Over a decade ago, the Government of Swaziland launched ‘Vision 2022’, outlining its long-term goal to be within the top 10 percent of countries that were considered as having ‘medium’ human development. However, since that time, Swaziland’ has seen a deterioration in a range indicators for human development and quality of life, including poverty eradication, employment creation, social equity, gender parity, social integration and environmental protection. The Human Development Index (HDI)[1], a broad measure of human development in relation to other countries, dropped from an estimated 0.641 in 1995 to 0.547 in 2005, ranking the country at 141 out of 177 countries.[2] This is a reversal of the previous upward trend between 1975 and 1995 (from 0.527 to 0.641).
Specific indicators relating to human development also reflect worrying trends in human development. Mortality rates have risen dramatically, with maternal mortality rate increasing from 229 per 100,000 in 1996 [3] to 589 deaths per 100,000 births in 2006, and under-five mortality rate increasing from 60 deaths per 1,000 in 1992 at 120 deaths per 1,000 live births.[4]. As a result, overall life expectancy at birth has dropped from 60 years in 1997 to 40.9 years in 2005.[5] Malnutrition also remains a major problem, with 21 percent of the population suffering from food insecurity and an estimated 40 percent relying on food aid.[6] High mortality and morbidity rates due to AIDS, coupled with a declining Total Fertility Rate (from 6.4 percent in 1986 to 3.8 percent in 2006/2007), has contributed to a drop in its population growth, from 2.9 percent in 1997 to below 1 percent in 2006.
Undoubtedly, HIV and AIDS is one of the most important factors behind many of these concerning trends, throwing Swaziland off track in meeting many of the MDGs. Available data suggests that the country still has the highest HIV prevalence in the world. Women and young people are especially hardest hit, with prevalence reaching almost 50 percent for young women (see Chapter 6). The repercussions are far reaching; leading to worsening dependency rates, increased poverty and destitution, substance abuse and increased demand for government support. According to recent NERCHA reports, the demographic impact of HIV and AIDS translates to an estimated 20 years of life expectancy lost. Without intervention, HIV and AIDS could seriously erode Swaziland’s human capital base.
The country has also experienced a general increase in disease burden due to the rising trend of other communicable and non-communicable diseases. The prevalence of tuberculosis (TB), an opportunistic infection that particularly affects patients with HIV, has increased from 263 per 10,000 in 1990 to 1,262 per 10,000 in 2005, including an increasing number of cases of multi-drug resistance (MDR) and several reported cases of extra-drug resistance (XDR) [7]. As the HIV epidemic ravages the country, the risk of a serious outbreak of TB, particularly MDR and XDR strains, is an urgent concern. Non-communicable diseases are also emerging as a serious threat to public health in the country. Outpatient data from all health facilities indicate that hypertension, diabetes mellitus, cardiovascular diseases and mental health disorders are on the increase.
The rising disease burden has partly contributed to an increase in the number of the disabled population in the country. Census data show that the prevalence of disability has increased from 2.2 percent to 3.3 percent in the last two decades. In the absence of comprehensive legislation or policy framework, people with disabilities are one of the most marginalized, neglected and isolated groups in society, often without any access to basic services such as education. The 2007 census show that only 15 percent of the disabled population have post primary education and and 50 percent have no access to basic education.
Indicators for education do show some positive signs, although numerous challenges remain. While Swaziland enjoyed universal education in 1985, by 2000 there were clear signs of the education system weakening under the strain of growing HIV/AIDS, poverty and food insecurity. The government has embarked on a number of initiatives to improve education services in light of these growing challenges, which are showing positive progress in implementatin. The introduction of an education grant for orphaned and vulnerable children (OVC) has contributed to a marked increase in school enrolment in recent years, up from 72 percent in primary schools in 2000 to an estimated 93 percent in 2007 and from 29 percent in secondary schools in 2000 to 33 percent in 2007. The pupil to teacher ratio has remained at 31-33 from 2003 to 2006 and the progression rate has been quite low, with only about 37 percent of children progressing to grade 5 without repetition.
The combined effects of poverty, food insecurity and HIV and AIDS place a heavy burden on national social welfare and health services, as well as traditional support structures. At the government level, weaknesses in the institutional-s arrangements for service delivery across the administrative apparatus, as well as limited technical skills and human resources, have become increasingly evident in the face of growing demand for services. At the community, while the family and community have traditionally played a vital role in protecting and caring for vulnerable people within their community, these have been seriously eroded as a result of the HIV/AIDS epidemic.
The impact on children has been particularly devastating, with growing numbers of OVC. As deaths due to HIV and AIDS are highest among adults of reproductive age, it is the elderly who often have to take their grandchildren into their care once their own children have passed away. Orphaned children not fortunate enough to have grandparents or extended family to care for them are often left to fend for themselves in child-headed households, increasing their vulnerability to different forms of abuse. While there are many initiatives to provide social services to vulnerable groups such as OVC and the elderly and disabled, the majority of OVC still receive no external support. Only 34 percent of OVC surveyed received school-related assistance, eight percent received social or material support and five percent received medical support.[8] A grant of 500 Emalangeni per quarter is available for people over 60 years of age, but for the many elderly now caring for grandchildren this is insufficient to even provide basic food and shelter for the household.
Population access to safe drinking water and proper sanitation, which is also a major determinant of health and human development, is skewed in favour of the urban areas. According to the 2006/2007 Swaziland Demographic and Health Survey (SDHS), 36 percent of the population do not have access to safe drinking water.. This rises to 43 percent in rural areas. The situation is more pronounced in the Lubombo and Shiselweni regions, where access to safe water is limited and sanitation facilities are poor. In Lubombo, a recent outbreak of cholera is of particular concern, and is associated with the use of unsafe waters. Often, the burden of collecting water fall on the shoulders of women, young girls and children, overburdening these sections of population and limiting their ability to take part in other activities conducive to their development such as schooling.
Inadequate access to these basic rights to education, health, and sanitation can be attributed to immediate causes such as limited capacity of relevant public agencies to deliver to services due to  poor infrastructure or facilities inadequate human resources aggravated by HIV and AIDS related attrition, limited financial resources; poverty,  insufficient supplies of  materials or commodities and  lack of quality assurance or weak oversight. However  there are underlying factors include the  lack or weak implementation of policies; weak planning and management including procurement; inequality in resource allocation, specifically urban bias in resource allocation, . These challenges are faced by all tentities involved in the delivery of basic social services, including Government agencies, NGOs, FBOs, CBOs and other service providers, who are key duty bearers in the provision of basic social services..

Current policies and strategies

In the past several years a number of policies have been put in place to improve human development in the areas of health, education and social welfare, a key achievement that demonstrates Government’s commitment to improving basic social service delivery. The health sector response to the growing disease burden, emerging conditions and other developments, is guided by the revised National Health Policy of 2007, where the Ministry of Health seeks to improve the health and social welfare of the people of Swaziland by providing preventive services that are of high quality, relevant, accessible, affordable, equitable and socially acceptable. The Health Policy has been operationalised through the Health Sector Strategy, the National Health Sector Strategic Plan (2008-2013) and the Integrated SRH Strategy (2008-2014). The National Multi-sectoral HIV and AIDS Policy provides the framework, direction and general principles for developing HIV and AIDS related interventions.  The National Youth Policy cites Prevention of HIV infection among young people as one of its strategies. To focus on implementation of these policies and strategies, the Government’s Programme of Action (2008-2013) provides a roadmap which spells out 23 priorities that include a healthy nation, an educated and skilled nation, a food-secure nation, protection and empowerment of vulnerable and disadvantaged groups, a safe and secure nation, and poverty alleviation..
The Government of Swaziland has also ratified the United Nations Convention on the Rights of the Child in 1995, and has also provided for special protection to children in the Constitution. The National Policy on Children aims at providing policy guidelines to ensure that appropriate interventions are put in place to adequately care for and protect children. With regards to social welfare, the National Social Welfare Policy, which is being finalized, provides a framework for improving the quality of life or human well-being through the provision of appropriate social welfare services that are developmental in nature.
For education, the National Education Policy of 1999 is being reviewed to incorporate the Training aspect in line with the realignment of the ministry, now Ministry of Education and Training. Currently the Government is drafting a policy in the area of ECCD, and has in place  a Curriculum Development Policy Document and an Inclusive Education Policy Document aimed at ensuring inclusive education at all levels. An Education Strategic Plan is also being drafted in line with the recommendations of the report on Education, Training and Skills Development for Shared Growth and Competitiveness, prepared by the Ministry.

Outstanding development challenges

Impact of HIV and AIDS on the Population
The HIV and AIDS epidemic has a profound effect on the demographic make up of the Swazi Society. Largely due to the epidemic population growth for Swaziland has slowed to less than 1 percent per annum. The population pyramid from the 2007 Census in shown in Figure 3. The ‘chimney’ shape of the pyramid reflects the high excess mortality due to HIV and AIDS in the reproductive age population. This has lead to a dramatic increase in the number of vulnerable populations, placing a significant stress on the limited resources at both the government and household levels. The impact of HIV and AIDS on human resources is analyzed in detail in

Education and Training Systems
Research indicate that high school fees and teenage pregnancy are two of the major causes of high dropout and repetition both at the primary and secondary levels. Repetition rates are among the highest in Southern Africa, with 16 percent in primary schools and 10 percent in secondary schools in 2004.[9]Further, 18 percent of school going children are reported to be out of school.[10] Other challenges to education are lack of qualified teachers and inadequate school infrastructure, particularly in rural areas, all of which adversely affects the quality of education and aggravate social disparities. Data show that a significant proportion of schools do not have electricity, safe water, adequate sanitation as well as school furniture. Poverty is also a major deterrent to access to quality education.
In recent years, the Government has scaled up efforts to ensure that all pupils, irrespective of their socio-economic backround, have access to education, particularly. Besides the introduction of the OVC Education Grant,  the provision of free books to all public primary school pupils and the gradual introduction of free stationery,  the planned implementation of the Free Primary Education are some of the interventions that the Government has undertaken to ensure the realisation of the right to education. Nevertheless, the educational system suffers from barriers to access, including the cost of school fees, uniforms, books and transport.

Human Resource Planning for Sustainable Development
As an offshoot of the poor educational system, the country’s human resource is generally poorly prepared for the labour market, particularly for sectors that house the majority of the poor people, such as agriculture. The skills competences are quite limited and their application to productive activities not well structured. Consequently, the country is not making full use of its human resources to address the major developmental challenges It faces. This has resulted in major weaknesses in service delivery across many sectors. The majority of the people have remained in the subsistence sector with little progress being registered to move them into the more productive sectors of the economy. The capacity of institutions to absorb trained and qualified human resources also call for strengthening. The projected decline of the population makes it imperative that long-term human resource planning be undertaken to properly prepare for the future in the changing environment. Human resource planning is particularly important for the country’s   sustainable development in view of the need to address the impacts of HIV and AIDS to preserve and develop

Swaziland’s most important resource which is its population.

Health System
The health delivery system is straining under the pressure of rising illness across the country due to the rising HIV and AIDS pandemic and other communicable diseases. The health workforce is inadequate in terms of both numbers and specialisations, and also struggles with rates of high attrition among its own personnel. Currently, the doctor to population ratio is 1 per 10,000, the nurse ratio is 5.6 per 10,000, and the midwife ratio is 6.4 per 10,000. Moreover, while 85 percent of the population lives within eight kilometres of a health facility, there is an urban bias in the distribution of health personnel and services, thus, rendering the more rural populations inadequately covered. Health infrastructure and equipment also remain insufficient, with 1 health facility per 8,000 people. There are also weak regulatory structures for the health system, a phenomenon that compromises quality assurance and standards. Procurement and supply management system for the health sector suffer from systemic challenges. Other challenges include inadequate management capacity and poor health management information system. These factors have resulted in serious shortfalls in the country’s health service delivery system and have, consequently, affected human welfare and development.

Social Protection Systems
In addition to pressure on the health system, HIV and AIDS have also significantly increased the burden on government social welfare services, as well as on traditional community support systems. At the government level, mechanisms for detecting and  registering those that deserve Government support due to their social and/or economic conditions have been daunting, and comprehensive access has not yet been achieved. Some of the challenges that have been faced include weak planning capacity for the provision of social services and absence of effectively decentralised systems of delivery. At the community level, a number of initiatives have evolved to support those who have become vulnerable in the face of HIV and AIDS, poverty and food insecurity, including the Home Based Care programme, KaGogo Centres, and Neighbourhood Care Points. Most of the initiatives have been sustained by local community members who give their time voluntarily or for minimal remuneration. This strong spirit of volunteerism and community engagement is being weakened as community members are increasingly forced to focus on self-preservation. Extra efforts must be made so that government services can respond to this growing demand, and that communities are supported in caring for people living with HIV and AIDS and all those affected by other vulnerabilities such as orphaned children, the elderly, female headed households.
 

[1] The HDI combines measures of life expectancy, literacy, educational attainment, and GDP per capita for countries worldwide

[2] UNDP, Human Development Report, New York, 2009.

[3] WHO, Swaziland National Health Profile, 1996

[4] Swaziland Central Statistics Office and Macro International Inc, Swaziland DHS 2006-07, Mbabane, Swaziland, 2008

[5] Human Development Report, 2007/2008

[6] Swaziland Vulnerability Assessment, 2006

 

[7] Alan Whiteside & Amy Whalley, Reviewing ‘Emergencies’ for Swaziland, Shift the Paradigm in a New Era, Mbabane, Swaziland, 2007

[8] Swaziland Central Statistics Office and Macro International Inc, Swaziland DHS 2006-07, Mbabane, Swaziland, 2008

[9] World Bank, Swaziland: Achieving Basic Education For All, Challenges and Policy Directions, Volume II, World Bank, Washington, 2006

[10] According to the Final Progress Report on the Achievement of the Millennium Development Goals, released in September 2007 by the Ministry of Economic Planning and Development, about 18 percent of school-going children are excluded from the system.