Swaziland National Policy on Sexual and Reproductive Health and Rights

Abstract

Sexual and reproductive health (SRH) concerns the well-being of women, as well as
that of their partners and children. The country is accelerating efforts toward the realization of Millennium Development Goals (MDGs) and strengthening the access and utilization of SRH services at all levels is one of the key initiatives that the Ministry of Health is targeting. High maternal mortality rate, high adolescent fertility rate, unmet need for family planning, and on-going problems with sexual and gender based violence (SGBV) are some of the indicators that highlight a need for a comprehensive sexuality education and evidence based interventions. This Policy provides concrete areas of focus and is aligned to international and national policies and frameworks. It addresses reproductive health and rights challenges faced by citizens of Swaziland and outlines implications for the different levels in the Ministry. It also recognises the role that other sectors play in improving the SRH of the people of the Kingdom of Swaziland.

This policy takes cognizance of the existing policies, frameworks and guidelines, in particular the National Health Policy which forms the basis for all population related programmes. The development of the policy involved extensive consultations with key informants and stakeholders in government and NGOs as well as opinion leaders at both the national, regional, Inkhundla and chiefdom levels. Young people, men and women as well as Community leaders were also consulted.

This document is designed to be used by policymakers, program managers and service providers at all levels in both public and private sectors in SRH. It forms the basis and mandate for all SRH activities, outlining the national strategic pillars for improving SRH. It will also enable us forge new partnerships - between governments and communities, nongovernmental organizations, development partners and the private sector - that are critical if we are to succeed in the implementation of integrated SRH services.

Full text

THE KINGDOM OF SWAZILAND
Ministry of Health
NATIONAL POLICY ON SEXUAL AND
REPRODUCTIVE HEALTH
2013
FOREWORD
1

Sexual and reproductive health (SRH) concerns the well-being of women, as well as
that of their partners and children. The country is accelerating efforts toward the
realization of Millennium Development Goals (MDGs) and strengthening the access and
utilization of SRH services at all levels is one of the key initiatives that the Ministry of
Health is targeting. High maternal mortality rate, high adolescent fertility rate, unmet
need for family planning, and on-going problems with sexual and gender based violence
(SGBV) are some of the indicators that highlight a need for a comprehensive sexuality
education and evidence based interventions. This Policy provides concrete areas of
focus and is aligned to international and national policies and frameworks. It addresses
reproductive health and rights challenges faced by citizens of Swaziland and outlines
implications for the different levels in the Ministry. It also recognises the role that other
sectors play in improving the SRH of the people of the Kingdom of Swaziland.
This policy takes cognizance of the existing policies, frameworks and guidelines, in
particular the National Health Policy which forms the basis for all population related
programmes. The development of the policy involved extensive consultations with key
informants and stakeholders in government and NGOs as well as opinion leaders at
both the national, regional, Inkhundla and chiefdom levels. Young people, men and
women as well as Community leaders were also consulted.
This document is designed to be used by policymakers, program managers and service
providers at all levels in both public and private sectors in SRH. It forms the basis and
mandate for all SRH activities, outlining the national strategic pillars for improving SRH.
It will also enable us forge new partnerships - between governments and communities,
nongovernmental organizations, development partners and the private sector - that are
critical if we are to succeed in the implementation of integrated SRH services.
On behalf of the Ministry of Health, I convey my gratitude to all members of the Policy
core team for dedicating their time to finalizing this Policy. The Ministry is also grateful
to training institutions, health institutions, and professional organizations, local and
international NGOs, development partners, community leaders and individuals who
participated and contributed to the validation of this National SRH Policy.
Honourable Benedict Xaba
Minister of Health
ACKNOWLEDGEMENTS
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The Ministry is very grateful for the technical and financial support received from the EU
and UNFPA for the development of this Policy. The input of the UN agencies and SRH
stakeholders into the policy was crucial and enabled finalization of this important
document. We also extend our appreciation to all implementing and bilateral partners of
SRH who made valuable contribution in time and effort in the development of the
document which will guide service provision. Many worked tirelessly in the core team
that supported the whole process while others reviewed drafts and made inputs.
We are so indebted to the Public Policy Coordinating Unit for technical guidance and
support in the whole process of the development of the policy, without whom the
document could not have been finalized. The leadership and guidance of the Ministry
through the Deputy Director – Public health is highly appreciated.
The SRH Programme is acknowledged for the continuous commitment and stewardship
in the delivery of integrated Sexual Reproductive Health services.
Dr Steven Shongwe
Principal Secretary
TABLE OF CONTENTS
3

GLOSSARY OF TERMS...................................................................................................6
GLOSSARY OF TERMS...................................................................................................6
6
INTEGRATION: COMBINATION OF DIFFERENT SEXUAL AND REPRODUCTIVE
HEALTH CARE SERVICES OR PROGRAMMES TO ENSURE EXPECTED
OUTCOMES. THIS MAY INVOLVE REFERRAL OF A CLIENT FROM ONE SERVICE
TO ANOTHER OR PROVISION OF ALL REQUISITE SERVICES AT THE SAME TIME
AND PLACE......................................................................................................................7
...........................................................................................................8
ABBREVIATIONS AND ACRONYMNS...........................................................................8
ABBREVIATIONS AND ACRONYMNS...........................................................................8
8
2.0 VISION, MISSION, GOAL AND OBJECTIVES.....................................................14
2.1 Vision......................................................................................................................14
2.2 Mission...................................................................................................................15
2.3 Goal........................................................................................................................15
2.4 Objectives...............................................................................................................15
3.0 GUIDING PRINCIPLES AND VALUES....................................................................15
3.1 Universal Access to Comprehensive SRH and Rights..........................................16
3.2. Quality of Care and integration of SRH services..................................................16
4. POLICY FRAMEWORK..............................................................................................17
4.11 Community involvement and participation in SRH...............................................17
4.1 Maternal, Neonatal, Adolescent and Family Planning...........................................18
4.2 Adolescent and Youth Sexual Reproductive Health and Rights............................19
4.3 Family Planning......................................................................................................21
4.4 Abortion and post abortion care.............................................................................22
4.5 STIs, HIV and AIDS................................................................................................23
4.6 Infertility..................................................................................................................24
4

4.7 Cancers of the reproductive system.......................................................................25
4.8 Gender and Sexual and Reproductive Health including GBV...............................26
4.9 Sexual Dysfunction.................................................................................................27
4.10 Sexual and Reproductive Health and Ageing......................................................28
4.11 Community involvement and participation in SRH...............................................29
5.0 INSTITUTIONAL FRAMEWORK FOR THE IMPLEMENTATION OF THE POLICY
31
5.0 INSTITUTIONAL FRAMEWORK FOR THE IMPLEMENTATION OF THE
POLICY...........................................................................................................................31
5.1 Implementation......................................................................................................32
5.2 Financing...............................................................................................................32
5.4 HUMAN RESOURCES.............................................................................................32
5.5 COORDINATION OF PARTNERS...........................................................................32
5.6 MONITORING AND EVALUATION OF THE POLICY.............................................32
5.3 Monitoring and evaluation of the policy.................................................................32
5.4 Policy Revision......................................................................................................33
6.0 CONCLUSION..........................................................................................................34
6.0 CONCLUSIONS........................................................................................................34
7. REFERENCES............................................................................................................35
5

GLOSSARY OF TERMS
Abortion: Abortion is the expulsion of the products of conception before 28 weeks
(viability stage) of gestation (MOH 2011).
Adolescent: A young person aged between 10 and 19 years (WHO)
Community: A group of people who share an interest, a neighbourhood, or a common
set of circumstances. They may or may not acknowledge membership of a particular
community (WHO, 2002).
Competent: Refers to capable, knowledgeable, skilled and proficient service providers
who are providing services according to national guidelines
Comprehensive: refers to health care that comprise of many elements of care such as
promotive, preventive, curative and rehabilitative services. Comprehensive SRH
services bring together all the elements of SRH to prevent, manage conditions.
Infertility: Failure by a couple to achieve a conception after twelve months of normal
regular and unprotected sexual intercourse.
6

Integration: Combination of different sexual and reproductive health care services or
programmes to ensure expected outcomes. This may involve referral of a client
from one service to another or provision of all requisite services at the same time
and place.
Maternal mortality ratio: Number of maternal deaths per 100,000 live births
Reproductive health: A state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity, in all matters relating to the reproductive
system, its functions, and processes. (ICPD 1994)
Service delivery level: refers to the different levels of service delivery in Swaziland
which include clinics, Health centre, regional hospitals and national referral hospitals
Sexual health: A state of physical, emotional, mental and social well-being in relation to
sexuality and not merely the absence of disease, dysfunction or infirmity, requires a
positive and respectful approach to sexuality and sexual relationships, and an
appreciation of the importance of having pleasurable and safe sexual experiences
Sexuality: A significant aspect of a person’s life, from birth to death, consisting of many
interrelated factors, including anatomy, growth and development, gender, relationships,
behaviors, attitudes, values, self-esteem, sexual health, reproduction.
Sexuality education: refers to age appropriate, medically accurate, culturally sensitive
education provided to individuals, couples and groups aimed at promoting
understanding sexual reproductive health and related rights and responsibilities.
Social justice: refers to the idea of creating a society or institution that is based on the
principles of equality and solidarity, that understands and values human rights, and that
recognizes the dignity of every human being.
Youth: young men and women aged from 15 to 35 years (MOSCYA, 2009)
7

ABBREVIATIONS AND ACRONYMNS
AIDS Acquired Immunodeficiency Syndrome
ANC Ante Natal Care
ART Anti-Retroviral Treatment
ARVs Anti-Retroviral
ASRHR Adolescent Sexual and Reproductive Health & Rights
AU African Union
BEOC Basic Essential Obstetric care
CEDAW Convection on the elimination of all forms of discrimination against
women
CEMD Confidential Enquiry into Maternal Deaths
CEOC Comprehensive Essential Obstetric Care
CHAI Clinton Health Access Initiatives
CME Continuous Medical Education
8

CMS Central Medical Store
CPR Contraceptive Prevalence Rate
CSO Central Statistics Office
DPM Deputy Prime Minister’s Office
EC Essential Care
ED Erectile dysfunction
EmONC Emergency Obstetric and Neonatal Care
EHCP Essential Health Care Package
FBO Faith Based Organisation
FP Family Planning
FWCW Fourth World Conference on Women
GBV Gender based Violence
GDP Gross Domestic Product
HIMS Health Information and Management System
HIV Human Immunodeficiency Virus
HRH Human Resource for Health
HSSP Health Sector Strategic Plan
ICPD International Conference on Population and Development
IDU Injection drug user
IMR Infant Mortality Rate
ISRHSP Integrated Sexual and Reproductive Health Strategic Plan
LGBTQ Lesbian, gays, bisexual, transsexuals and queer
MARPs Most at risk populations
MCH Maternal Child Health
MDG Millennium Development Goal
M&E Monitoring and evaluation
MMR Maternal Mortality Ratio
MNCH Maternal, Newborn and Child Health
MEPD Ministry of Economic Planning and Development
MoET Ministry of Education and Training
MoH Ministry of Health
9

MoJCA Ministry of Justice and constitutional affairs
MoSCYA Ministry of Sports Culture & Youth Affairs
MoU Memorandum of Understanding
MTCT Mother - to - Child Transmission
NCD Non communicable diseases
NCLS National Clinical Laboratory Services
NDS National Development Strategy
NEPAD New Partnership for Africas Development
NGO Non-Governmental Organisation
NHP National Health Policy
NHSSP National Health Sector Strategic Plan
NMR Neonatal Mortality Rate
PAC Post Abortion Care
PEP Post-exposure prophylaxis
PHC Primary health care
PLWHA People Living With HIV/AIDS
PMTCT Prevention of Mother to Child Transmission
PoA Plan of action
PRSAP Poverty Reduction Strategy and Action Programme
SADC Southern Africa Development Community
SDHS Swaziland Demographic and Health Survey
SGBV Sexual Gender Based Violence
SRH Sexual and Reproductive Health
SRHR Sexual and Reproductive Health & Rights
SRHC Sexual and Reproductive Healthcare
SRHCS Sexual and Reproductive Health Commodity Security
SRHP Sexual and Reproductive Health Programme
SPEED Smart Programme for Empowerment and Economic Development
SSA Sub-Saharan Africa
STI Sexually Transmitted Infections
TFR Total Fertility Rate
10

UNFPA United Nations Population Fund
UNGASS United Nations General Assembly Special Session
VCT Voluntary Counselling and Testing
1.0 INTRODUCTION
The Kingdom of Swaziland is a
landlocked country in Southern Africa
with an estimated land area of 17,364
km2. It shares its border with
Mozambique to the East, the Republic of
South Africa to the North, West and
South. Swaziland is classified as a
lower-middle income country with a
per capita income of US $ 2.280.
11

According to the Swaziland Population Census the total population is 1,018,449 in
2007. Females make up 52.6% of the total population and the corresponding proportion
for males is 47.44%. The total population of reproductive age (15-49years) was
projected at 53.5% in 2011. The population of Swaziland is generally young, with 47%
of the total being aged less than 18 years (CSO 2007). The Total Fertility Rate (TFR)
was 3.95 in 2007, a drop from 4.5 in 1997 and inter-censal population growth rate
between 1997 and 2007 was 0.9% annually down from 2.9% a decade earlier. This
decline is partly attributed to the increase in contraceptive prevalence rate (CPR) from
17% in 1990 to 50.6% in 2007 and an unexpected increase in mortality. The MMR has
remained high at 370 in 1995 to 589/100,000 live births in 2007(SDHS 2006-07). The
IMR and NMR have also increased as a result of the HIV/AIDS epidemic. Despite the
drop in TFR and increase in the CPR from the unmet need for FP is high. Early sexual
debut among youth is still high and 25% of all institutional deliveries are by adolescent
girls. There is poor or no integration of services such as FP, HIV/AIDS, STIs, and
MNCH.
Gender based violence and sexual dysfunctions are common social and medical
conditions. The complex interactions among all the
stated issues contribute to high morbidity and
mortality.
1.1 POLICY DEVELOPMENT PROCESS
In 2002 the MoH started drafting a National Policy
on SRH. However this important document has not
been finalized and has remained in draft form to
date. In its absence a national SRH strategy
covering the period 2002-2006, followed by the
Integrated National SRH Strategic Plan 2008-2015 were developed to guide the
national response to SRH challenges. There remained a need for an overarching policy
document to guide SRH interventions in the country.
12
The country’s HIV situation:
19% prevalence
among the 2 years and
older (CSO 2007)
26% among sexually
active adults (31% for
women and 19% for men)
(CSO 2007)
41.1% among antenatal
care clients (2010 HIV
ANC Serosurveillance)
The country’s HIV situation:
19% prevalence
among the 2 years and
older (CSO 2007)
26% among sexually
active adults (31% for
women and 19% for men)
(CSO 2007)
41.1% among antenatal
care clients (2010 HIV
ANC Serosurveillance)

In 2011 steps were taken to develop and finalize an SRH Policy. The policy was
developed through consultations with key stakeholders in a process that was led by the
Ministry of Health through the SRHP. The SRH policy is meant to ensure proper
coordination, integration and harmonious delivery of comprehensive SRH services in
order to better the health and the well-being of the population as well as to contribute to
its socio-economic development as set out in the PRSAP and other national documents.
The steps indicated in the box below were taken in the development of this policy.
1.2 GAPS AND ACHIEVEMENTS
There are many achievements that the country has reached in the provision of SRH
services; however some gaps still exist as shown in the following table.
Achievements Gaps
Existence of a functional SRH
programme
Integration of SRH and HIV
services in PHC services
A dedicated RH commodities
budget line
Development of the Integrated
Sexual and Reproductive Strategic
Plan ( 2008-2015)
Introduction of Confidential Enquiry
into Maternal Deaths ( CEMD)
Inclusion of sexual health education
SRH Policy in draft form
Inadequate skill and competence
among health professionals to deliver
SRH Health services
Health disparities in the distribution of
health resources in the rural and
urban health facilities
Weak coordination of SHR services
No FP services in ART centres
Inadequate data on abortion.
Inadequate skills in demand creation
for SRH services
13
Key Steps in the Development of the SRH Policy:
A situation analysis conducted to inform the Policy development,
Desk review of relevant national strategy documents
Gap Analysis to inform areas of intervention focus
Review of the draft with national relevant stakeholders

in schools in the Education Policy
( 2010)
Existence of a Gender policy
( 2010) which calls for redressing
support for gender based violence
for survivors
SRH service delivery guidelines in
place (Family planning, PMTCT,
cervical cancer and obstetric
guidelines)
94% women accessed ANC
services and 74.1% delivered in
health facility (CSO 2007)
Limited decentralization of SRH
services to community level e.g.
outreach services
Inadequate youth friendly services
Integration of SRH information and
services into wellness programmes
Discrepancy in provision, distribution
and utilization of SRH equipment
Inadequate data on access to
comprehensive SRH services
1.3 Rationale
An overarching Policy on SRH will ensure proper coordination, integration and
harmonious delivery of comprehensive SRH information and services in order to
improve the health and well-being of the population as well as contribute to its socio-
economic development as set out in the Poverty Reduction Strategy and Action Plan
and other national documents.
2.0 VISION, MISSION, GOAL AND OBJECTIVES
This policy is developed as an integral part of the Government’s efforts to address the
social and economic development of its peoples by improving their sexual and
reproductive health and well-being and upholding their rights.
2.1 Vision:
A healthy and well-informed population with universal access to quality SRH services,
that are sustainable and which are provided through an efficient, effective and rights
based support system.
14

2.2 Mission:
To provide, facilitate and support an integrated and well-coordinated sexual and
reproductive health services and information upholding the rights of women, men,
youth, adolescents and children in Swaziland.
2.3 Goal:
To guide establishment of an evidence-based framework for the implementation of a
well-coordinated and integrated sexual and reproductive health and rights programmes
in order to attain the highest level of health and well-being for all people of Swaziland.
2.4 Objectives:
i) To inform and guide actions of policy makers and programmers
ii) To inform and guide the development of an integrated SRH strategic framework
iii) To facilitate mobilization and appropriate allocation of resources
iv) To guide the integration of SRH services with other services.all health service
delivery areas
v) To guide appropriate monitoring and evaluation of SRH programme
3.0 Guiding principles and values:
The following are the guiding principles and values for the operationalization of this
policy and implementation of all components of the SRH programme in Swaziland.
3.1 Human rights
The policy recognizes that every citizen is entitled to fundamental human rights and
freedoms, including the right to health which incorporates the right to sexual and
reproductive health, irrespective of sex, gender, culture, religion, age, race, disability,
HIV and economic status.
3.2 Client centredness
15

Service provision will be considerate of the client’s personal circumstances,
preferences, values, family situations and lifestyles.
3.3 Universal Access Coverage to Comprehensive SRH services
The SRH policy seeks to ensure that all people have access to the needed services of
sufficient quality while ensuring that the use of services does not expose the users to
financial hardships. recognizes universal access to comprehensive SRH services as
vital. There will be provision of relevant education and information to in and out of
school adolescents and youth, men and women for them to make appropriate decisions
regarding SRH issues.
3.4 Quality of Care
Provision of the highest possible quality and evidence-based SRH services to all
individuals in all health service delivery levels, including HIV/AIDS in a manner that is
sensitive to the country’s population dynamics will be done.
3.5 Integration
Service provision will be integrated to enable SRH services to be provided with HIV
services.
3.6 Community involvement and participation
Communities will be involved all levels of programme planning, design, implementation,
monitoring and evaluation.
3.7 Alignment to national and international guiding documents
The policy recognizes and is aligned to national and international documents as
indicated in the table below:
National documents International documents
1National Health Policy, 2007 ICPD PoA
2National Health Sector Strategic Plan, 2009 FWCW
3The Integrated SRH Strategic Plan (2008-2015) MDGs
16

4National Youth Policy, 2009 The AU Continental Policy
Framework on SRH&R
5The Education Policy Maputo Plan of Action
6The Gender Policy, 2010 SADC protocols
7National Population Policy
8Decentralization Policy
4. POLICY FRAMEWORK
This section outlines policy statements on the SRH elements that the Government of
Swaziland shall implement with partners. These elements include maternal, neonatal
and child health; Adolescent and Youth Sexual Reproductive Health and Human Rights;
family planning; abortion and post abortion care; STIs, HIV and AIDS; infertility; cancers
of the reproductive system; Gender and Sexual and Reproductive Health including GBV
sexual dysfunction; SRH and ageing; Community involvement and participation in SRH.
17

4.1 MATERNAL, NEONATAL AND CHILD HEALTH
Quality health care is essential in the reduction of maternal, neonatal and child morbidity
and mortality. Despite the high antenatal care attendance and facility deliveries;
maternal, neonatal and child morbidity and mortality have remained high with most
deaths attributed to HIV. The country has a limited number of health facilities that
provide maternity services (labour and delivery services) and most of them do not meet
the full complement for EmONC and access to referral facilities is limited by inadequate
pre-hospital services and unclearly defined referral structures.
Policy Statements
i. Quality maternal, neonatal and child health services shall be provided by
competent and skilled service providers during antenatal, labour and
delivery and postnatal period in adequately equipped health facilities
providing maternal, neonatal and child health services.
ii. All individuals, families and communities shall have access to evidence
based, comprehensive sexuality education, information and services on
maternal, neonatal and child health.
POLICY IMPLICATIONS
The Ministry of Health shall:
•Provide human resources, infrastructure, equipment and supplies for the
provision of MNCH services
The SRH Program shall:
•Provide technical guidance tools (standards and protocols) for the provision of
MNCH services
18

•Build capacity of health facilities and health care providers to provide a full
complement for EmONC and community based interventions.
Health service providers shall:
•Provide quality MNCH services according to national guidelines.
4.2 Adolescent and Youth Sexual Reproductive Health and Rights
Adolescents and youth in Swaziland do not have adequate information and accessibility
to services which will enable them to make informed decisions on their sexuality and
reproductive Health. However the observed decline in HIV prevalence among the
adolescents over the past years provides an opportunity for strengthening ASRH
services.
POLICY STATEMENT
Comprehensive sexuality education, information and integrated SRH services shall be
provided to all children, adolescents and young people at all levels of health care
delivery system and other relevant settings according to their age and need.
POLICY IMPLICATIONS
The Ministry of Health shall:
•Provide an enabling environment and resources for the provision of ASRH
services.
•Collaborate with other government ministries to advocate for the provision of
sexuality education, ASRH information and services.
•Provide resources for the implementation of ASRH programmes.
The SRH Programme shall:
19

•Provide technical guidance and tools on ASRH issues at all levels of service
provision
The Health service providers shall:
•Provide comprehensive sexuality education, ASRH information and services at
all levels.
20

4.3 Family Planning
Access to comprehensive FP information and services remains one of the SRH
challenges in Swaziland. The contraceptive prevalence is 65% (MICS, 2010) and the
unmet need for family planning is 13% among currently married women (MICS 2010)
while it is 65.8% among pregnant women living with HIV.(12th Serosurveillance, 2010).
The MOH is implementing interventions aimed at scaling up access and integration FP
in all service delivery areas especially in ART centres.
POLICY STATEMENT
Family planning information and services shall be provided at all levels of care to every
individual or couple according to their needs.
Policy Implications
The Ministry of Health shall:
•Create an enabling environment to ensure availability and accessibility of family
planning information and services to all persons regardless of sex, gender, age,
status, sexual orientation and religion according to their needs.
•Secure resources for the provision of comprehensive FP services
The SRH programme shall:
•Provide technical guidance and provide tools (standards, guidelines and
protocols) to facilitate provision of FP services at all levels.
•Facilitate integration of HIV/AIDS services into FP services and vice versa.
21

•Build capacity of health facilities and health care providers to integrate FP and
HIV services.
The health service providers shall:
•Provide comprehensive FP information and services to all persons according to
their needs.
4.4 Abortion and post abortion care
Abortion is only permitted in the country based only on medical or therapeutic grounds
including where the pregnancy resulted from rape, incest or unlawful sexual intercourse
with a mentally challenged female and on such other grounds as per Constitution of
Swaziland (2005). Poor management of abortion can lead to complications, maternal
morbidity and mortality.
Policy Statement:
Comprehensive information and quality health services shall be provided to women and
men of reproductive age group to reduce incidence, manage abortions, and prevent
complications of abortion
Policy Implications:
The Ministry of Health shall:
•Strengthen timely access to safe medical abortion services and post abortion
services within the ambits of the laws of the country
•Avail necessary skills, supplies and commodities required for pre and post-
abortion care services
The Sexual and Reproductive Health Programme shall:
22

•Provide technical guidance to health service providers on the prevention,
management of abortion and post abortion care
•Provide post abortion care services and supplies at all levels
Health service providers shall:
Provide non-judgmental abortion and post abortion care, services, information and
counselling to all clients.
4.5 STIs, HIV and AIDS
STIs, HIV and AIDS account for significant proportions of morbidity and mortality in
Swaziland. Prevention of both diseases is an imperative priority for the country with
emphasis on integrated service delivery for prevention, treatment, care and support
including impact mitigation. The country has developed an HIV and AIDS policy as well
as the HIV and AIDS National Strategic Framework which guides interventions.
Policy Statement:
Comprehensive information, services and support shall be provided to all individuals for
prevention and integrated management of STIs and HIV.
Policy implications:
The Ministry of Health shall:
•Secure resources including competent and skilled human resources required for
management of STIs, HIV and AIDS
•Improve monitoring and evaluation systems for STIs, HIV and AIDS
interventions
The Sexual and Reproductive Health Programme shall:
•Collaborate with the National AIDS Programme and other partners to provide
technical guidance to health care providers at all levels on STIs, HIV and AIDS
management
23

•Increase accessibility and availability of commodities and supplies for prevention
and management of STIs, HIV and AIDS at all levels of service provision
The Health service providers shall:
•Provide comprehensive information and management of STIs, HIV and AIDS
•Engage communities on STIs, HIV and AIDS prevention and treatment activities
4.6 Infertility
Infertility can cause significant distress to the individual, partner, spouse and family. Any
individual or couple with infertility has a right to information and services. Efforts should
be directed to counseling, prevention and early treatment of conditions that may lead to
infertility.
Policy Statement:
Information and services to prevent and manage infertility shall be provided to all
women and men of reproductive age group
Policy implications:
The Ministry of Health shall:
•Secure resources including competent and skilled human resources required for
infertility management
The Sexual and Reproductive Health Programme shall:
•Provide technical guidance to health care providers on necessary skills and
competencies to prevent and manage infertility conditions
•Increase access to comprehensive information and services to all individuals and
significant others with infertility conditions
The Health service providers shall:
24

•Provide infertility information and services to all individuals
4.7 Cancers of the reproductive system
Cancers of the reproductive system are among the leading conditions that affect men
and women. Patients requiring oncology services which include cervical cancer lead the
number of patients referred to South Africa (KPMG 2011).
Policy Statement
Prevention, screening, management and follow-up of cancers of the reproductive
system among men and women shall be provided at all service delivery levels to
improve their quality of life.
Policy Implications
The Ministry of Health shall:
•Provide resources for cancer prevention, management and control
•Improve monitoring and evaluation mechanisms for cancers of the reproductive
system
25

The SRH Programme shall:
•Provide technical guidance to health care providers in prevention, treatment and
control of cancers of the reproductive system
•Develop Social and Behavioral Change Communication strategies for cancers of
the reproductive system
The health service providers shall:
•Render services to prevent and manage cancers of the reproductive system
according to national guidelines.
4.8 Gender, Sexual and Reproductive Health including GBV
Gender issues are central to SRH and the National Gender Policy that was developed
in 2010 encompasses SRH. Gender Based Violence is often sexual in nature and leads
to the violation of sexual and reproductive health and rights of girls, women and boys in
the communities.
Policy Implications:
The Ministry of Health shall;
•Provide resources to respond to Gender based violence in SRH services
•Collaborate with other government ministries and partners in addressing issues of
gender based violence
26
POLICY STATEMENT:
SRH information and services shall be provided to community members, survivors of
Gender Based Violence and affected others.

The SRH Programme shall;
•Provide technical guidance on the provision of services to survivors of gender-based
violence for all the levels of care.
•Liaise with other organizations and programmes
Health Service Providers shall:
•Render services at all levels of service provision according to national guidelines
4.9 Sexual Dysfunction
Sexual dysfunction can be caused by physical or psychological /mental problems and
some may be a result of medical or surgical interventions as well as complications of
diseases. Types of sexual dysfunction include erectile dysfunction (ED) which is the
most common form among males while for women lack of desire is the main problem.
Sexual dysfunction disrupts the family as a unit considered the cornerstone of society
and may lead to a number of social and health problems. Sexual dysfunction affects
persons from adolescence upward.
Policy Statement:
i. Comprehensive information and integrated services on healthy lifestyles
shall be made available to all individuals across all levels of health care to
reduce the risk of sexual dysfunction.
ii. Sexual dysfunction will be diagnosed and treated in health facilities using
national guidelines.
Policy Implications:
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The Ministry of Health shall:
•Include sexual dysfunction indicators and targets in the Strategic Information
Framework.
•Commit adequate resources to address sexual dysfunction.
The SRH Programme shall:
•Document the nature and magnitude of sexual dysfunctions.
•Plan and facilitate capacity building for all cadres of health care providers on
prevention and management of sexual dysfunction.
•Provide technical guidance for the provision of services to prevent and manage
sexual dysfunction.
•Develop social and behaviour change communication strategies for the prevention
and treatment of sexual dysfunction.
Health service providers shall:
•Provide education at community, health facility and institutional levels on sexual
dysfunction
•Diagnose and treat sexual dysfunction
4.10 Sexual and Reproductive Health and Ageing
Ageing in both women and men is associated with decline in all body functions including
sexual capacity and a high incidence of NCDs which negatively impact on their sexual
and reproductive health. Individuals experience a number of SRH related problems
such as malignancies and sexual dysfunction which may lead to relationship
disharmony and psychological problems. Women experience menopause, a process
signifying the end of reproductive capacity even though there may be a small risk of
unexpected conception. Men experience andropause resulting in reduced sexual drive
and function even though fertility may persist longer. SRH services must provide
services for the ageing which frequently include fertility issues and sexual dysfunction.
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Policy Statement:
Comprehensive information and integrated services will be made available at all levels
to men and women of ages 50 years and above for the prevention and management of
sexual and reproductive health conditions common during the ageing process
Policy implications:
The Ministry of Health shall:
•Allocate resources to strengthen SRH services for the ageing.
The SRH Programme shall:
•Provide technical guidance for the provision of SRH services for persons 50
years and above.
•Plan and facilitate capacity building on sexual and reproductive health issues of
persons 50 years and above
•Monitor SRH service delivery for persons aged 50years and above.
Health service providers shall:
•Provide comprehensive information and services at community, health facility
and institutions on SRH and ageing.
4.11 Community involvement and participation in SRH
Community awareness, involvement and participation are essential for successful SRH
programming. It facilitates empowerment of community leaders and community health
volunteers on their roles and responsibilities in creating community awareness about
SRH issues and services. A well informed community is more likely to have better SRH
status and service utilisation.
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Policy Statement:
Communities shall be involved and participate in planning, implementation and
evaluation of SRH services and programmes
Policy Implications:
The Ministry of Health shall:
•Provide resources for community involvement and participation in SRH issues.
•Facilitate decentralization of SRH services to communities.
•Collaborate with other government Ministries and partners to mobilise and
sensitize communities on SRH
The SRH Programme shall:
•Collaborate with the CSO to conduct periodic surveys to solicit community views
for incorporation into SRH programming
•Plan and facilitate capacity building on reproductive rights and responsibilities
Health service providers shall:
•Provide health promotion services to communities in SRH
•Provide facility and community outreach services that include SRH rights and
responsibilities
Communities shall:
•Develop and implement mechanisms for participation in health issues including
SRH
•Identify and communicate health needs/ concerns to relevant health structures.
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5.0 INSTITUTIONAL FRAMEWORK FOR THE IMPLEMENTATION OF
THE POLICY
Operationalizing this policy will need the cooperation and support of all stakeholders.
The MoH through the SRHP will coordinate, lead and be responsible for the execution
of the following activities:
1. Implementation and management of SRH Service Delivery including SRHCS.
2. Ensuring skilled, adequate and motivated human resources.
3. Ensuring proper HIMS, M&E, coordination of and guiding operations research on
SRH.
4. Ensuring adequate financing and proportionate allocation of financial resources for
various components of SRH.
5. Ensuring Reproductive Health Commodity Security.
Good health services are those which deliver effective, safe, quality personal and non-
personal health interventions to those that need them, when and where needed, with
appropriate utilisation of available resources. Service delivery at all levels is guided by
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the essential health care package (EHCP). Routine and proper maintenance of physical
health infrastructure is pre-requisite for adherence to standard, provision of quality
SRHC and client satisfaction.
A list of different partners and their roles is annexed.
5.1 Implementation
The policy shall be regulated by the Health services Act as well as the Public Health Act
and/or its revisions. In line with the Health sector Policy and Strategic Plan, this policy
shall be translated into the SRH strategic plan, organizational and departmental work
plans, operational protocols and guidelines.
5.2 Financing
Implementation of this policy shall be funded primarily by Government with contributions
from development partners and private sector. Innovative public, private partnership is
encouraged. The Ministry’s budget shall reflect details of the SRH Strategic plan and
approved action plan. The SRH Strategic Plan shall be costed and be used for resource
mobilization in the public sector and development partners.
5.3Reproductive Health Commodity Security
The Ministry of Health shall ensure availability of resources for reproductive health
commodity security.
5.4 Human resources
The Ministry of Health shall endeavour to provide competent and adequate quantities of
SRH human resources in line with Human Resources for Health requirements.
5.5 Coordination of partners
The Ministry of Health shall co-opt strategic partners, supervise and monitor their
activities to achieve the goals of this policy.
5.6 Monitoring and evaluation of the policy
Monitoring and evaluation of the policy will be done to determine whether its
implementation is on course and the objectives are being achieved. The monitoring and
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evaluation unit of the Ministry will be responsible for the monitoring and evaluation of
this policy. Implementation shall be monitored through establishment of baselines,
indicators and targets as well as the timeframe for the M&E activities to be conducted.
Annual progress review meetings and periodic evaluations as well as preparation and
dissemination of the related reports will be conducted through the M&E Unit in
collaboration with the SRHP.
5.7 Policy Revision
This policy will be reviewed after 5 years of its approval based on the progress
generated through M&E activities. The MoH through the SRHP will be responsible for
initiating and leading the review process in consultation with the relevant stakeholders.
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6.0 CONCLUSION
The development of the SRH Policy is a major step towards ensuring universal access
to quality SRH services for all the people of Swaziland. The SRH Policy calls for the
establishment of an enabling environment through strengthening of the capacity of the
SRHP, increase coverage of SRH services, provide competent health professionals at
all levels of the health system.
The successful development of an SRH strategy based on this Policy will depend
greatly on the leadership of the MoH through the Sexual and reproductive Health
Programme in harnessing the inputs of the relevant stakeholders, creating working
partnerships with the implementing/development partners in ensuring coordination.
Mobilization, allocation and management of resources will be critical for the successful
implementation of this policy.
The understanding, adoption and implementation of this Policy will contribute positively
to the improvement of peoples’ sexual reproductive health and rights.
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7.0 REFERENCES:
1. Central Statistical Office (2007), Swaziland Population and Housing Census,
Mbabane, Swaziland.
2. Central Statistical Office and Macro International (2007), Swaziland Demographic
and Health Survey, Mbabane, Swaziland.
3. World Bank (2006), World Development Indicators, Washington DC.
4. CSO 2010. Multiple indicator cluster survey
5. KPMG 2011. Interim Report: Evaluation of the Civil Servants Medical Referral
Scheme and Phalala Fund.
6. MoEPD (1997), Swaziland National Development Strategy, a Twenty-five Year
Vision.
7. MoEPD (2006), Poverty Reduction Strategy and Action Plan (PRSAP), Mbabane,
Swaziland.
8. MoEPD (2006), The National Decentralisation Policy, Mbabane, Swaziland.
9. Ministry of Health (2007), National Health Policy, Mbabane, Swaziland.
10. MoH (2011), Management Guidelines for common Obstetric and Gynaecologic
Conditions
11. MoH (2011), Swaziland Primary Health Care, Mbabane, Swaziland.
12. MoHSW(2009), National Health Sector Strategic Plan 2008-2013, Mbabane,
Swaziland.
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13. MoH (2009), Campaign for the Reduction of Maternal Mortality in Swaziland,
Mbabane, Swaziland.
14. MoHSW (2002), SRH Strategic Plan of Action 2002 – 2006, Mbabane,
Swaziland.
15. MoHSW (2008), Integrated SRH Strategic Plan of Action 2008 – 2015, Mbabane,
Swaziland.
16. MoH (2010), Pharmaceutical Policy, Mbabane, Swaziland.
17. NERCHA (2009), The National Multi – Sectoral Strategic Framework for HIV and
AIDS 2009 – 2014, Mbabane, Swaziland.
18. MoH (2010), Guidelines For Prevention of Mother to Child HIV Transmission, 3 rd
ed.
19. MOH (2011), The SRH Situational Analysis.
20. Ministry of Education and Training Swaziland (2011). Secondary/High School
Guidance and Counseling Syllabus Form One to Form Five 2012-2017,
Mbabane, Swaziland.
21. Deputy Prime Minister’s Office (2011), National Gender Policy, Mbabane,
Swaziland.
22. MoEPD (2002) Smart Programme for Empowerment for Economic Development.
Mbabane Swaziland.
23. MoSCYA (2009), National Youth Action Plan 2009-2013, Mbabane, Swaziland.
24. MoSCYA (2009), Swaziland National Youth Policy
25. UN (1994), the ICPD Programme of Action, United Nations, New York, USA.
26. UN Millennium Development Goals. At http://www.un.org/miilenniumgooals/.
27. African Union (2001), The Abuja Declaration on HIV/AIDS; Malaria, TB and other
Infectious Conditions, Addis Ababa.
28. African Union (2006), Universal Access to Comprehensive Sexual and
Reproductive Health Services in Africa, The Continental Policy Framework for
Sexual and Reproductive Health and Rights 2007-2010, Addis Ababa.
29. UNAIDS/WHO (2007), AIDS Epidemic Update, Geneva.
30. UNGASS (2011), Declaration of Commitment on HIV/AIDS, New York, USA.
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31. SADC (2008), Gender Protection Protocol, Gaborone, Botswana.
32. MoH/WHO (2010), Service Availability Mapping, Geneva.
33. MoH/UNFPA (2011), Situational Analysis of the SRH&R, Mbabane, Swaziland.
34. Kingdom of Swaziland (2005), Constitution of Swaziland, Mbabane, Swaziland.
35. UN (1967),The Convention on the Elimination of all Forms of Discrimination
against Women, New York, USA.
36. WHO (2002), Community Participation in Local Health and sustainable
development. Approaches and techniques.
Annex 1: List of National and International Partners
Planning and service provision in SRH is led by the MOH and implemented in
collaboration with international and bilateral partners and civil society most of whom are
listed below:
Civil Society Organizations
Family Life Association Swaziland
Elisabeth Glaser Pediatric AIDS Foundation
Mothers to Mothers
Swaziland National Youth Council
AIDS Health Care Foundation
Clinton Health Access Initiative
Baylor Clinic
Population Services International
Khulisa Umntfwana
Swaziland Action Group Against Abuse
Swaziland Breast and Cervical Cancer
Swaziland Infant Nutrition Action Network
Alliance of Mayors Initiative for community actions on AIDS at the local level
Lusweti
Baphalali Red Cross
Swaziland National Network of People Living with HIV
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Save the children
UNISWA
NERCHA
Training Institutions
Development partners
European Union
President Emergency Plan for AIDS Relief
United Nations Agencies
World Bank
Ministry of Health
Swaziland National Nutrition council
Swaziland National AIDS programme
Expanded programme on immunization
School Health Programme
Strategic Information Department
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Annex 2: Consultants and core-team for the development of the policy
The consultants who facilitated compilation of this policy are:
1. Professor Valentino M. Lemoa
2. Dr Lewis Ndhlovu
3. Ms Happiness Mkhatshwa
The core team which worked with the consultants were as follows:
Name and Surname Organization
Ms Phumzile Mabuza SRH Programme Manager
Ms Bonisile Nhlabatsi SRH Programme
Ms Margaret Thwala-Tembe UNFPA
Ms Thamary Silindza UNFPA
Mr Petros Dlamini UNFPA
Ms Marjorie Mavuso UNFPA
Ms Sanelisiwe Tsela UNFPA
Ms Gcinile Buthelezi USG/ CDC Chief of Party
Ms Emma Bicego National Population Unit
Dr Mathe Mbabane Government Hospital
Mr Makhosini Mamba UNICEF
Ms Dudu Dlamini WHO
Professor Nonhlanhla Sukati UNISWA Faculty of Health Sciences
Dr Winnie Nhlengethwa SANU
Ms Dudu Simelane The Family Life Association of Swaziland
Ms Nozipho Motsa SRH Programme
Ms Monica Bango SRH Programme
Ms Thembie Masuku EGPAF
Matron Marilyn Msibi Sithobela Health Centre
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