Find Health and Medical expertise in Swaziland

The health system is based on the concept of primary, secondary and tertiary levels of health care. At primary level there are community-based health care workers, clinics and outreach services. At secondary level, there are health centres that also serve as referral points for primary levels. The tertiary level comprises hospitals, specialised hospitals and national referral hospitals. There are 14 hospitals, six of which are private; five government health centres; six public health units; and 215 clinics and outreach sites. The clinics, which are managed by nurses, are mostly located in rural areas, with only 23 having maternity facilities. The country’s main referral hospital is the Government Hospital in the capital, Mbabane. There is also a large market for traditional healers.

Most pharmaceuticals are imported from countries like India and South Africa. There is a small amount of local pharmaceutical manufacturing.

Health services are usually chargeable under a pre-payment scheme, which makes health care unaffordable for some. There is also a shortage of health care professionals, particularly in rural areas. Children, orphans and the disabled get free health care. Some charities and international aid organisations provide free health care. Private health insurance is available, but usually only to those who work in the formal sector. The government is considering introducing a national health insurance scheme with the aim of making health care available to all. The World Health Organization Country Co-operation Strategic Agenda (2014–19) includes the strengthening of health systems as a priority. There is a Centre for Disease Control and Prevention active in Swaziland and it is particularly focused on trying to halt the spread of AIDS.

Communicable and non-communicable diseases

Communicable diseases along with maternal, perinatal and nutritional conditions in Swaziland accounted for an estimated 63% of all mortality in 2012. The prevalence of HIV in Swaziland, as a percentage of the population aged 15–49 years, stood at 27.4% in 2012. HIV prevalence increased consistently in the period 1990–2005, following which the figures become more level but continue on an incline. In 2012 there were 295 reported cases of malaria in Swaziland. There was a considerable fall in deaths from malaria in the decade 2001–12. In the period 1990–2013 there was a great increase in the estimated incidence of tuberculosis (TB) in Swaziland, accompanied by an increase of more than 100% in estimated mortality (when mortality data excludes cases co-morbid with HIV) from the disease. Non-communicable diseases (NCDs) in Swaziland accounted for an estimated 28% of all mortality in 2012. The most prevalent NCDs in Swaziland are cardiovascular diseases, which accounted for 10% of total deaths across all age groups in 2012. Non-communicable variants of respiratory diseases, cancer and diabetes contributed 3% each to total mortality in 2012.

Infant mortality in Swaziland was 46 deaths per 1,000 live births in 2014, with an under-five mortality rate of 80 deaths per 1,000 live births in 2013. There has been a decline in the under-five mortality rate since 2005. Prior to this, the under-five mortality rate increased from approximately 83 deaths per 1,000 live births in 1990 to 128 deaths per 1,000 live births in 2003.

Government expenditure

In 2013 government expenditure on health was 6.3% of GDP. In the most recent survey, conducted between 1997 and 2010, there were 16 doctors, and 320 nurses and midwives per 100,000 people. Additionally, in 2010, 82% of births were attended by qualified health staff and in 2013, 85% of one-year-olds were immunised with a dose of measles. In 2014, 74% of people were using an improved drinking water source and 58% had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Swaziland has five pharmaceutical personnel per 100,000 people.

Around a quarter of health care in Swaziland (26%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 8.5% of GDP in 2012, of which 74% (US$192 per capita) was covered by the government.

Swaziland was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 2004 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.