Implementation of regional and international HIV prevention - SAfAIDS

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7.2 Procurement processesProcurement is a very pivotal aspect of the operationalisation of any plan or programme. In thissub-section we assess whether the HIV and AIDS co-ordinating bodies and Ministries of Healthin the two countries have published any binding procedures setting out transparent andequitable rules for procurement of goods and services from private suppliers and also assesswhether in practice there are mechanisms in place to ensure that these rules are enforced.In Swaziland NERCHA oversees procurement of ARVs, making use of funds from theGovernment and the Global Fund to Fight Aids, Tuberculosis and Malaria. To reduce thepossibility of abuse and misuse or misallocation of resources, NERCHA will not pay or transfermoney to banking accounts of implementing agencies, but it pays directly to suppliers inaccordance with approved projects. As the national co-ordinator for all activities related to HIVand AIDS, NERCHA is also responsible for sourcing funding and disbursing it to affected andinfected people.In Zambia procurement is an important function of both the MoH and NAC. Being publicservice institutions, they are both bound and guided by the Zambia National Tender BoardAct (Cap 394. MoH procurement is further guided by the Ministry of Health ProcurementManagement System (MoH, 2006-2010 Strategic Plan). The purpose of the procurementmanagement system is to provide a well co-ordinated, efficient, cost-effective, transparent andaccountable procurement service to all levels of health care delivery. With the establishmentof the Central Board of Health (CBoH) the central procurement functions of MoH were splitinto two. MoH is responsible for the development of policies and guidelines in line with theZNTB Act while CBoH was subcontracted by the MoH to deal with the procurement of publichealth goods and services financed by both the government or a donor. In order to furtherenhance transparency, efficiency and effectiveness MoH developed procurement plans in2004, in consultation with co-operating partners, leading to a draft procurement plan. NAChas its own procurement guidelines which are in keeping with the provisions of the ZNTB Act.Like the MoH, NAC has procurement systems and guidelines which guide all procurements.These guidelines are provided for in the NASF. However, there seem to be apparent challengesrelated to misappropriation of funds within the MoH due to loopholes in the system and aweak legal framework that has structural inadequacies.42
8.0 HUMAN RESOURCE MANAGEMENTHuman resource management is key to the success of HIV and AIDS response. In this section,we review recruitment, retention and promotion and conditions of work in the health sector inSwaziland and Zambia.8.1 Recruitment, retention and promotion of health personnelThe health sector in both countries faces a severe human resources shortage at all levels ofthe health system, which is significantly undermining the capacity to provide even the basichealth care services to the people. This is even acknowledged in the HIV and AIDS policiesand strategic frameworks of both countries. The already inadequate health systems have alsosuffered further deteriorations due to high staff attrition rates attributed to the migration ofhealth professions and HIV/AIDS-related deaths. In Swaziland, the doctor to patient ratio is 1 per100,000 and the nurse to patient is 56 per 100,000 6 . The situation is slightly better in Zambiabut still does not meet the required minimum standards. The doctor to patient ratio is 1 per17,589 and the nurse to patient ratio is 53 per 100,000 (MoH HRS Database). The WHO hasrecommended the Staff/Population ratios for Africa of 1:5,000 and 1:700 for doctors and nursesrespectively. Based on the figures above, it is apparent that the doctors and nurses in bothcountries are significantly overworked. Generally, the current health sector human resourcecapacity in the two countries does not exceed 50% of the recommended establishment.Furthermore, the distribution of health care staff is skewed across provinces and districts in thetwo countries. In Swaziland over 50% of the health workforce is deployed in hospitals mainlylocated in urban areas where only 20% of the population lives, leaving the majority of 80%under-served (MoHSW, 2006).In both countries inadequacy of human resources emanates partly from the countries’ limitedability to develop and supply adequate human resources for the health sector. In Swaziland,there are three local training institutions for health professionals: the Faculty of Health Sciencesat the University of Swaziland, which trains almost 70% of the professional nursing cadres incommunity and medical and surgical nursing; the Nazarene College of Nursing; and The GoodShepherd Nursing School, which trains 40 Nursing Assistants per year. There are no trainingfacilities for medical doctors, rehabilitation therapists, biomedical engineering technicians,laboratory technicians or radiographers. Currently, all these professionals are sent to othercountries for training. Once qualified, they often never return (NHSSP, 2008-2013, 2008).Furthermore, Swaziland has a policy which prohibits the recruitment of foreign nurses. TheFaculty of Health is trying to re-establish training for clinical officers, pharmacy techniciansand dental therapists. The MoH has requested the Ministry of Public Service to lift a ban onthe recruitment of foreign nurses 7 . The nurses would be paid by the Global Fund to FightAIDS, Tuberculosis and Malaria. In Zambia, the rate of producing health workers by traininginstitutions is outpaced by demand for these workers, especially with the ever-increasingburden of disease brought about by HIV and AIDS, resurgent epidemics and inadequatefunding of training institutions.436 MoHSW 2006 Selected Health Services Indicators by Region (2006)7 Swaziland: Nurses Fleeing the HIV/AIDs frontline” (ReutersAlertNet : http://www.alertnet.org)
Page 3 and 4: ACKNOWLEDGEMENTSThis research was c
Page 5 and 6: 6.0 HIV/AIDS STRATEGIC PLANNING, MO
Page 7 and 8: SAfAIDS Southern Africa HIV & AIDS
Page 9 and 10: Generally, survey findings show tha
Page 11 and 12: The national HIV prevention, treatm
Page 13 and 14: RecommendationsSwaziland-specific r
Page 15 and 16: Civil Society Organisationsa) Co-or
Page 17 and 18: 1.0 INTRODUCTION1.1 BackgroundHIV i
Page 19 and 20: 2.0 METHODOLOGYThis assessment prim
Page 21 and 22: Table 2 below shows HIV and AIDS es
Page 23 and 24: Having developed its first PMTCT gu
Page 25 and 26: Zambia is one of the Sub-Sahara Afr
Page 27 and 28: During the reporting period it was
Page 29 and 30: In Zambia the HIV and AIDS response
Page 31 and 32: Convention or Declaration Date Swaz
Page 33 and 34: However, serious gaps exist. The tw
Page 35 and 36: Generally, HIV and AIDS data in bot
Page 37 and 38: through focus group discussions inv
Page 39 and 40: co-ordinate the national response a
Page 41 and 42: All these positions are filled. UNA
Page 43: 7.0 FUNDING MECHANISMS FOR HIV AND
Page 47 and 48: 9.0 EXTERNAL OVERSIGHT MECHANISMSTh
Page 49 and 50: Nevertheless, the media in Zambia s
Page 51 and 52: 10.1.2 Specific lessons from Zambia
Page 53 and 54: 11.0 MECHANISMS FOR CO-ORDINATION O
Page 55 and 56: 12.1.1 SwazilandA number of key sta
Page 57 and 58: e) Strengthen M&E systems of key de
Page 59 and 60: REFERENCES1. A Report on the Assess
Page 61: ACTION POINTS FOR FUTURE USE59
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Implementation of regional and international HIV prevention - SAfAIDS

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