Healing Eswatini: How Citizens, Health Workers, and Policy Reforms Can Restore Faith in the Nation’s Health System
By Karabo Ngoepe
Across Eswatini, stories about illness often begin with a sigh. Long queues, empty pharmacies, and anxious parents have become part of everyday life.
Yet behind the frustration, there’s also resilience, people, health workers, and policymakers determined to fix what’s broken.
According to a new Afrobarometer survey, conducted nationwide in April–May 2025, 72% of emaSwati say the government is performing “fairly badly” or “very badly” in improving basic health services.
That’s a tough verdict. But it’s also a loud signal, people care deeply about their health system, and they want it to work.
Eswatini’s story isn’t all grim. The country has achieved what many nations still dream of, near-universal HIV treatment. About 97% of people living with HIV know their status, and nearly all are on life-saving medication with suppressed viral loads. That success proves what can happen when the health sector is well-coordinated and well-funded.
The challenge now is to bring that same level of commitment to the rest of the system.
Afrobarometer found that 88% of citizens who visited a clinic in the past year encountered medicine or supply shortages, and 79% faced long waiting times.
In rural areas, where clinics are few and far between, just 31% of residents live within walking distance of a facility, compared to 68% in towns.
But for all the frustrations, 68% of emaSwati say they still believe the government should guarantee access to quality health care for all, even if it means paying higher taxes. That belief in the promise of universal health care is a foundation to build on.
“We are worried — but we still believe”
For many families, health care challenges hit hardest when it comes to medicine.
“My baby was referred to the hospital,” shared Nokuthula, a mother from Lubombo. “But the pharmacy had no stock. We had to buy medicine privately, and it was expensive. Still, I can’t give up. I know there are people in government who care.”
Like Nokuthula, 93% of citizens say they worry about being able to afford or access care but worry can also inspire action. It’s prompting a growing national conversation about solutions.
Eswatini currently spends 8.1% of its national budget on health, just over half the 15% target agreed to under the Abuja Declaration. The Ministry of Health has acknowledged that reaching that benchmark is critical for rebuilding the system.
To improve reliability, the government has also announced the creation of the Eswatini Medical Supplies Agency, a new state-owned body set to streamline medicine procurement and end chronic stock-outs that have plagued the Central Medical Stores.
Health experts are calling this a “game-changer,” provided it’s backed by transparency and efficiency.
At the same time, the ministry’s National Health Sector Strategic Plan (2024/25–2027/28) commits to:
Upgrading rural clinics and hospitals.
Recruiting new nurses, doctors, and pharmacists to close the 10,000-personnel gap.
Modernising hospital infrastructure and digital record systems.
Expanding community outreach through mobile health services.
In many communities, health workers are doing what they can with limited resources. At a rural clinic in Shiselweni, a nurse says small, practical changes can make a big difference.
“We’ve started community days where villagers come for checkups and health talks. Sometimes we don’t have all the medicines, but we make sure people understand their conditions and where to get help.”
Non-profit organisations and churches have also stepped in, providing free health screenings, maternal care education, and counselling services in areas where government reach is thin.
These partnerships are proving that improving health care is not just about government funding, it’s also about coordination and community trust.
Health experts and citizens suggest a few key priorities that could start showing real progress within months, not years:
1. Reinvest in people.
Hiring more health-care workers — especially in rural clinics — will reduce burnout and improve service delivery.
2. Strengthen local health committees.
Empowering communities to monitor clinics, report shortages, and support outreach builds accountability.
3. Guarantee essential medicines.
The new medical supplies agency must publish stock levels and delivery schedules to ensure transparency.
4. Expand insurance and safety nets.
With only 6% of emaSwati covered by medical aid, introducing affordable public health insurance could protect families from catastrophic costs.
5. Leverage technology.
Introducing mobile apps for medicine tracking, appointments, and telemedicine could bring services closer to remote areas.
6. Feed and heal.
Integrating nutrition programmes with health services would tackle two issues at once — hunger and disease prevention.
Health reform cannot rest on the government alone. Civil society, private companies, traditional leaders, and ordinary citizens all have roles to play.
An economist says Eswatini can take lessons from its own HIV response.
“That success came from unity, government, donors, and communities, all pulling in one direction. We can do the same for our broader health system if we treat it with the same urgency.”
The Afrobarometer findings may sound bleak, but they’re also a roadmap for change. They tell leaders exactly where people are hurting and what they value most: reliability, dignity, and care.
If Eswatini strengthens its health funding, fixes its medicine supply, and brings clinics closer to the people, it can turn this moment of worry into one of renewal.
As one nurse put it, “We may be short of medicine, but we’re not short of heart. If everyone plays their part, Eswatini’s health system can heal itself and its people.”
Quick Facts (Afrobarometer 2025)
72% say government performing poorly on health services.
88% of patients faced medicine shortages.
75% went without care or medicine in the past year.
93% worry about affording treatment.
Only 6% have medical insurance.
Rural access to clinics: 31% vs 68% urban.