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5 years Strategic Plan for HIV prevention in Swaziland Problem Solution Essay

Executive Summary

The issue of Human Immunodeficiency Virus (HIV) spread and infections is an international concern with nations across the globe endeavouring to provide a long-term sustainable solution in combating this pandemic. The HIV issue has been a constant problem that has elicited national debates and called for serious interventions to secure the world’s population against HIV-related fatalities.

Within Sub-Saharan Africa, Swaziland is one of the most rigorously HIV-affected nations with approximately one out of three adults infected by HIV. By 2005, the HIV prevalence rates among expectant women were estimated to be 43% and approximately 75-80% of TB patients co-infected with the HIV. Despite interventions showing a significant reduction in prevalence rates, the HIV infection is continually becoming a constant problem in Swaziland.

This paper thus provides a five-year strategic plan for HIV prevention and health promotion to provide long-term sustainable HIV response. The strategic plan entails procedural, steady, and successive approaches towards establishing the prevalence rates and levels of HIV infection coupled with providing a long-term sustainable response plan that also involves strengthening the connection between health care systems and HIV intervention plans.

Strategy Development

For years, HIV/AIDS infections have been part of the global healthcare discussions, as nations across the world endeavour to find potential strategies to avert this impediment to public health. Mermin (2011) notes that with the looming danger imposed by the growing cases of HIV/AIDS infections across the world, HIV forms one of the international calamities as one of the issues that should get considerable attention within the health care sector.

According to World Health Organisation (WHO) (2005), Swaziland is currently one of the most severely HIV-affected nations, with the first case in this country reported in 1987. In Swaziland, by 2005, more than one individual in three grown persons suffered from this infection, with the HIV prevalence rates in expectant women estimated to approximately 43% (WHO 2005).

Therefore, further infection would probably be detrimental to Swaziland’s health care sector. Central to avoiding further spread, this five-year strategic plan for HIV prevention and health promotion will provide a long-term sustainable HIV response.

Health refers to the degree of wellness in human or a state of mental, physical, or social fitness (Whitehead 2001). Health promotion is the process that enables persons to enhance control, management, and/or eradication of an infection by increasing control on the determinants of health (McQueen 2000).

Health promotion is doubtlessly the most fundamental efficient, ethical, sustainable, and effective approach towards attaining good health. Health promotion strategies notably engage families and communities in preventing ailments, optimising care, and holding accountable healthcare providers (Delaney 1994; McQueen 2000).

The majority of the health promotion theories normally develop from the behavioural and societal sciences where the relationship amongst knowledge, behaviour, and social norms becomes a major factor that influences the health care phenomena. Davies and MacDowall (2006) recognise a theory whose model of health promotion hinges upon increasing control on the determinants of health where health education, health protection, and health prevention are significant factors in promoting good health.

Outline of strategy plan

The entire plan entails a comprehensive strategic framework that seeks to provide an effective, efficient, and most appropriate solution to the underlying HIV/AIDS infection pandemic in Swaziland. This five-year HIV prevention and health promotion strategic plan encompasses a broad framework of an analysis that also entails comprehensive responses on various essential determinants of heath from individual, family, and community levels (WHO 2009).

The framework of the strategic plan identifies essential aims and objectives, principles, and values that would guide the achievement of positive outcomes in combating HIV infection and promoting healthcare. Concerning core objectives, the strategic plan employs the SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criterion, which is renowned in personal development, project management, and performance management.

As Mermin (2011) recommends, the framework will also provide a comprehensive list and description of core interventions for each approach as well as activities involved in the interventions. Finally, the strategic plan will propose mechanisms imperative in the monitoring and evaluation approaches.

Aims and Objectives

Contemporarily, the government of Swaziland has expressed extensive commitment towards fighting HIV/AIDS and there is a need to enhance knowledge economy as part of supporting the government (Xaba 2011; Curtis 2000).

The main intent of the strategic five-year HIV prevention and health promotion plan is to provide a comprehensive healthcare intervention approach that will significantly champion efforts in reducing HIV/AIDS infection in Swaziland. The strategy herein will aim at endorsing a long-term and sustainable HIV/AIDS response through a series of interventions that will eventually aid in achieving good health in the country.

As essential health elements of healthcare, the strategic plan will analyse and embark on social determinants of health that propel infection rates and hampers responses (Corsi & Finlay 2011). Since it is a five-year strategic plan aimed at enhancing the community’s response to HIV/AIDS infection, this plan seeks to improve the health and social welfare condition of the Swaziland populace through providing precautionary services that will eventually improve the healthcare system in the country.

The five-year (2013-2018) response to HIV/AIDS prevention and health promotion strategy will have a number of objectives, as stated below, which will include jointly supportive strategic directions towards achieving the stated aim.

Objective 1: By the year ending 2018, the plan will reduce new infections of HIV/AIDS by 50% particularly in youthful generation aged between 15-24 years.

Objective 2: In the five years stipulated timeframe, the intended strategy will help in reducing the annual number of new infections by 35%.

Objective 3: By the end of the year 2018, the strategy will increase the percentage of individuals diagnosed with HIV at early stages of the disease by 35%.

Objective 4: By the end of 2018, cases of mother-to child transmissions will reduce by 80% and approximately 50% of infected pregnant mothers will have received education of prenatal precautions. By 2018, the health care system should reduce sexual transmission of HIV by 60% and reduce by 50% the number of HIV-diagnosed persons who report having unprotected sexual intercourse.

Strategy & Implementation Plan

In a bid to achieve an effective response towards eliminating HIV pandemic and reducing significant infections annually, the national ministry of health should follow the aforementioned four strategic directions that will eventually enable responders to achieve substantive results. The approaches or strategic directions articulated herein will help in achieving the goals and measurable objectives stipulated in the five-year strategic plan.

The first strategy will entail community needs assessment and diagnosis of HIV to ascertain the extent of infection and provide a backdrop to the work plan on how to approach the issue. The second strategy will involve optimising HIV protection, treatment, and care approaches through HIV-specific interventions and approaches.

The third strategic direction will involve developing or leveraging broader health outcomes by integrating effective HIV responses and enhancing support by seeking other potential support initiatives. The fourth strategy will entail building strong and sustainable platforms and systems in an effort to reduce vulnerability, risk factors, and strengthening of health systems.

Strategy 1: Community assessment and HIV diagnosis

Any meaningful attempt towards comprehensive healthcare approach begins with the assessment process and in the case of this HIV prevention and health promotion strategic plan, community assessment will be imperative (Watson 2001). This assessment will enlighten the strategic plan on addressing social determinants of health and most significantly, those associated with HIV vulnerability and risks.

Determinants of health may include general socio-economic, cultural, and environmental conditions, societal and community lifestyles, or individual lifestyle factor (Davies & MacDowall 2006). The assessment process should involve comprehensive research process to assemble data on the extent of HIV infection with the communities and HIV prevalence rates coupled with identifying the underlying social and economic determinants of health and other HIV vulnerability and risk elements.

Summerside and Davis (2001) posit, “Increased prevalence, in itself, is widely understood as a key factor in increased incidence of new HIV infections” (p.2). This knowledge will act as the background to the analysis of the causal and contributing factors surrounding HIV pandemic within communities.

Strategy 2: Optimising HIV protection, treatment, and care approaches

After examining the prevalence rates and determining the social determinants of health that significantly drive the epidemic and hinder the response, the plan will embark on optimising HIV protection, treatment, and care approaches. The core elements involved in this phase of the strategy include integrating and improving the effectiveness, quality, and coverage of HIV-specific intercessions, as well as identifying new interventions prior to emerging evidences (Sidibé 2012).

Optimising HIV protection will entail processes of diagnosis to increase the percentage of persons diagnosed with HIV that determines prevalence rates, identify most-at-risk populations, and provide health care support to victims including regular testing and counselling to avoid stigmatisation among victims (Valdiserri 2002; Schulden et al. 2008).

It will also involve struggling to eliminate HIV infections in newborns, preventing sexual transmissions of HIV, and eliminating new infections in children and youth through diversified HIV testing and counselling approaches. Through treatment and care programs, the response team will engage in diagnosis and treatment of opportunistic infections to help in removing co-morbidities and co-infections among victims of HIV.

Strategy 3: Developing or leveraging broader health outcomes

The third strategic direction will involve developing HIV optimising programs that significantly connect between HIV and other crucial health areas. Over the years, HIV programs have lacked consistent support following inadequacy human and financial capital, and thus strengthening the connection between HIV prevention programs and other healthcare initiatives can provide long-term sustainable solution.

According to WHO (2011), “linking programs and integrating HIV into other health services have the potential to improve the efficiency and effectiveness of both HIV-specific and broader health investments” (p.19). This approach assists significantly in expanding the coverage of improved antenatal care services, helps in reducing infection cases involving mother-to-child transmissions of the disease, as well as enhancing effective HIV programs that reduce co-morbidities and co-infections.

This collaborative approach towards HIV pandemic and other health programs should alleviate program coordination, guarantee consistency across guidelines, and support program targets. From the county levels, practitioners at this stage should strengthen collaborative HIV response activities, address sexual health rights, and link HIV treatment with injection safety programs.

Strategy 4: Building strong and sustainable platforms and systems

Since HIV is a chronic infection and protection lapses emerge, there is a need to ensure a continuous process of HIV prevention through finalising the process by building sustainable systems. The progress made in the initial stages of promoting good health and preventing populations from HIV infection should not be a seasoned process, but a continuous procedural strategy that will commence in successive sessions.

The health care system in Swaziland system has been serving in splintered vision towards handling the HIV pandemic, and thus strengthening the national health systems will significantly help in enhancing victims’ access to healthcare services. According to Edejer et al. (2005), HIV related investments would translate to improvement in financing strategies in healthcare and help in integrating chronic disease management programs within areas suffering from limited resources.

WHO (2011) affirms that building strong and sustainable health system will include intensification of the six building blocks of the health system that include effective service delivery, well-trained sufficient workforce, strong health-information system, access to medical products and technologies, ample health financing, as well as strong governance and leadership.

Implementation process

The strategy would require a substantive approach in executing the plan for maximum performance and achievement of the desired goals and targets. According to WHO (2011), “the effective implementation of the strategy depends on concerted action by all stakeholders in the health sector response to HIV” (p. 31). As part of ensuring that the strategy achieves its targets and objectives, developing an autonomous implementation committee to oversee the processes and execution of the programs would be imperative.

In the beginning of the process, this autonomous implementation commission will engage in ensuring that healthcare practitioners work systematically in collecting, analysing, and integrating data towards monitoring HIV epidemic as stated in the strategic directions (1-4). The implementation agency will ensure that participants strictly follow the procedures of handling the prevention and health promotion strategy as stipulated.

The committee will be responsible for connecting the workforce with other supportive groups as well as ensuring effective communication and collaborative working that will channel the activities in the most desirable manner. Overseeing activities of the workforce in the county levels will require this implementation committee since the workforce training, recruitment, replacement, and task-shifting strategies would require sensitive management approach (McLeroy et al. 2003).

Financing programs is very critical in national HIV responses as funds may cause divisions among participants, hence the implementation committee will responsibly supervise funding of the projects and payment of the workforce.

Patient-monitoring systems will require the implementation agency where the committee will ensure data quality, support patient retention, ensure positive outcomes, and support achievement of quality of patient care. The committee will ensure that the national HIV response observes important elements of gender equity, human rights, and health laws and regulations.

Evaluation Plan

Monitoring and evaluation mechanisms will include comprehensive follow-up of the progress of the strategy implementation from the initial phase to the end of the five-year period. According to Idoko (2010), “monitoring and evaluation (M&E) system serves to provide the data needed to guide the planning, coordination, and implementation of the HIV response; assess the effectiveness of the HIV response; and identify areas for program improvement” (p.60).

Apart from having an autonomous implementation committee, this aspect might not provide the exact results of the strategy achievement, and thus the formation of an appraisal agency to make an overall assessment of the implementation committee will be imperative (Levey 2007).

The appraisal committee as recommended by Evans et al. (2005), will have sovereignty over collecting individual monitoring and evaluation research data regarding the progress of the HIV response strategy and finally combine, analyse, and interpret the results relative to those assembled by the implementation committee. The monitoring and evaluation framework will ensure an assessment of HIV response interventions and report the results to the higher national levels including Swaziland’s Ministry of Health.

Summary of Plan

The strategic plan for HIV prevention and health promotion would seek to promote a long-term sustainable HIV reaction plan in addressing this menace in Swaziland. In achieving effective results towards combating HIV infection, the national ministry of health should follow the aforementioned four strategic directions in the five-year stipulated period.

The first strategic direction will involve undertaking community assessment and HIV diagnosis to ascertain the level of infection and analyse the prevalence rates of HIV, as well as examining social determinants of health influencing HIV spreading and hampering its response. The second strategic direction will involve optimising HIV protection, treatment, and care approaches as well as removing co-morbidities and co-infections among victims of HIV.

The third strategic direction will involve creating a collaborative approach towards HIV that will include a connection between HIV and other crucial health areas to enhance HIV approach within the health care systems. The last strategic direction will involve building strong and sustainable platforms and systems to enhance the six building blocks of the healthcare system.

Reference List

Corsi, D., Finlay, J. & Subramanian, S/ 2011, ‘Global Burden of Double Malnutrition: Has Anyone Seen It’, PLoS ONE, vol. 6 no. 9, pp. 1-13.

Curtis, J. 2000, Health Psychology, Routledge, London.

Davies, M. & MacDowall, W. 2006, Understanding Public Health: Health Promotion Theory, Open University Press, London.

Delaney F. 1994, ‘Nursing and health promotion: conceptual concerns’, Journal of Advanced Nursing, vol. 20 no.5, pp. 828-835.

Edejer, T., Aikins, M., Black, R., Wolfson, L., Hutubessy, R. & Evans, D. 2005, ‘Cost effectiveness analysis of strategies in developing countries for child health’, British Medical Journal, vol. 331 , pp. 1177–91.

Evans, B., Adam, T., Edejer, T., Lim, S., & Cassels, A. 2005, ‘Time to reassess strategies for improving health in developing countries,’ British Medical Journal, vol. 331 no.7525, pp. 1133–1136.

Levey, A. 2007, ‘Chronic kidney disease as a global public health problem: Approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes’, Kidney International, vol. 72 no.3, pp. 247-259.

McLeroy, K., Norton, L., Kegler, M., Burdine, J. & Sumaya, C. 2003, ‘Community-based interventions’, American Journal of Public Health, vol.93 no.4, pp. 529–533.

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Sidibé, M. 2012, UNAIDS report on the global aids epidemic 2012. Web.

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Valdiserri, R. 2002, ‘HIV/AIDS Stigma: An Impediment to Public Health’, American Journal of Public Health, vol. 9 no. 3, pp. 341-342.

Watson, M. 2001, ‘Normative needs assessment: Is this an appropriate way in which to meet the new public health agenda’, International Journal of Health Promotion and Education, vol.40 no.1, pp. 4–8.

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Xaba, B. 2011, Elimination of new HIV infections among children by 2015 and keeping their mothers alive. Web.

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1. IvyPanda. "5 years Strategic Plan for HIV prevention in Swaziland." January 14, 2020. https://ivypanda.com/essays/5-years-strategic-plan-for-hiv-prevention-in-swaziland/.


IvyPanda. "5 years Strategic Plan for HIV prevention in Swaziland." January 14, 2020. https://ivypanda.com/essays/5-years-strategic-plan-for-hiv-prevention-in-swaziland/.


IvyPanda. 2020. "5 years Strategic Plan for HIV prevention in Swaziland." January 14, 2020. https://ivypanda.com/essays/5-years-strategic-plan-for-hiv-prevention-in-swaziland/.


IvyPanda. (2020) '5 years Strategic Plan for HIV prevention in Swaziland'. 14 January.

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