Most pharmaceuticals are imported from countries like India and South Africa. There is a small amount of local pharmaceutical manufacturing, producing a range of solid and liquid formulations. The Swaziland Pharmaceutical Strategic Plan 2012–16 was developed to provide a roadmap for pharmaceutical services development in the health sector. The most recent mental health legislation was the Mental Health Act 1978. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Swaziland to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 25 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 80 deaths per 1,000 live births, more than three times the target figure. The measles immunisation rate in 2012 was 85 per cent, down from 88 per cent the previous year. Swaziland is unlikely, therefore, to meet either of these targets when the 2015 data is analysed. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Swaziland, maternal mortality should fall to 75 cases per 100,000 live births. In 2013 Swaziland had an adjusted maternal mortality ratio of 310 deaths per 100,000 live births – more than four times the target (this figure was estimated at 320 deaths per 100,000 by UN agencies/World Bank in 2010). Based on the data reported by the country so far, it can be seen that this target is far from being achieved. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2010 this figure stood at 82 per cent, so it is unlikely that this target will be achieved. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. It is encouraging that deaths from malaria have fallen in the period 2001–12, however, the prevalence of the disease has increased from 58 cases in 2008 to 295 in 2012. HIV prevalence in Swaziland was 27.4 per cent in 2012 (in the 15–49 age group); not only is this figure extremely high, but there has also been no reduction in prevalence of the disease since records began in 1990. Additionally, there has been an increase in the estimated incidence of and mortality (when mortality data excludes cases comorbid with HIV) from TB since 1990. Consequently, Swaziland is unlikely to achieve this goal when the 2015 data is analysed. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Around a quarter of health care in Swaziland (26 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 8.5 per cent of GDP in 2012, of which 74 per cent (US$192 per capita) was covered by the government. Swa z i l a n d Health services are usually chargeable under a pre-payment scheme, which makes health care unaffordable for some. There is also a shortage of health care professionals, particularly in rural areas. Children, orphans and the disabled get free health care. Some charities and international aid organisations provide free health care. Private health insurance is available, but usually only to those who work in the formal sector. The government is considering introducing a national health insurance scheme with the aim of making health care available to all. The World Health Organization Country Co-operation Strategic Agenda (2014–19) includes the strengthening of health systems as a priority. There is a Centre for Disease Control and Prevention active in Swaziland and it is particularly focused on trying to halt the spread of AIDS. Swaziland was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 2004 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 43,000 people in Swaziland are over the age of 65 – 17 per cent of the total population (2013). At the age of 60 a person in Swaziland can be expected to live for an additional 16 years, on average (2013). Swaziland’s Old Age Grant dates back to 2005. Today, monthly pension credits are paid by the state at a rate of US$20 per person (2007–12) on a pensionstested basis. Population over 65 3% The elderly qualify for free health care. As in neighbouring countries, AIDS has left many older people without children to care for them. In addition, they often find themselves raising their orphaned grandchildren. Charities are active in Swaziland delivering food parcels to the elderly and assisting with other services for older people. Further information Ministry of Health: www.gov.sz Commonwealth Health Online: www.commonwealthhealth.org/health/africa/swaziland Commonwealth Health Partnerships 2015 275
Commonwealth Health Partnerships 2015
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