Keypoints:
- Afrobarometer finds 70% rate government poorly
- 9 in 10 report medicine shortages at clinics
- Citizens back universal health coverage despite tax rise
A NEW Afrobarometer Round 10 survey released on October 31 paints a sobering picture of Eswatini’s public health system, revealing deep dissatisfaction among citizens with the quality, accessibility, and affordability of medical services.
Despite the government’s stated goal of building a ‘healthy and productive population that lives longer, fulfilling, and responsible lives,’ as outlined in its National Health Sector Strategic Plan 2024/2025–2027/2028, many Emaswati feel left behind by the country’s struggling health sector.
Declining progress toward universal coverage
According to the World Health Organisation (2024), Eswatini scored 58 percent on the Universal Health Coverage (UHC) Index, higher than the sub-Saharan average of 46 percent but down from 63 percent in 2017. The government has set a target of reaching 70 percent coverage by 2028, a goal WHO says will require significantly faster progress.
Eswatini has achieved remarkable success in controlling HIV, becoming the first African nation to reach the UNAIDS 95-95-95 targets seven years ahead of schedule. Currently, 97 percent of citizens living with HIV know their status, 98.3 percent receive antiretroviral therapy, and 98.4 percent have achieved viral suppression.
Funding and staffing shortfalls cripple services
However, the wider health system continues to struggle. The Ministry of Health receives 8.1 percent of the national budget — around E3.2bn in 2025 — barely half of the 15 percent Abuja Declaration target. Health Minister Mduduzi Matsebula recently acknowledged the need to ‘transform health funding’ to address persistent shortages.
Public facilities face multiple challenges, including decaying infrastructure, overcrowded wards, equipment breakdowns, and severe staff shortages due to a hiring freeze in place since 2018. The World Health Organisation estimates a shortfall of more than 10,000 healthcare workers. Chronic medicine shortages have fuelled public anger, sparking protests in 2023 when patients were forced to buy drugs privately at inflated prices.
Afrobarometer survey reveals public discontent
The Afrobarometer Round 10 findings underline this widespread frustration. Among respondents who visited a public clinic or hospital within the past year:
- Nearly nine in ten reported shortages of medicines or medical supplies.
- Eight in ten endured long waiting times.
- Six in ten said treatment or drugs were unaffordable.
Three in four respondents said they went without medical care at least once during the past year, while large majorities expressed fear about accessing or affording care when needed.
Citizens back universal health coverage
More than seven in ten Emaswati rated the government’s performance on basic health services as poor, and two-thirds blamed inadequate funding for persistent shortages. Half of respondents favoured privatising the state-owned Central Medical Stores (CMS) to stabilise medicine supply chains.
Despite their frustrations, citizens remain committed to the principle of universal health coverage. Two-thirds of those surveyed said they support government efforts to guarantee access to adequate health care for all — even if it requires raising taxes.
The findings from Afrobarometer Round 10 suggest that while Eswatini’s health ambitions remain high, achieving them will depend on whether the government can translate its strategic plans into tangible improvements at clinics and hospitals across the kingdom.
