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Expanding Service Delivery in Swaziland

Expanding Service Delivery in Swaziland

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Expanding Service Delivery in Swaziland

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  1. Expanding Service Delivery in Swaziland Dr S.V. Magagula – Deputy Director of Health Services - MCTF Chairperson

  2. Background • HIV prevalence – 26% in reproductive age group • 42% ANC sentinel surveillance 2008 • MC prevalence – SDHS 2006/7 revealed 8% MC • Currently approximately 10% of target for 5 year operational plan • Key Players – Government, NGOs, FBOs, Development partners (UN, USG/PEPFAR, Bill & Melinda Gates Foundation), volunteer agencies A NATION AT WAR WITH HIV&AIDS

  3. Drivers of the epidemic • Inadequate depth of knowledge • Multiple concurrent sexual partners • Low rates of male circumcision • Low condom use/inconsistent use • High mobility of the population • Abuse of gender power relations by men • Sexually transmitted diseases • Poverty • Substance abuse • Loss of morals (Christian or cultural) A NATION AT WAR WITH HIV&AIDS

  4. NSF 2009/13- Result Based Framework • Impact level Result – National Strategic Framework (NSF) • The rate of new infections per year has reduced from 3% to below 2.3% by year 2014 • Priority interventions • Social and behavior change communication programs • Reduction of MCPS • Increased and deepened knowledge of HIV and AIDS • Scaling up Prevention of mother to child treatment • Male circumcision • Targeting populations at risk i.e. migrant populations sex workers male and female youth A NATION AT WAR WITH HIV&AIDS

  5. Experiences in previous 2-3yrs • Operational Guidance – Development of the national MC policy; strategy/operational plan; MC protocols, BCC strategy aligned to the National SBCC strategy- posted to the MC Website • Establishment of TWGs – Male Circumcision Task Force - clinical, communication, QA, research and M&E subcommittees • Facilities- expanded from 1 to 6 in the last 9 months: Hospitals – RFM, Mankayane, Pigg's Peak, Good Shepherd Hospital; NGOs – FLAS, PSI-Litsemba Letfu A NATION AT WAR WITH HIV&AIDS

  6. 2-3 years experience • Training of health care workers/providers - Drs, nurses • Volunteer programme inception • Cabinet approved the proposed ASI in the last February 2010 • Dedicated national MC coordinator August 2009 • Communication – MC weekly articles in the local newspapers, national radio programme initiated, IEC materials developed, community dialogues (8 communities per region); Inter-personal communication at community level to recruit for mobile outreach. A NATION AT WAR WITH HIV&AIDS

  7. Key experiences • QA – all facilities targeted for MC service delivery assessed & improvement target for each facility was set • Over April-May (3 week school holiday over 2,000 MCs were conducted by 3 facilities • Commodities security through partners A NATION AT WAR WITH HIV&AIDS

  8. Key accomplishments • Implementation – Government, Mission (FBOs), NGOs & volunteer support • Establishment of Men’s Clinic (Litsemba Letfu) and 2nd FLAS outlet in Manzini • Strengthened Partnerships • Service delivery/numbers of MCs from 2008 to date – 10,000 which is about 10% on planned coverage (110,000 target 2009-2013) A NATION AT WAR WITH HIV&AIDS

  9. Facilitating & Constraining Factors Facilitating factors: • Partnerships & commitment • Funding • Absence of traditional MC Constraining factors: • Lack of clear M&E plan • Slow national roll-out A NATION AT WAR WITH HIV&AIDS

  10. Lessons learnt • Strategic alliances are key in accomplishment of goal • All is possible with resources (human, financial, material) • Political commitment is crucial to expand the roll-out - Parliament A NATION AT WAR WITH HIV&AIDS

  11. Key next steps 2010-11 • Scale-up using Accelerated Saturation Initiative • Embracing the MOVE model • Infrastructural improvement of facilities to deliver MC • Expanded MC Research activities A NATION AT WAR WITH HIV&AIDS

  12. Support needed to scale up • Accelerated Saturation Initiative to reach scale according to operational plan • Human resource • Exploring task sharing as necessary • M & E in process of developing and strengthening the system A NATION AT WAR WITH HIV&AIDS

  13. Thank You! A NATION AT WAR WITH HIV&AIDS