SERVICE AVAILABILITY MAPPING (SAM) 2006 - 2007 KINGDOM OF SWAZILAND MINISTRY OF HEALTH AND SOCIAL WELFARE AND MINISTRY OF EDUCATION IN COLLABORATION WITH THE WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR AFRICA © World Health Organization 2008 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. 2 Acknowledgements It was the first time that Service Availability Mapping (SAM) was carried out in Swaziland. This important initiative was possible because of the commitment of senior authorities in the Ministry of Health and Social Welfare. Special gratitude goes to Ms Nomathemba Dlamini, the Principal Secretary, and Mr. Sikelela Dlamini, the Undersecretary of the Ministry of Health and Social Welfare and the Chairman of the SAM Steering Committee, who were very supportive from the beginning of the process. The effective involvement of various units within the Ministry of Health and Social Welfare was highly appreciated. The contribution of the Swaziland National Programme on AIDS particularly the Monitoring and Evaluation Unit which supervised the whole process from the consultative stakeholders meeting until the finalization of the report was determinant. We particularly would like to thank Sibongile Maseko, former M&E focal point, Sibongile Mndzebele, current M & E focal point in Ministry of Health and Social Welfare, M&E officers Nomsa Mulima, Sandile Dlamini, and Nqaba Nhlebela who actively participated in planning, data collection and analysis. The contribution throughout the process of the Office of the Surveyor General in the Ministry of Natural Resources, namely Mr. Sidney Simelane, chairman of the SAM Technical Committee, and Mr. Patrick Mkhonta, was very much appreciated. The same goes to the National Emergency Response Council to HIV/AIDS (NERCHA) for their participation in data analysis. We are grateful to WHO, particularly to Dr David Okello, former WR in Swaziland, and to Dr Edward Maganu, current WHO Representative in Swaziland, for their advice encouragement and support. Our appreciation also goes to Dr Augistin Ntlivamunda, HIV/AIDS Country Officer, Dr Benjamin Gama, National Programme Officer, Mr. Thamsanqa Dlamini, IT Officer, and Mr Phakama Dlamini for the role they played in SAM planning, execution and data analysis. Special thanks go to Dr Gorge Loth, former WHO/HQ staff and who retired in 2006, and to Shanthi Noriega Minichiello, Service Availability Mapping Focal Point in HQ/Geneva, for the key roles they played in planning and implementation of SAM in Swaziland. Without their determination and technical support, the exercise would not have been possible. Finally, we acknowledge the valuable financial support from WHO, the collaborative and supportive efforts from the Regional Office in Brazzaville and headquarters in Geneva. 3 Abbreviations and acronyms ACT Artemisin-based Combination Therapy AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care ART Antiretroviral Therapy ARV Antiretroviral ASRH Adolescent Sexual and Reproductive Health CDR Crude Death Rate FDI Foreign Direct Investment GDP Gross Domestic Product GPS Global Positioning System HIV Human Immunodeficiency Virus HRH Human Resources for Health HTC HIV Testing and Counseling IMA/ART Integrated Management of Adult Illness/Antiretroviral Therapy IMCI Integrated Management of Childhood Illness IMR Infant Mortality Rate NVP/AZT Neverapine/zidovudin MMR Maternal Mortality Rate MoEPD Ministry of Economic Planning and Development MoH Ministry of Health NCD Non-Communicable Disease ORS Oral Rehydration Salts TB Tuberculosis PDA Personal Digital Assistant PEP Post Exposure Prophylaxis PHU Primary Health Unit PLACE Priority for Local AIDS Control Efforts PLWHA People Living With HIV/AIDS PMTCT Prevention of Mother to Child Transmission PPA Priority Prevention Area PSAM Prevention Service Availability Mapping SAM Service Availability Mapping U5MR Under-Five Mortality Rate VCT Voluntary counselling and Testing WHO World Health Organization 4 Table of contents 1. Background....................................................................................................................9 1.1 Geography and population .................................................................................11 1.2 Economic profile .................................................................................................14 1.3 Health profile.......................................................................................................14 1.4 Education profile .................................................................................................15 2. Service Availability Mapping (SAM)............................................................................17 2.1 Background.........................................................................................................18 2.2 Objectives ...........................................................................................................18 2.3 Methodology .......................................................................................................19 3. Results, health services survey ..................................................................................21 3.1 Foreword.............................................................................................................22 3.2 Executive summary.............................................................................................23 3.2.1 Regional results ..........................................................................................23 3.2.2 Results from health facilities .......................................................................23 3.3 Regional results ..................................................................................................25 3.3.1 Health infrastructure....................................................................................25 Health facilities.............................................................................................25 Laboratory capacity ......................................................................................26 Blood safety services....................................................................................26 Injection equipment ......................................................................................28 Oxygen, indoor spraying and X-ray .............................................................28 Communication technology..........................................................................29 3.3.2 Service availability ............................................................................................29 HIV/AIDS treatment ....................................................................................29 Maternal and child health .............................................................................30 Tuberculosis case management ....................................................................30 3.3.3 Social marketing programmes ..................................................................31 3.4 Facility census results.........................................................................................32 3.4.1 Health infrastructure....................................................................................32 Health facilities.............................................................................................32 Communications...........................................................................................34 Water source.................................................................................................40 Sterilization...................................................................................................42 3.4.2 Human resources........................................................................................43 3.4.3 Basic equipment..........................................................................................48 Equipment availability in hospitals ..............................................................48 Equipment availability in health facilities....................................................48 3.4.4 Availability of essential drugs in health facilities..........................................50 3.4.5 Laboratory capacity.....................................................................................52 3.4.6 Service availability.......................................................................................53