/Swaziland’s targeted condom distribution has increased dramatically over the years and saw the organization distribute over 5 million male condoms and 149,000 female condoms in 2013.
HIV Counseling and Testing
HIV counseling and testing (HTC) is an essential component of public health efforts to reduce HIV incidence and to improve access to HIV care and treatment. Supported by PEPFAR and in close cooperation with the government of the Kingdom of Swaziland and partners in the public and private sector, PSI provides HTC services 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 HTC. PSI/Swaziland 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/Swaziland 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 HTC services reach everyone, PSI/Swaziland has taken this service to people’s homesteads by providing door to door HTC 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/Swaziland, under the HTC program, has increased the number of people who know their HIV status over the years and currently is responsible for about 45 percent of HTC nationwide. In 2013 alone PSI tested 88,000 people and successfully referred about 60 percent of clients who tested positive to care and treatment. Current strategies for improving the uptake of HTC services include conducting diverse models of service delivery like door to door testing and chieftaincy-level (community) outreach targeting men, women and youth. PSI uses geographic information systems (GIS) to map HTC coverage and inform service concentration strategies. HTC services are also offered as part of the VMMC package, and 90 percent of all VMMC clients opt for the service.
Behavior Change Communication
PSI communicates to different sectors of the public about the importance of taking informed decision about their lives such as delayed sexual debut, risks associated with multiple and concurrent sexual partners, and adopting healthy lifestyle choices.
PSI/Swaziland 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, and addressing gender-based violence and its impact on HIV transmission. PSI in support of government conducted a gender marketing plan to identify determinants that needs to be addressed. PSI is currently finalizing a gender campaign based on the outputs of that plan, and pretesting of the message has been completed.
Health Systems Strengthening
PSI/Swaziland works with the Ministry of Health and the National Emergency Response Council on HIV/AIDS (NERCHA) to scale up prevention activities in collaboration with multi-sectoral partners to ensure a results-based and coordinated HIV response. PSI recently supported government by training 20 Ministerial communication officers on communication, HIV and gender in a bid to improve HIV-related communication at the governmental level.
- Government of Swaziland/Ministry of Health
- Government of Swaziland/Deputy Prime Ministers Office
- The National Emergency Response Council on HIV/AIDS (NERCHA)
- UN Agencies (UNICEF, UNAIDS, UNFPA, 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)
- 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)
- 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.
- Barriers to Referral in Swaziland: Perceptions from Providers and Clients of a System Under Stress
This study examines the referral system in Swaziland from the perspectives of health providers, community health workers, traditional healers, clients seeking facility-based care, and managers of private health organizations.
- NGO Maps and Monitors Swaziland Efforts in Fight against HIV/AIDS
In this issue of the "Healthy GIS" newsletter, PSI's mobile mapping survey on condom availability is featured.