The Kingdom of Swaziland
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THE KINGDOM OF SWAZILAND MASTERPLAN TOWARDS THE ELIMINATION OF NEGLECTED TROPICAL DISEASES - 2015- 2020 Foreword Acknowledgements Table of Contents .......................................................................................................................................... 1 LIST OF TABLES .................................................................................................................. 5 PART 1: SITUATION ANALYSIS ....................................................................................... 10 1.1 Country profile ......................................................................................................... 10 1.1.1 Geographical characteristics ............................................................................... 10 1.1 .2 PHYSICAL FEATURES AND CLIMATIC CONDITIONS ....................................... 11 1.1.3. ADMINISTRATIVE STRUCTURES, DEMOGRAPHY AND COMMUNITY STRUCTURES ................................................................................................................... 12 1.3.2 Population ............................................................................................................. 13 Health Information System ........................................................................................... 25 Health workforce ........................................................................................................... 26 Medical products ........................................................................................................... 27 Leadership and governance ......................................................................................... 28 2.10 Intersectoral Collaboration ................................................................................ 29 1.3. NEGLECTED TROPICAL DISEASE SITUATION ANALYSIS ................................. 29 1.3.1 Epidemiology and burden of disease .................................................................. 29 1.3.3 GAPS AND PRIORITIES .................................................................................... 39 LIST OF TABLES Table 1: Swaziland population by gender, region and density ............................................. 13 Table 2: National Population Data ...................................................................................... 13 Table 3: Service delivery capacity, by region ...................................................................... 22 Table 4: Distribution of Health Facilities across Regions by type ......................................... 23 Table 5: Prevalence of bilharzia seen at the national laboratory from 1999 to 2010 ............ 30 Table 6: STH and SCH prevalence by Tinkhundla .............................................................. 32 Table 7: NTDs Coendemicity by Tinkhundla ....................................................................... 35 Table 8: NTDs mapping status ........................................................................................... 37 Table 9: Summary of intervention information on existing PCT programmes ...................... 38 Table 10: Summary of intervention information on existing CN programmes ...................... 38 Table 11: SWOT counteracting table .................................................................................. 39 Table 12: Strategic framework summary ............................................................................ 41 Table 13: Summary of NTD Disease Specific goals and objectives..................................... 42 Table 14: Activities for implementing strategic priority 1: Strengthen government ownership, advocacy, coordination and partnership ...................................................................... 43 Table 15: Strategic Priority 2: Enhance planning for results, resource mobilization and financial sustainability of national NTD programmes. .................................................. 44 Table 16:Tinkhundla requiring interventions or mapping for each targeted NTD ................. 46 Table 17: Types of Mass drug administration ...................................................................... 46 Table 18: Activities for PCT interventions ............................................................................ 48 Table 19: Package 3.2: Case management and chronic care ............................................. 49 Table 20: Activities for case management and interventions .............................................. 49 Table 21: Intervention packages for Transmission control ................................................... 50 Table 22: Activities for transmission control ........................................................................ 50 Table 23: Activities and resources needed for strengthening capacity for NTD programme 52 Table 24: Phasing in targeted districts in scaling up an NTD programme ............................ 53 Table 25: Strategic Priority 4: Activities for enhancing NTD monitoring and evaluation, surveillance and operations research .......................................................................... 53 Table 26: Activities for strengthening pharmacovigilance in NTD programmes. .................. 56 Table 27: Post intervention surveillance and integration within primary health care ............ 59 Figures Page Figure 1: The map of Swazilandshowing regions and towns ............................................... 10 Figure 2: The ecological and physiographic zones of Swaziland ......................................... 11 Figure 3: Water and Sanitation coverage by location: 2007-2014 ....................................... 18 Figure 4: Structure of the health service delivery system .................................................... 22 Figure 5: Organogram of the Ministry of Health with respect to NTD control ....................... 29 Figure 6: Prevalence of bilharzia and intestinal worms from 2005 to 2008 .......................... 30 Acronyms INTRODUCTION Neglected Tropical Diseases (NTDs) are a group of diseases that affect the poor and marginalized communities in our societies. They are usually found in the developing world and thrive well in the tropics where the climate and environmental conditions are conducive. The NTDs portfolio includes protozoa infections like Leishmaniasis, Human African and American Trypanososmiasis; bacterial infections that include trachoma, leprosy, and buruli ulcer, and those that are caused by helminthes such as Soil Transmitted Helminthes (STH) (Hookworms, Ascariasis, Trichuriasis, Lymphatic Filariasis, Onchocerciasis, Drancunculiasis, Cysticercosis and Schistosomiasis. Although these NTDs are preventable and can be controlled, an estimated 1 billion people, which is one seventh of the world’s population, are affected by these NTDs. About 500,000 to 1 million deaths occur annually as a result of NTDs. NTDs are chronic, disfiguring and disabling conditions. They are among the leading perpetuators of poverty as they significantly diminish economic productivity in affected adults and intellectual and physical development of the next generation, thus reinforcing a cycle of poverty. Among these NTDs are those targeted for control and include Soil Transmitted Helminthes (STH), Onchocerciasis and Lymphatic Filariasis .Those for elimination are Schistosomiasis, STH and Trachoma which are also the commonest NTDs globally. In June 2012, pharmaceutical companies, donors, endemic countries and non- Governmental Organizations, inspired by the World Health Organization’s (WHO) Road Map on NTDs, adopted the London Declaration on NTDs of 2012 to contribute to technical knowledge, drugs, research funding and other resources to treat and prevent NTDs among the world’s poorest populations. This public–private partnership has facilitated progress in the fight against NTDs as a result of the donations received from the partners. It is worth noting however, that the available financial resources and global political commitments will not be sufficient to reach the established World Health Assembly goals. The control and elimination of the NTDs requires integrated programs with the ultimate goal of ensuring effectiveness and sustainability of health systems in the developing world. To this end, i. Collaboration amongst a range of institutions across disease areas to deliver an integrated NTDs control approach should be prioritised. Initiatives, such as the International Health Partnership (IHP), which recognize the need for joint planning among partners, in direct collaboration with ministries of health may be viable mechanisms in the control and eradication strategies of NTDs; ii. Coordination and sustainability on the part of both donors and national governments including from the Ministries of Health and Finance should be strengthened; iii. Accountability mechanisms to ensure that all partners deliver on agreed commitments is necessary in enhancing the implementation processes; iv. The role of the World Health Organisation, through its country offices and direct links with ministries of health, as part of their mandate, has the function of control and elimination of NTDs and should continue to collaborate with governments and development partners in this effort. The Swaziland National Bilharzia and Worms Control Programme, which serves as the national NTDs Programme, was developed in 1981. Its mandate is dual in approach to morbidity control, with de-worming for the schistosomiasis and soil – transmitted Helminthiasis is done