Eswatini: Emaswati Criticise Government’s Performance On Health, Say Public Health Facilities Lack Medicines

More than eight in 10 citizens say they worry ‘a lot’ about obtaining or affording medical care.

Key findings

• Six in 10 Emaswati (61%) report having contact with a public clinic or hospital during the past 12 months. More women than men report visiting a public health facility (72% vs. 52%).
• Among Emaswati who had contact with a public health facility: o Three-fifths (61%) say it was “easy” or “very easy” to get the services they needed. o But almost nine in 10 (88%) say they experienced a lack of medicines or medical supplies at least once or twice, while at least half encountered long wait times (79%), unaffordable care or medicines (61%), and absent medical personnel (50%). o And one in 20 (5%) report having to pay a bribe, give a gift, or do a favour for a health worker in order to receive the services they needed.
• The proportion of citizens who report going without medical care at least once during the past year more than doubled between 2015 (33%) and 2025 (75%).
• More than nine in 10 Emaswati (93%) say they worry about obtaining or affording medical care for themselves or family members, including 81% who worry “a lot.”
• Only 6% of respondents say they have medical aid coverage. o Seven in 10 (70%) cite a lack of affordability as the main reason for not having health insurance.
• Almost three-fourths (72%) of Emaswati say the government is doing “fairly badly” or “very badly” on improving basic health services.
• About two-thirds (68%) of citizens “agree” or “strongly agree” that the government should ensure universal access to adequate health care, even if it means higher taxes.
• A similar proportion (67%) blame the drugs shortage on insufficient government funding.
• Half (51%) “agree” or “strongly agree” that the CMS should be privatised to ensure a reliable supply of drugs and medical supplies, though 35% disagree.
• The government of Eswatini has emphasised the importance of having a “healthy and productive population that lives longer, fulfilling, and responsible lives” (Ministry of Health, 2016). Through its National Health Sector Strategic Plan 2024/2025-2027/2028, the Ministry of Health (2024) is working to accelerate progress toward universal health coverage (UHC) by 2030, with a focus on expanding service coverage and building an inclusive and effective health-care system.

• In 2024, Eswatini reached 58% on the UHC Index, a composite metric indicating the overall level of UHC attainment within a country (World Health Organization, 2024). While Eswatini’s most recent score is higher than the regional average (46%), it is lower than its 2017 score (63%) (Ministry of Health, 2024). The country set itself a target of 70% service coverage by 2028, which the World Health Organization (2024) says will require faster progress.

  Eswatini was the first African country to obtain HIV epidemic control,1 reaching the UNAIDS 95-95-95 targets seven years ahead of the 2030 target (World Health Organization, 2023). At present, 97% of Emaswati living with HIV know their HIV status, 98.3% of those with a confirmed HIV-positive diagnosis receive antiretroviral therapy (ART), and 98.4% of people receiving ART have achieved viral suppression (Rijkenberg, 2025).

  However, in recent years, the public health-care system has struggled to deliver quality services. One of the central challenges is inadequate funding: While the government currently allocates 8.1% of the national budget to the health sector (totalling E3.2 billion in 2025) (Rijkenberg, 2025), this is barely more than half of the 15% commitment it made when signing the Abuja Declaration for health financing in 2001 (Africa CDC, 2025). In July this year, Minister of Health Mduduzi Matsebula admitted a “need to transform health funding” (Simelane, 2025).

  Matsebula listed several other challenges facing the health-care sector, including dilapidated infrastructure, overcrowding of facilities, the poor condition of medical tools and equipment, and insufficient human resources due to a hiring freeze on civil servants that has been in place since 2018 (Simelane, 2025). The World Health Organization (2024) notes that Eswatini has a deficit of more than 10,000 health-care workers. Shortages of medicines in public health facilities – forcing patients to buy them at high prices from private suppliers – is a persistent issue; in 2023, it triggered mass protests (Africa Press, 2023).

  Afrobarometer Round 10 survey findings reveal widespread frustration with the public health care sector.

  Among citizens who had contact with a public clinic or hospital in the past year, almost nine in 10 say they experienced a lack of medicines or medical supplies during their visit, eight in 10 report long wait times, and six in 10 say the cost of care or medicines was unaffordable.

  Overwhelming majorities of respondents lack medical coverage and worry about obtaining or affording necessary medical care. Three-fourths report going without medical care at least once during the past year.

  More than seven in 10 Emaswati rate the government’s performance on providing basic health services poorly. Two-thirds point to inadequate public funding as the reason for the current shortages of drugs and medical supplies, and half favour privatising the state-owned Central Medical Stores (CMS) to ensure a reliable supply.

  Emaswati express strong support for universal health coverage: Two-thirds say the government should ensure that all citizens have access to adequate health care, even if it means raising taxes.