Mbabane, Swaziland- When a new principal Secretary joined the Ministry of Health last year, she found her staff demoralized and baffled by the lack of capacity to tackle the highest HIV-prevalence rate in Africa.
She turned to USAID, which stepped in to assist through its Capacity Project, a five-year, $10 million effort. Only in its first year, Principal Secretary S. Dlamini, is pleased with the results.
“There was no team work, people were not held accountable, and there was a general lack of commitment to the job,” she said. “But now I see the morale strengthened, and my staff are taking up the challenge of make a change.”
The project gave the Ministry of Health, a decrepit building commonly referred to as the Ministry of Illness, a facelift. It began training staff on improving service delivery, HIV/AIDS awareness, and management skills.
In March, some 60 senior medical and nursing staff met for a retreat where they identified challenges faced by the ministry, and formed several task groups that are now tackling specific problems, with technical assistance from the Capacity Project.
One group is addressing staff training needs, another aims to improve the supervision system. A group tackling the improvement of care set up an information desk on HIV/AIDS services at the entry of the ministry’s office. It helped set up a wellness clinic for medical staff and their families, and is now working on a new workplace policy for the ministry.
“Swaziland is famous for drafting policies, but they are shelved,” said Stembile Mugore, regional HIV/AIDS program coordinator with the Capacity Project. “But now they have a human resources strategy that has actually moved to the cabinet approval.”
She added: “they also have a revised strategic plan. So people have really been motivated to look at how they can perform differently.”
A task force group is reviewing and changing job descriptions for nurses: some date to the 1970s and do not address duties pertaining to HIV/AIDS, which today makes up the majority of the work.
“Swaziland like any other developing country has a mix of challenges in the health sector,” Mugore said. “There is a definite leadership and management challenge in terms of the skills and capacity to cope with the changing situation – the environment is very influenced by prevalence of HIV and TB, and that calls for certain skills.
“There is also a have limited human resources capacity,” she said. “If people leave, recruitment and retainment are very weak.”
Swaziland graduates junior health professionals from three colleges, which creates an abundance of nurses and lab technicians. But it can take can take nine months to a year to be offered a job, “and nobody is going to wait that long – they are going to get another job, in another field,” Mugore said.
Doctors, pharmacists, and many nurses are trained in South Africa. A high percentage of them stay abroad where they can earn higher salaries.
Addressing HIV/AIDS has to be everybody’s business, all the time,” said Jawara Lumumba, whose company carried out the leadership retreat on behalf of the Capacity Project. “The retreat served to provide stimulation for change.”
