According to the CIA World Factbook (2009), Swaziland has the highest HIV infection rate in the world (26% of all adults; more in other reports) and also the lowest life expectancy at 32 years, which is six years lower than the next lowest average of Angola.
From another perspective, the last available World Health Organization (WHO) data in 2002 shows that 61% of all deaths in the country were caused by HIV/AIDS. With a record crude death rate of 30 per 1000, this means that about 2% of the Swazi population dies from HIV every year.
Chronic illnesses that are the most prolific causes of death in the developed world accounting only for a minute fraction of deaths in Swaziland; for example, heart disease, strokes and cancer cause fewer than 5% of deaths in Swaziland in total, compared to 55% of all deaths yearly in the US.
Swaziland's healthcare system consists of public and private healthcare facilities, as well as traditional based medicine offered by community healers and physicians. The public healthcare sector is administered by the Ministry of Health & Social Welfare, providing an efficient number of healthcare facilities in the country.
Public healthcare facilities are spread out throughout Swaziland; around 80% of the population is located within 8 km from a healthcare facility and 63% are able to access a facility within one hour. Although access to healthcare is adequate, limited healthcare personnel and resources make it virtually impossible to efficiently administer quality healthcare services.
The first level of healthcare in Swaziland is provided by health clinics, where primary healthcare, family planning and vaccination services are available. Outpatient services, dental, basic inpatient, and minor surgery is provided by health centres and public health units; staffed by regional medical officers and nurses.
Hospitals in Swaziland provide emergency, inpatient, outpatient, maternity, and some speciality services. Patients who can afford it are referred to South Africa where a higher level of medical care is available. The Ministry of Health has also distributed 4000 'rural health motivators' to increase health education and basic healthcare services among the rural population, focusing on HIV/AIDS and malaria prevention. Rural health motivators are employed by the state and are typically provided with ten weeks medical training.
The private healthcare system provides the highest standard of healthcare services in Swaziland. With increased funding, private healthcare facilities are able to staff an efficient number of doctors, provide more equipment and a wider range of healthcare services. Almost 50% of doctors in Swaziland are provided by the private sector, employed mainly in private health centres, hospitals and smaller health clinics that are attached to hotels in Swaziland.
There are over 100 private health clinics in Swaziland that are based in Manzini, Mbabane, Nhlangano, Matsapha, Big Bend, Siteki, Simunyi and Mhlume. There are three private hospitals in Swaziland, all which are located in the capital Manzini.
The Manzini Clinic Private Hospital provides a large range of services including emergency, diagnostic, CT scan and X-rays, general surgery, ophthalmology, dentistry, maternity, gynaecology, ear nose and throat, and psychology.
The Mbabane Government Hospital is the main referral hospital within the public health sector. Other large public hospitals in Swaziland include the Manzini Clinic, Mbabane Clinic, Hlatikulu Government Hospital, the Mankayane Government Hospital, and the Pigg's Peak Government Hospital.
While Swaziland’s private medical facilities are able to offer higher standards of care than the public options, expatriates in the country should be aware that the country’s private medical services will cost significantly more to access than public treatment options.
In 2004, Swaziland acknowledged for the first time that it suffered an AIDS crisis, with 38.8% of tested pregnant women infected with HIV. Life expectancy has fallen from 61 years in 2000 to 32 years in 2009. Tuberculosis is also a significant problem, with an 18% mortality rate. Many patients have a multi-drug resistant strain, and 83% are co-infected with HIV. Infant mortality was at 110 per 1,000 in 2005, with the WHO showing that 47% of all deaths under five are HIV/AIDS related.
Public expenditure was at 4% of the GDP of the country, whereas private expenditure was at 2.3%. There were 16 physicians per 100,000 persons in the early 2000s. Traditional healers are still consulted by over 80% of the population.