Eswatini Project Briefs

Support Eswatini to Achieve and Sustain Epidemic Control (SEASEC)

The principal objective of Georgetown University’s (GU) SEASEC program is to partner with the Ministry of Health (MOH) of the Kingdom of Eswatini (KoE) to build capacity and provide technical assistance throughout the health system to optimize comprehensive HIV and TB prevention and treatment services in two regions, Manzini and Lubombo. Expected outcomes include sustaining the previously achieved UNAIDS 95-95-95 targets across all populations in the supported regions while identifying and addressing any final gaps, decreasing the cervical cancer disease burden, and maintaining high TB case finding and treatment success rates in supported facilities with the goal of TB control. Another major goal is to support national MOH-led multi-sectoral readiness planning for sustainability of the HIV response.

Georgetown University (GU) is supporting the Ministry of Health (MOH) of Eswatini in two administrative regions (Manzini and Lubombo) to provide site level support at 84 MOH health facilities, with complementary activities in the surrounding communities. Activities are implemented in line with the following project objectives: (1) support MOH to deliver effective, efficient, patient centered, and human rights-based quality comprehensive TB and HIV prevention, care and treatment services across the care spectrum and for all populations in Manzini and Lubombo; (2) develop capacity of facility managers to implement national guidelines and programs with fidelity and manage implementation of clinical HIV and TB related services; (3) routinely monitor and review HIV outcomes at supported facilities (including HIV positive yield, linkages, treatment initiation, retention and viral load suppression) and support required reporting and data use at the Eswatini National Aids Program (ENAP) and the National TB Control Program (NTCP); and (4) work with MOH to assure sustained HIV epidemic control by the KoE public health system, and support transition of technical and programmatic oversight of HIV and TB related services to MOH.

By harnessing lessons from other Georgetown programs implementing the LISTEN (Local Innovations Scaled Through Enterprise Networks) approach, including in Eswatini, SEASEC is leveraging communities of practice (CP), human-centered design (HCD), and data-driven decision-making to catalyze, capture, and scale locally driven health system innovations. Through a bottom-up approach in service design, implementation, and monitoring, SEASEC is establishing ways for the health service delivery system to be accountable to the consumers of the services and meaningfully integrate patient/community voices in the national HIV/TB response.

Working with the Health Information Management Systems (HMIS) Unit within MoH, SEASEC is supporting the optimal use of the Client Management Information System (CMIS), and Laboratory Management Information System (LMIS) to monitor real time program status for seamless clinical services delivery. In response to COVID-19, SEASEC is also expanding the virtual learning platforms for training/mentoring healthcare workers.

Local Innovation Scaled through Enterprise Networks (LISTEN)

Significant progress has been made in sub-Saharan Africa in recent years to scale up HIV testing and the provision of antiretroviral therapy. However, HIV remains high in vulnerable populations such as adolescent girls and young women (AGYW) and key populations, and the youth bulge in many of the countries threatens gains made. This is further compounded by persistent challenges in reaching the most marginalized populations with both prevention and treatment services.

Controlling the spread of HIV requires appropriate demand for and effective delivery of a package of services that meet the needs of vulnerable populations and reflects an understanding of the many micro-epidemics that exist, the drivers of each of those epidemics, and the respective interventions most likely to have the greatest impact. Communities are an important resource that can help to ensure that services are relevant to, and reach, the people who need them most.

The Local Innovations Scaled through Enterprise Networks (LISTEN) process under which the Center for Global Health Practice and Impact provides technical assistance integrates the community into the design and testing of solutions to reach at-risk populations that are currently not being reached with conventional strategies. It also facilitates expanding engagement at the community level, and supporting linkages to the formal health system and to decision-makers throughout the system up to sub-national and national political leaders.

The LISTEN process employs human-centered design (HCD) methods that involve members of high-risk, low-service engagement target populations, and the people and places in their lives. This is done to identify alternative ways to successfully engage these populations with HIV prevention services.

The primary pillars of LISTEN are:

Communities of practice that are linked horizontally and vertically
Data and metrics of the impact that are relevant to each community of practice
Human-centered design that acts as the glue for the process

LISTEN conceptualizes a community of practice (CP) as a group of people organized around a key purpose (e.g., health, economic empowerment, public safety, etc.) and a delivery point (any interface between the supply and demand of those services). In the LISTEN process, trained facilitators work with identified groups and organizations to adopt and employ a CP process for continuous improvement. LISTEN strengthens and empowers already established and new CP to use HCD and data for greater impact in addressing their priorities, and HIV prevention.

The project objectives are to:

Establish LISTEN as a platform for sustainable community engagement
Apply LISTEN to systematize local reach and innovation for HIV prevention
Use LISTEN as a platform to introduce new technologies for HIV prevention

With funding from the Bill and Melinda Gates Foundation, LISTEN is currently being implemented in Kenya in partnership with the National Aids Control Council (NACC) and in Eswatini in partnership with the Eswatini Ministry of Health.

With funding from PEPFAR/CDC, the LISTEN process is also being applied in HIV care and treatment programs in Eswatini, Haiti and Cameroon.

Accelerating COVID-19 Vaccination Coverage in Eswatini

With funding from UNICEF, CGHPI will collaborate with the Eswatini Ministry of Health (MoH) to increase vaccination coverage in the regions of Lubombo and Manzini. It will provide technical assistance to support vaccine service delivery, health care worker training, and development of IEC materials. The project will be conducted in collaboration with the MoH Health Promotion Unit and stakeholders to address lack of information and misinformation about COVID, including regarding the benefits of vaccination, through targeted campaigns.

The overall objective of the project is to rapidly scale up COVID-19 vaccination in underperforming Tinkhundla, guided by data, to reach herd immunity, minimize deaths and severe disease, curtail the health system impact, fully resume socio-economic activity, and reduce the risk of new variants. The implementation of this project will be closely aligned with MoH’s vaccination campaigns and in coordination with its Control Room and other stakeholders.