KEY POPULATIONS INFORMATION HEALTH SYSTEM FOR SWAZILAND

Since 2010, the annual global number of new HIV infections among adults (15 years and older) has remained static, at an estimated 1.9 million. Members of Key Populations (KP), including sex workers, people who inject drugs, transgender people, prisoners and men who have sex with men, and their sexual partners accounted for 45% of all new HIV infections in 2015. In some countries and regions, infection rates among key populations are extremely high—HIV prevalence among sex workers varies between 50% and 70% in several countries in southern Africa.

The Issue

In Swaziland, key populations, according to the e-NSF are defined as Female Sex Workers (FSW), Men having Sex with Men (MSM), adolescent girls and young women (AGYW), transport operators, IDU, inmates, factory workers, and cane cutters. Swaziland has the highest HIV prevalence among sex workers in the world with an estimated 70.4% living with HIV. Estimates further suggest that HIV prevalence among men who have sex with men is 17.7%, and 35% for prisoners. Currently, organisations focusing their efforts towards providing clinical care to key populations are using a paper-based system of capturing their health data. There is no automated key populations system in existence. Some implementing partners and organisations engaging with key populations collect their data manually, using their own forms or register books.

The Intervention

Under the Global Fund grant “HIV Reduction in Swaziland” awarded to the Coordinating Assembly of Non-Governmental Organisation (CANGO), IHM Southern Africa has been engaged to provide technical support in the development of a Key Population Data Collection System.
The scope of work for IHM includes developing a comprehensive monitoring and evaluation system for collecting and reporting Key Population activities implementing by key population stakeholders in the country.

IHM has developed a paper-based data collection tool, by merging all the various paper-based tools used by the different partners into one document. Thereafter, developed an automated electronic system inclusive of all the components of the paper-based tool with some additional functionalities. Twenty-six performance indicators were identified and agreed upon by all implementing partners involved in the project.

The system develops a Unique Identifier for each patient with the aim of improving KP reporting and minimizes the double counting of KPs for improved reporting. Additionally, to collecting key health indicators, the system also has a referral functionality where clinicians are able to refer Key Populations to specific hospitals or specialists.
In order to ensure confidentiality of Key Population data, the systems KP database has been entirely encrypted. This has also been used as a mechanism to ease the concerns of key populations who fear discrimination and stigma posed against them.

System Piloting

The automated electronic system will be piloted with one facility, and the paper-based system with another health facility. Family Life Association of Swaziland (FLAS) will be used for the piloting of the system in their medical facility, and use their mobile facilities for the paper-based system. FLAS was selected to be the pilot site as they work very closely with Key Populations in the country.

Partners Involved

Implementing partners involved in the execution of this project include the Ministry of Health’s HMIS Unit, CANGO, IHM Southern Africa, FLAS, SNAP, FHI 360, HC3, URC, EGPAF, and Rock of Hope. Through this project, the Ministry of Health will be able to identify the number of KPs receiving services in order to improve the reach and services provided. Furthermore, the project will assist the country with accurate baseline information when sourcing for funding in this area.

Acknowledgement:

Lungile Nkambule, CANGO Monitoring and Evaluation Manager
Mustafa Ashek Mahmud, IHM Southern Africa Senior Software Architects
Feziwe Makhubu, IHM Program Associate – M&E

Photography Credit: Population Council

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