The Ministry of Health sets national policy, regulates health services and runs public programmes. Regional Health Services coordinate planning in their areas. Public facilities work alongside mission hospitals, private providers, community services and traditional health practitioners. Traditional and other informal providers may be used in practice, but their services do not replace formal diagnosis, referral, emergency treatment or prescribed follow-up. A Rural Health Motivator (RHM) is a community-based worker who helps connect households with prevention, referral, treatment adherence and continuing care. Community Health Workers perform similar community-facing functions in some programmes. A Public Health Unit provides health promotion, prevention, outpatient treatment and outreach. A clinic provides outpatient care; a clinic with a maternity wing can also provide maternity services, while a clinic without one has a narrower facility role. Health centres offer broader services, and regional referral hospitals handle cases requiring hospital, specialist or inpatient capacity. National and specialised hospitals provide the highest levels of referral care. The documented care pathway is generally community or RHM support, clinic or Public Health Unit, health centre, regional referral hospital and then national or specialised hospital when necessary. A clinician may refer directly to a higher-level facility when the condition requires surgery, specialist assessment, inpatient care, advanced tests or treatment that the first facility cannot provide. Health facilities may offer medical and nursing care, laboratories, X-rays, surgery, gynaecology and obstetrics, paediatrics, inpatient and outpatient services, pharmacies, HIV treatment, voluntary counselling and testing, prevention of mother-to-child transmission, mental-health care, dental care, physiotherapy, ear-nose-and-throat care, orthopaedics and environmental health services. The available facility figures require a date warning. The SARA 2017 reference, still cited as an outdated baseline in the Ministry of Health Annual Report 2024/25, listed 1 national referral hospital, 5 regional referral hospitals, 3 specialised hospitals, 5 health centres, 7 Public Health Units, 31 clinics with maternity services, 203 clinics without maternity services, 65 specialised clinics and 7 private hospitals. A new SARA assessment was announced, so these figures should not be treated as the current national total. Public policy and the National Health Policy state that essential public-health and clinical services should be accessible to citizens and that inability to pay should not prevent access to basic care. Section 60(8) of the Constitution provides that the State should secure basic health-care services. The documented system does not show a single universal health-insurance equivalent. Financing, distance, roads and other infrastructure, staff shortages, medicine availability and congestion at referral facilities can still determine how quickly a person receives care. In 2024, the WHO reported a Universal Health Coverage Index of 58% and a Service Availability Index of 63%. The health-worker deficit was reported at 10,531. In the Ministry of Health financial year 2024/25, 3,765 of 4,272 established posts were filled, leaving 507 vacancies. Prevention includes the Eswatini Expanded Programme on Immunisation, including routine childhood vaccination and HPV vaccination for girls aged 9 to 14. Reported 2024/25 coverage included 80% for BCG and 80.4% for DPT. HIV services include self-testing, test-and-start treatment, voluntary medical male circumcision, pre-exposure prophylaxis and nurse-led antiretroviral treatment. Multi-month antiretroviral prescriptions can cover up to six months in suitable cases. In the 2022 WHO cascade for people aged 15 and above, 94% were estimated to know their HIV status, 97% of those people were receiving antiretroviral treatment and 96% of those on treatment had viral suppression. An estimate for December 2024 counted 226,596 people living with HIV, of whom 219,797 were estimated to know their status. HIV remains a major health concern, and tuberculosis is also a substantial burden. WHO reported tuberculosis incidence of 348 cases per 100,000 people in 2021. Eswatini uses tuberculosis preventive treatment for people living with HIV, with a reported programme target or coverage level of at least 70%, as well as drug-resistant tuberculosis services, GeneXpert testing and regional or facility-level treatment. Sexually transmitted infections and hepatitis B are addressed in antenatal care. A hepatitis-B birth dose had not yet been introduced in the documented period. Maternal and child services include antenatal care, skilled birth attendance, postnatal care, maternity services, paediatric treatment and prevention of mother-to-child HIV transmission. The Ministry of Health recorded 19,046 births and 18 maternal deaths in financial year 2024/25, together with 517 perinatal deaths. UNICEF reported under-five mortality of 45.1 deaths per 1,000 live births in 2024. Reported child-care indicators included care-seeking for acute respiratory infection at 60%, oral rehydration solution use for diarrhoea at 68%, third-dose DTP coverage at 84% and second-dose measles coverage at 87%. Effective antiretroviral coverage for prevention of mother-to-child transmission was reported above 95%. Some current maternal indicators were unavailable, so older or partial figures should not be used as a complete national picture. Noncommunicable diseases also require care. Hypertension is among the frequent causes of illness. Cervical cancer is a leading cancer affecting women, while depression, anxiety and substance misuse are common mental-health conditions. Mental-health services are provided through the Psychiatric Government Hospital, regional units and general health facilities. Suicide rates were reported as increasing, but population-level mental-health data remain limited. Medicines are guided by the Essential Medicines List 2021 and Standard Treatment Guidelines. The Ministry of Health and WHO aim to improve availability, access and affordability through primary health care. Medicine shortages remain a system risk. A 2024 ministerial statement reported that the medicine order-fill rate had improved from about 30% to 60–70%, but this does not mean every facility has every medicine at every time. The documented material does not establish one current nationwide fee schedule, uniform waiting time or guaranteed availability for every service. For an immediate medical emergency, the Emergency Communication Centre can be reached on 977 without a communication charge. Pre-hospital emergency medical services, advanced life-support ambulances and trauma and referral networks support urgent evacuation. In financial year 2024/25, the system recorded 427,187 calls, 53,778 critical cases and 48,101 evacuations; 89% of reported evacuations were successful. Emergency care should not be delayed while seeking a routine appointment or a lower-level facility when the condition is severe. Some patients require treatment outside Eswatini. The Phalala Fund can support eligible Eswatini nationals who do not have another medical scheme after local treatment options have been considered. A clinician's referral goes through technical review and the Phalala Board. Possible referrals may involve South Africa or Mozambique. Supporting documents can include a travel document, medical visa, quotation, referral letter, guarantee letter, appointment confirmation and hospital or doctor details. After treatment, the process can require a medical report, medicines, follow-up arrangements and transport coordination. Civil servants and their dependants may instead fall under the Civil Servants Medical Referral Scheme, depending on the applicable rules. After discharge, the treatment record, prescribed medicines and follow-up appointments determine continuing care. Physiotherapy and rehabilitation may be provided through hospital services. Mental-health care can include social reintegration and community follow-up. RHMs and community-based workers can support referral completion, treatment adherence and chronic-care follow-up. The receiving facility, treatment plan and the patient's condition determine which follow-up services are needed.
Health in Eswatini
Health care in Eswatini combines public, mission and private facilities with community-based services and traditional health practitioners. Care commonly moves from a Rural Health Motivator or community health worker to a clinic or Public Health Unit, then a health centre and referral hospital when the case requires more capacity. The system covers prevention, HIV and TB services, maternity and child care, medicines, mental health, emergency transport, specialist treatment and rehabilitation, but distance, staff shortages, medicine supply and referral congestion can delay access. Essential public-health and clinical services are intended to be available to citizens, while the practical pathway and availability depend on the facility and catchment area.
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