Eswatini

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Africa

7.2%CHE/GDP

10.4%OOP/CHE

11.4%GGHE-D/GGE

5BGDP (USD)

1.2MPopulation

Eswatini, a lower middle-income country in Southern Africa, is actively pursuing health financing reforms to advance universal health coverage (UHC) for its population. Eswatini faces significant challenges in ensuring equitable access to health care services. The GDP per capita of US$ 3,986.9 (in 2022) and Gini coefficient rate of 0.51 indicate high income inequality.

Health care system and health financing status

The country’s health care system comprises formal and informal sectors, with a bias in health facility distribution towards urban areas while 70% of the population resides in rural areas. Eswatini grapples with a high burden of communicable and noncommunicable diseases (NCDs), with NCDs accounting for 46% of deaths in 2019.

Eswatini allocated approximately 7.2% of its GDP to health care in 2022, with a per capita government health expenditure of US$ 283.9. In the same year, government health expenditure as a percentage of total government spending stood at 11.3%, falling short of international targets like the Abuja Declaration’s 15% benchmark.^[1] Of the total health expenditure, 45% was contributed by the government and 28% by donors in 2022.^[2] While Eswatini has not implemented a national health insurance scheme, the government heavily subsidizes public health care services. These include initiatives like the Phalala Fund, a government funded scheme financing specialized health care services for the Eswatini population with limited ability to pay. Out-of-pocket (OOP) health care spending is very low at 10% in 2022,^[1] and only 2.7% of the population faces OOP health expenditures exceeding 40% of their non-food expenses.^[2]

Commitment to universal health coverage

Eswatini’s commitment to advancing UHC is evident in key policy documents such as the Eswatini National Health Sector Policy 2016-2026. The policy emphasizes affordable health care and protection from financial hardship, outlining thematic areas including sustainable health care financing, financial risk protection, resource efficiency, and equitable access to services.

Another document supporting UHC is the National Health Financing Policy 2015-2022, which underscores the government’s dedication to advancing UHC through comprehensive health financing reforms.

References

[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)

[2] World Health Organization – Eswatini, Country Cooperation Strategy 2022–2026 – Eswatini