INTRODUCTION Swaziland is affected by a double burden of disease similar to other developing countries in the World; the combination of long established infectious diseases, with a rapidly growing new epidemic of chronic NCDs. Until recently, risk factors such as raised blood pressure, cholesterol, tobacco use, excess alcohol consumption, obesity, and the diseases linked to them were associated with developed countries. It is less well recognized that non-communicable diseases such as hypertension, diabetes, cancers, injuries and their risk factors are important contributors to mortality and morbidity in the country, but all along NCDs have not received the attention they deserve in terms of resource allocation and prioritization. THE PRESENT SITUATION. According to the annual statistics report for the Ministry of Health and Social Welfare 1999, out-patient data from all health facilities indicates that hypertension and heart diseases were responsible for 33,540 and 3,146 cases respectively. Forty-three percent of hypertensive cases were diagnosed in primary health care facilities, whereas 39% of heart diseases were diagnosed in tertiary health care facilities. Risk factors for non- communicable diseases (NCDs) include sedentary lifestyles, unhealthy diet, heavy alcohol consumption and smoking. In the period 1990 to 1995, a total of 503 and 317 cases of cancer were histologically diagnosed among women and men, respectively. Among women, cancer of the cervix accounted for 43.1% followed by cancer of the breast (10.2%). Among men, skin cancer was the most common (22.1%), followed by cancer of genital organs (13.9%) and oral cavity cancer (12.3%). The STEPS survey conducted in 2008 has demonstrated that the Swazi adult population aged 25 – 75 years has a high level of physical inactivity. People are leading a sedentary lifestyle. Overall consumption of fruit and vegetables in the population is extremely low in all age groups 2.8% in the 45 – 54 year old age group. 89% of the population 25-75 years was consuming less than an average of 5 vegetables a day. Overweight and obesity were more prevalent in males and females with females reporting morbid obesity six more times than males. Hypercholesterolaemia was found in 5.2% males and 4.2% females. Moderate elevations of triglycerides were found in 5.2% males and 4.2% females. Modifiable risk factors to more than two NCDs were found to be prevalent in at least 50% of the female population and at 43% in the male adult population. Swaziland ranks as the third highest in obesity in Africa when STEPS surveys were compared across countries in Africa. MILESTONES • Advocacy for political support – NCDs is prioritized in the Ministry. • Policy document drafted – draft 0 • Strategic Plan Developed – Diabetes Mellitus, Cardiovascular Diseases, Chronic Obstructive Pulmonary Diseases, Malignancies, Epilepsy, Prevention of Blindness. • Baseline Data collected using the STEPWISE approach. • School based Screening to test children for obesity, blood pressure, elevetated blood sugars, tobacco consumption and dietary intake – 2400 children tested. • Work Based and Community screening – 5000 people screened. • Decentralization of diabetes mellitus to the Primary Health Care – in process. • Guidelines and protocols on the treatment of diabetes mellitus and cardiovascular diseases conducted. • Walk In screening unit established to enable the at risk population of the general public to test themselves for diabetes mellitus, cardiovascular diseases, obesity and overweight, sight, and healthy lifestyle including intake of alcohol, tobacco, unhealthy diet and physical activity. • NCD Centre of Excellence – a one stop diagnostic, treatment and rehabilitative centre for NCDs – a work in progress. • Awareness has been developed to the general population on NCDs using International Awareness Days through mass media. • Capacity Building to nurses 80. • Support Groups for people living with NCDs have been formed – Cancer Association, Swaziland Breast Cancer Network, Swaziland Epilepsy Organization, Swaziland Diabetes Association. CHALLENGES. INTRODUCTION Swaziland is affected by a double burden of disease similar to other developing countries in the World; the combination of long established infectious diseases, with a rapidly growing new epidemic of chronic NCDs. Until recently, risk factors such as raised blood pressure, cholesterol, tobacco use, excess alcohol consumption, obesity, and the diseases linked to them were associated with developed countries. It is less well recognized that non-communicable diseases such as hypertension, diabetes, cancers, injuries and their risk factors are important contributors to mortality and morbidity in the country, but all along NCDs have not received the attention they deserve in terms of resource allocation and prioritization. THE PRESENT SITUATION. According to the annual statistics report for the Ministry of Health and Social Welfare 1999, out-patient data from all health facilities indicates that hypertension and heart diseases were responsible for 33,540 and 3,146 cases respectively. Forty-three percent of hypertensive cases were diagnosed in primary health care facilities, whereas 39% of heart diseases were diagnosed in tertiary health care facilities. Risk factors for non- communicable diseases (NCDs) include sedentary lifestyles, unhealthy diet, heavy alcohol consumption and smoking. In the period 1990 to 1995, a total of 503 and 317 cases of cancer were histologically diagnosed among women and men, respectively. Among women, cancer of the cervix accounted for 43.1% followed by cancer of the breast (10.2%). Among men, skin cancer was the most common (22.1%), followed by cancer of genital organs (13.9%) and oral cavity cancer (12.3%). The STEPS survey conducted in 2008 has demonstrated that the Swazi adult population aged 25 – 75 years has a high level of physical inactivity. People are leading a sedentary lifestyle. Overall consumption of fruit and vegetables in the population is extremely low in all age groups 2.8% in the 45 – 54 year old age group. 89% of the population 25-75 years was consuming less than an average of 5 vegetables a day. Overweight and obesity were more prevalent in males and females with females reporting morbid obesity six more times than males. Hypercholesterolaemia was found in 5.2% males and 4.2% females. Moderate elevations of triglycerides were found in 5.2% males and 4.2% females. Modifiable risk factors to more than two NCDs were found to be prevalent in at least 50% of the female population and at 43% in the male adult population. Swaziland ranks as the third highest in obesity in Africa when STEPS surveys were compared across countries in Africa. Resources – human, financial, logistics.