Circumstance, rather than planning, has placed the battle against HIV/AIDS firmly in the hands of Swaziland's 355 chiefdoms.

The decentralisation strategy has evolved from government's failure to command the fight against the disease, or even deliver healthcare at its urban hospitals, and much less so in rural areas, where four out of five Swazis live.

According to UN estimates, 33.4 percent of Swaziland's roughly one million people between the ages of 15 and 49 are HIV positive - the world's highest prevalence rate.

Swaziland, ruled by sub-Saharan Africa's last absolute monarch, King Mswati III, has a well-established traditional hierarchy, and the use of it to coordinate efforts against HIV/AIDS is being seen as a grassroots-driven solution.

"From now on, action against AIDS will be determined by the chiefdoms, and will not be imposed on the people by distant bureaucracies. Who better to know what assistance is required than the people in mud huts who are tending relatives with AIDS?" said Mbali Mbingo, a nurse at a clinic in the Sigombeni area, about 30km north of Swaziland's commercial centre, Manzini.

Treatment protocols for HIV/AIDS patients have changed dramatically in the past year: previously, issues such as food aid and home-based care were handled by a profusion of competing non-governmental organisations (NGOs); now, health matters are coordinated by the chief's kraal. The kraal is the chief's compound, which often houses his extended family and is also the local seat of customary authority and administration.

"The people tell the NGOs what they need; before, the NGOs would tell the people what to do. Some of the NGOs were fighting over patients, now there is harmony," Mbingo told IRIN.

The kraal system

The hundreds of chief's kraals play a central role in the lives of Swazis: this is where the community has weekly meetings; the councils of elders and local traditional leaders adjudicate disputes amongst neighbours; and births, deaths and marriages are recorded.

International donor agencies such as the UN Children's Fund (UNICEF) used the kraal network to solicit support for the establishment of Neighbourhood Care Points for orphans and vulnerable children; during the onset of this year's food crisis the World Food Programme and Food and Agriculture Organisation briefed Swazis about their crop assessment survey at the chiefs' kraals.

The devolution of public health has brought new structures, built beside the kraal and known as KaGogo, the SiSwati for "at Granny's place", where HIV/AIDS information is disseminated.

"Every homestead has a hut where granny resides, and it is to this place that family members go for advice. The cool, sympathetic head of the respected elder resides there, and her advice and compassion are even-handed. When we decided to call the AIDS centres at the chief's kraal KaGogo, all Swazis immediately understood what the place was for," Sibusiso Dlamini, programme director for the National Emergency Council on HIV/AIDS (NERCHA), told IRIN.

Over the years, Swaziland has drawn a host of well-meaning health and social welfare NGOs, as well as philanthropic individuals but, according to some critics, the uncoordinated nature of this support, and disjointed government HIV/AIDS policies, has exacerbated and even contributed to the spread of HIV/AIDS.

"People would hear different messages from different groups," Pholile Dlamini, an HIV/AIDS counsellor in Manzini, told IRIN.

NERCHA, which distributes money received from the Global Fund to fight AIDS, Tuberculosis and Malaria, the government and the private sector to healthcare groups, has sought to draw the different strands together to provide a coherent response to HIV/AIDS.

NGOs sowed confusion

"We found that some households would receive food aid from different NGOs. People would be taking ARVs they sourced from one health organisation, and then they would be visited by another health group who told them their medication was no good, and put them on a different regimen," Dlamini said.

"Out of the one-room KaGogo huts now come coordinated community responses that are ending such confusion. What NERCHA does on a national level, KaGogo is doing on a local level."

The KaGogo are simple structures of brick or mud, with a roof of straw or galvanised iron sheets, and the Global Fund has equipped each of them with two desks, 50 chairs and a filing cabinet. This is the base of the local HIV/AIDS coordinator, or KaGogo secretary, who also leads an HIV/AIDS committee chosen from among the community.

NERCHA trains the secretaries to collect data, and identify orphans and vulnerable children, as well as people who require ARV medication or have other health needs.

"In the past, government and NGOs would tell people what they needed. Now the KaGogo centre tells these organisations what the community requires. It may be ARVs, testing facilities, home-based care, a computer," said Dlamini.

The KaGogo have also given communities an access point. In the past, NGOs that meant well but were ignorant of local customs often stirred resentment in a community, who felt they were being patronised and cajoled by foreign "experts".

"Now, any group from the outside must first go to the chief's kraal. They introduce themselves at the KaGogo and, if their services are needed, they will be invited into the community," Dlamini said.

Although communities differ, each knows its own requirements: a better-educated community may request AIDS information in brochures, while an area with a high level of illiteracy may request that condoms be available at certain points, with illustrations showing how to use them correctly.

"Our national AIDS response is in three parts: prevention, care and education. We've revolutionised the way of achieving these goals by reversing the usual top-down government approach. Now the people's voices give us direction, and we provide what is needed," Dlamini said.

Blessed Ginindza, 65, who has 15 grandchildren, learned of the KaGogo centre during a community meeting at her chief's kraal in Sigombeni. When asked her opinion, she said, "Africans are village people; it is smart of the educated ones to recognise this."