Swaziland's healthcare system is in critical condition, but the hopeful reaction to government's new National Health Policy is tempered by concern over whether the promised improvements will actually be implemented.

Health officials are emphasising the importance of a finalised National Health Policy, unveiled last week, but other observers have been less enthusiastic: "If Swaziland's policies were to be turned into food, no one would cry hunger in this country," said Senator Mbho Shongwe.

Despite being pleased to have contributed to the policy, health non-governmental organisations (NGOs) and grassroots healthcare workers, like nurses and home-based care providers, are doubtful that their contributions will see a practical result.

"It all comes down to money, doesn't it? Everything in the health policy has a price tag. Is government going to meet its promises and obligations to put more into national health?" wondered Samuel Khumalo, an HIV voluntary testing and counselling officer.

The Times of Swaziland, an independent daily newspaper, lashed out at government in a commentary on Wednesday for immediately being able to produce large sums of money to help people displaced by the recent bush fires, instead of using the money to assist dying patients at the main hospital in Mbabane, the capital.

The National Emergency Council on HIV/AIDS, which distributes money from the UN Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis to HIV/AIDS groups, has been critical of what it considers government under-spending on health services.

Promises

Health minister Njabulo Mabuza said the failure to curb the spread of HIV/AIDS and the deterioration of health services could be blamed on the absence of a National Health Policy.

Prime Minister Themba Dlamini urged the health sector to work in a coordinated manner to implement the new plan's guidelines, and promised that essential materials and personnel would be imported as a matter of urgency.

"All the necessary tools like computers, additional staff and facilities are coming by the end of next month. If we lack any skills, government is prepared to go and buy them," said the premier.

He surprised critics who have complained of a lack of urgency in the face of a national health emergency by setting the end of September as the deadline for delivery.

The new national policy establishes the World Health Organisation's Essential Drugs List as the benchmark for all drug dispensers in the country.

Patient policy is defined in human rights terms: "In the provision of health services, all professionals shall observe and protect the basic rights of clients as provided by the Bill of Rights in the Constitution." However, the document acknowledges limitations in service delivery, and sets 2015 as the target for significantly improved healthcare in Swaziland.

Negative perceptions of the country's health services come from a daily drumbeat of media stories depicting understaffed and disintegrating clinics and hospitals, where patients lie on the floor, terminal patients are discharged into the care of their families without receiving treatment, endless queues of patients await drugs that are in short supply or nonexistent, and demoralised nurses fail to cope with exploding case loads brought on by worsening poverty and an expanding AIDS epidemic.

Samantha Dube, a healthcare worker in the main commercial town, Manzini, was one of hundreds who contributed to the development of the policy. "It is essential, but it is still a lifeless document until we bring it to life," she pointed out.

"What is important is that so many groups contributed. The policy calls for a decentralisation of health services from the command of the Ministry of Health in Mbabane, and that is good, because the central government bureaucracy has proved so incapable."