UN Integrated Regional Information System - November 14, 2008

"If you don't do what I have just said about improving hospitals, you must just hit the road and head home," Dlamini instructed Minister of Health and Social Welfare Benedict Xaba.

Like the Prime Minister and the rest of cabinet, Xaba was appointed to his job in November by King Mswati III, after the general election on 19 September.

Along with a food crisis and high unemployment, the deteriorating health in a country with less than one million people poses the greatest threat to the long-term development of this landlocked, resource-poor nation.

At Raleigh Fitkin Memorial (RFM) Hospital in the central town of Manzini, the country's industrial hub, where the premier and health minister paid a visit this week, sophisticated diagnostic machines lie idle, lacking spare parts or simply a competent technician to run them.

Problem to be poor

"Patients lie on floors; people with contagious disease are crowded in with others patients. The queues are endless. One of our greatest fears working here is catching HIV," one of the nursing staff told IRIN.

"From time to time there are shortages of basics, like rubber gloves, but you can't stop assisting people; you can't shun a bleeding person because he or she may be HIV-positive." UNAIDS estimates that over a quarter of the sexually active adult population is HIV positive.

The hospital, built in 1930 with American money, was the first to offer medical assistance to Swazis, when the country was still under British colonial rule.

Twenty years ago it was a no-frills, well-maintained facility, but modest renovations have not kept pace with a doubling of the urban population, whose newcomers tend to dwell in poor informal settlements ringing the town.

"The poor cannot afford doctors, so the RFM emergency room is their primary healthcare [clinic]," said Joseph Mamba, a social welfare worker in Manzini.

Hearing from hospital staff, administrators and patients about these Dickensian conditions, a visibly angry Dlamini ordered improvements to start by the end of 2008.

Health officials hope the premier's passion is not short-lived, and that the health ministry can be reformed. In the recent past it was led by members of the royal family, who have been pilloried in the press for being reportedly unqualified and incompetent.

The perennial problems of low morale and the brain-drain of qualified staff to other countries are not likely to be rectified until the government reprioritises its spending and increases the budget allocation to the health sector.

Life expectancy in Swaziland is just 33 years, according to the UN Development Programme. A decade ago a population of 1.2 million was projected for 2008; now there are fewer than one million, and only 9 percent of men and 12 percent of women can expect to see their 65th year.

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