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An essential health benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many low income countries introduced or updated EHBs in the 2000s. In Swaziland the EHB was first developed in 2010 and publicly launched in 2012. The Regional Network for Equity in Health in East and Southern Africa (EQUINET) with the support from other stakeholders conducted a case study in Swaziland to understand the motivations for developing the EHB; the methods used to develop, define and cost it; how it is being disseminated and communicated; how it is being used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability; and the facilitators and barriers to its development, uptake or use.