• Reference: P-SZ-IB0-001
• Appraisal Date: 11/11/2010
• Board Presentation: 15/02/2011
• Status: PipelinePIPE
• Implementing Agency: GOVERNMENT OF SWAZILAND MINISTRY OF FINANCE
• Location: THROUGH OUT THE COUNTRY

The project is designed with the framework of supporting the NHSP pillars. The strategic plan focuses on 8 major strategic pillars as priorities with key objectives including the following:

(i)Organization and Management of Services

(ii)Co-ordination

(iii) Human Resources

(iv)Quality Assurance

(v)Health Financing

(vi)Infrastructure Development and Equipment Management (vii) Service Provision: Public Health and Clinical Services. (viii) Service Provision: Social Welfare However, the support by the Bank and its co-financiers will focus on Infrastructure Development and Equipment Management.

The specific objective of the project is to improve the delivery of health care services

In response to these unfavourable developments in the health sector, the government of Swaziland also initiated steps in an effort to improve health service performance. For this reason the country's Poverty Reduction Strategy and Action Programme (PRSAP) in 2004 identified the health sector as a priority area. The government followed it up with a revision of the National Health Policy in 2007 to guide the Ministry of Health and Social Welfare (MoHSW) in effecting strategies to address the problem areas in health service delivery and also serve as the road map for addressing future challenges. The Ministry has also prepared a five-year National Health Strategic Plan (NHSP) to implement the new health policy and thereby turn the country's poverty reduction strategies (PRSAP) into concrete MDG-based long-term results-oriented health plan. The essence of the NHSP is to reposition the health sector (and especially the MoHSW) to leverage its strategic competencies to redefine its approach to improving quality of health care and consequently health outcomes.

With the rapid increase in the burden of disease in the country and the pressure on the health sector to respond effectively, the proposed project has been designed to strengthen the provision of health care and social services by the MOHSW. The proposed project is consistent with the framework of the Country Strategy Paper (CSP, 2005), NHSP, NEPAD and National Smart Partnership Forum 2004. The project equally reflects the concerns of the Poverty Reduction Strategy and Action Plan (PRSAP) to improve quality of life and reduce the incidence of poverty in Swaziland from its current level of 66% to 30% by 2015, in line with the Millennium Development Goals (MDG) and eliminate it by 2020. In addition to reinforcing the health care delivery system, the project is designed to focus on facilitating the convergence of the formal health system with community-based programs to maximize access, utilization, and quality of services for vulnerable populations. To this end, the process and the development of the project formulation framework will be carried out through a participatory and consultative process involving various stakeholders including beneficiaries, public and private sector, civil society organizations (CSOs) UN and other donor agencies in Swaziland.

The design of the project has also taken into account lessons learned from previous interventions. The Health Service Improvement Project financed through ADB and NTF with UA1.676 million and UA1.729 million respectively, was approved in 1983. This was followed in 1996 by a grant of UA 0.53 million for the health sector study. The main lesson learned from these interventions is the need to have a strong management team to avoid delays on procurement and disbursement of resources. Similarly, Government implemented projects showed the need to avoid prolonged implementation period that leads to high cost overruns. Updated findings of the study provided a comprehensive situation analysis of the health care system and outlined some of the shortcomings that were affecting the performance of the sector. It is in response to the lessons learned and recommendations from the health sector study that the project intends to strengthen the institutional capacity of the health sector and the health care and social welfare delivery system as well as to implement the project effectively and efficiently.

Estimates of poverty indicate that 66% of the population lives below the poverty line (estimated at E71 per person per month). These people are made to remain in the poverty trap because of several factors such as gender inequality, inaccessibility to productive assets and proper health facilities. About 45% of the urban population is poor, compared to 71% of the rural population. Shiselweni is the poorest region, with 78% of the population poor, followed by Lubombo where 66% of the population is poor. Hhohho and Manzini exhibit the lowest poverty levels at 60% and 59% respectively.

Gender relations in the country are not balanced. They usually favour males in most spheres of life. Culturally, women are minors, and this minority status is reinforced by marriage under both customary and common law. At family level, men largely make decisions pertaining to the number of children and contraceptive use. This situation exerts pressure for high fertility. In addition, despite the high prevalence of HIV/AIDS, women still have to negotiate with their partner on the use of condoms. At national level, there is inadequate representation of women in almost all decision-making structures.

In the current cabinet, there are only two women out of 15 Ministers. In the House of Senate, out of 30 Senators only four are women, and in the House of Assembly there are four women out of 65 members. Traditionally all chiefs males and females can only act in regency until the rightful heir is installed. Within the context of SADC, Swaziland has committed itself to having 30% of all positions in political and decision-making structures to be occupied by women by 2005. The problem of gender-based violence is common and increasing. It includes battery, rape and incest, to name a few. The institutional arrangements for dealing with these problems are still lacking.

KGOSIDINTSI Nana Beth Gokwadilwe - OSHD3

Amount
UAC 23,000,000