Global Health Institute

Health Challenges in Eswatini

Twenty years ago, Eswatini was facing severe HIV and tuberculosis (TB) crises, coupled with a growing non-communicable diseases (such as cancers, hypertension, and diabetes mellitus) burden—hence a “perfect public health storm.” Eswatini has the highest per capita burden of cervical cancer in the world. These health challenges are exacerbated by the country’s social determinants of health, such as poverty and low literacy rates. Gender inequality and gender-based violence are persistent challenges that disproportionately affect women and girls. Approximately one in three females has experienced gender-based violence and suffered mental, sexual, and reproductive health consequences.

In recent years, committed leadership at the national and community levels, along with support from multiple donors and technical assistance programs, has led to significant progress and put Eswatini’s health on a more positive trajectory. The country is now a shining star in the response to both HIV and TB. CGHPI has proudly contributed to this success by responding to needs identified by community leaders including improved service delivery, training health care workers, engaging communities for positive norm change, implementation science, and translation of research into police and guidelines.

The work is made possible through a collaborative and responsive Ministry of Health, other community partners, and a diverse range of funding agencies, such as Bill and Melinda Gates Foundation, the US President’s Emergency Fund for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), UNICEF, FIND, and the Task Force for Global Health.

Improving Health Care Outcomes

Since 2020, CGHPI Eswatini and its community partners have supported more than 280,000 people to learn their HIV status, identifying over 10,000 people living with HIV and linking them to antiretroviral treatment. CGHPI Eswatini currently supports over 110,000 people living with HIV on treatment in supported regions—96% of all people living with HIV in the supported regions on treatment. Of them, 98% are virally suppressed and therefore have minimal risk of transmitting HIV to their sexual partners. To “close the tap” of new infections, CGHPI is implementing a robust HIV prevention program, targeting adolescent girls and young women where new HIV infections are seven times higher than among their male counterparts. These achievements have been possible through the funding from PEPFAR/CDC. CGHPI is supporting Eswatini to close the remaining gaps after achieving UNAIDS HIV epidemic control targets in 2020.

Through the same funding, CGPHI Eswatini supported cervical cancer screening for over 40,000 women living with HIV and treatment of 1,200 found with precancerous lesions, thereby improving survival and overall health, decreasing gender disparity in health outcomes. CGHPI Eswatini is also supporting the Ministry of Health to scale up vaccination against human papilloma virus (HPV), the virus that causes cervical cancer, among young girls ages 9 to 14 years old through funding from PEPFAR/CDC and the Task Force for Global Health. Similarly, with funding from UNICEF and the Task Force for Global Health, CGPHI Eswatini also expanded vaccination for COVID-19 from 20% to 53% population coverage in the two regions where it focuses.

Creating Lasting Impact

CGHPI’s country team in Eswatini, led by Dr. Samson Haumba, an assistant professor of medicine at Georgetown University School of Medicine, is currently implementing multiple projects within the country and directly managing 160 employees and 400 staff who are seconded to Ministry of Health facilities. CGHPI Eswatini operates in two of the four geographical regions of Eswatini (Manzini and Lubombo), where it supports clinical services improvement in 88 health facilities and community engagement and health promotion in 29 constituencies and nationally. CGPHI Eswatini is the PEPFAR technical assistance lead partner for the country’s HIV and TB programs.

In 2022, CGHPI Eswatini expanded from technical assistance to include management of clinical services at the Chakaza Emphilweni Clinic, based in Matsapha in the industrial hub of Eswatini. Haumba explained the meaning behind the clinic name.

“We named the clinic Chakaza after the siSwati word for ‘flourish and bloom,’ a concept that we have fully embraced as a powerful ethos of growth and vitality. The word encapsulates the essence of positive development, which goes beyond just existing, but thriving and feeling fulfilled in life. The intentional use of the Chakaza name has been pivotal in driving impactful initiatives in Eswatini.”

Innovative Solutions

The CGHPI model incorporates four key pillars: human-centered design, data science, continuous quality improvement, and transition and sustainability approaches. As the team leverages its distinctive strengths at the intersection of education, research, and service, it puts particular emphasis on innovation and systems thinking, recognizing the complexity of health and health care.

One particular approach that harnesses technology is the automated medication dispenser systems, locally known as “LuLa Meds” (loosely translated as “easy meds”), alluding to the ease of accessing prescription medication through the system. Designed to allow patients to swiftly and conveniently collect their pre-dispensed antiretroviral treatment, TB and non-communicable diseases medications at any time of day or night, the automated medication dispenser systems ensure that vital treatments are readily available at their fingertips. Through this innovation, patient Zanele Magagula shared that instead of arriving at the clinic dispensary at 5:00 a.m. to wait for three hours for her treatment refill so that she can be at work on time, she now spends less than five minutes picking up her medications at a time convenient for her.