BY SIFISO NHLABATSI
LOBAMBA – Eswatini is set to introduce a National Health Insurance Scheme (NHIS) as part of major health financing reforms aimed at ensuring that citizens access quality healthcare without suffering financial hardship.
The National Health Insurance Fund is expected to commence operations in April 2028, marking a significant step towards achieving Universal Health Coverage (UHC) by expanding financial protection, reducing household healthcare costs and creating a more sustainable health financing system.
According to the Ministry of Health’s first quarter performance report for the 2026/2027 financial year, the introduction of the NHIS forms part of Government’s broader efforts to transform the country’s health financing model from a fragmented, input-based system into a unified and equitable financing framework.
The Ministry stated that Eswatini has entered a decisive phase in strengthening its health system, guided by policies and strategies that place Universal Health Coverage at the centre of national development.
The reforms are anchored on key instruments including the National Development Plan 2024–2028, the National Health Sector Policy 2016–2026, the National Health Sector Strategic Plan 2024–2028 and the National Health Financing Policy.
These commitments have informed the development of Eswatini’s first National Health Financing Strategy (NHFS) 2025–2030, which outlines measures to improve efficiency, equity and financial protection within the health sector.
The NHIS is expected to increase access to healthcare by strengthening prepayment and pooling mechanisms, ensuring that citizens contribute towards healthcare financing in a structured manner while reducing dependence on direct payments at the point of receiving services.
The Ministry has set a target of reducing out-of-pocket healthcare expenditure to below 10 per cent of total health spending once the scheme is fully implemented.
Currently, household contributions remain a concern, with the latest National Health Accounts (NHA) 2022/23 showing that out-of-pocket expenditure accounts for 13.4 per cent of total health expenditure.
The same report revealed that donor funding contributes 41.6 per cent of total health expenditure, highlighting the need to strengthen domestic financing and reduce reliance on external support.
The Ministry said the institutionalisation of National Health Accounts surveys will play a critical role in tracking health expenditure and generating evidence to guide policy decisions.
The NHA tracks resources from their sources to beneficiaries, covering government, private sector, non-governmental organisations, donors, insurance schemes and households.
Meanwhile, Government continues to maintain pro-poor healthcare interventions while preparing for the NHIS rollout.
Citizens currently benefit from free primary healthcare services, while subsidised services are available at higher levels of care.
Vulnerable groups, including elderly persons, children under five years, people with mental illness, prisoners and victims of road traffic emergencies, continue to receive free healthcare services at all levels.
Additional support mechanisms such as the Phalala Fund and the Civil Servant Medical Scheme provide access to specialist and tertiary healthcare services, helping to reduce financial barriers faced by households.
The Ministry highlighted that the establishment of the National Health Insurance Fund represents a major milestone in building a resilient health system capable of delivering sustainable healthcare services.
Once operational, the NHIS is expected to promote social solidarity by ensuring that healthcare costs are shared more equitably across society, while improving access to quality services for all citizens regardless of their financial status.
The progress recorded during the first quarter signals Government’s commitment towards creating a healthcare system where no liSwati is denied access to essential medical services because of financial constraints.
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