Eswatini: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is evidence that Eswatini has an AMR plan, and it covers surveillance, detection, and reporting. The Implementation Plan – National Antimicrobial Resistance Containment Strategic Plan 2018–2022, on page 32, outlines an activity to develop structured surveillance systems across the three sectors involved in AMR containment, including priority pathogens. The plan covers surveillance, detection, and reporting under Strategic Objective 2 on page 14, including provisions to detect emerging resistance and report to GLASS and other entities.¹

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 0

There is no publicly available evidence that Eswatini maintains a national laboratory system which tests for 7+1 World Health Organisation (WHO) priority antimicrobial resistant (AMR) pathogens, although it is still in the process of setting up sentinel sites according to international standards. According to the Joint External Evaluation (JEE) for the Kingdom of Eswatini, conducted in April 2018, AMR surveillance and detection is done at three public laboratories, including the National Reference Laboratory (NRL) and Raleigh Fitkin Memorial Hospital Laboratory, as well as two private facilities. AMR detection for animals is done at the Central Veterinary Laboratory. According to the report, the National Reference Laboratory conducts 6 International Health Regulations (IHR) core tests for malaria, measles, meningitis, food poisoning, typhoid, and cholera, while the Central Veterinary Laboratory conducts 5 IHR core tests for tuberculosis, highly-pathogenic avian Influenzae, brucellosis, salmonellosis, and rabies. There is no evidence in the report of testing for the AMR pathogens. ² The Swaziland Health Laboratory Services, the national laboratory for Swaziland within the Ministry of Health, serves as a reference laboratory for infectious diseases, but there is no indication on its website that it conducts AMR surveillance specifically. ³ There is no additional evidence of a national laboratory system that tests for priority AMR pathogens through the Ministry of Health, Ministry of Agriculture. ⁴⁵. The Implementation Plan – National Antimicrobial Resistance Containment Strategic Plan 2018–2022 does not contain relevant information. ⁶

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that there is any government agency in Eswatini that conducts environmental detection and surveillance activities for antimicrobial residues and antimicrobial resistant (AMR) organisms. Among its other activities, the Swaziland Health Laboratory Services, the national laboratory for Swaziland, engages in "[e]environmental health and protection" which includes "conduct[ing] scientific analyses of environmental (air, water, and soil) and biological samples in order to identify and monitor potential threats to human health, while ensuring compliance with environmental regulations." ⁷ However, there is no indication that it specifically tests for antimicrobial residues or AMR organisms. According to the Joint External Evaluation (JEE), conducted in April 2018, the Eswatini Environment Authority (which replaced the Swaziland Environment Authority [SEA]) is responsible for managing environmental surveillance and response, but there is no specific mention of detection or surveillance for antimicrobial residues or AMR organisms. ⁸⁹ The Annual Budget Performance Report For Financial Year 2024 – 2025 published in February 2025 states on page that "Eswatini established environmental surveillance sites in all four regions of the Kingdom where samples are collected monthly," however, it is unknown what type of samples or pathogens are collected at these site. ¹⁰

Neither the Ministry of Tourism and Environmental Affairs or the Ministry of Natural Resources and Energy, which both handle different aspects of environmental protection, conduct environmental monitoring for antimicrobial residues or AMR organisms. ¹¹¹² The Ministry of Agriculture, which maintains a soil testing unit, does not appear to include surveillance for antimicrobial organisms. ¹³ Likewise, the Ministry of Health environmental health unit does not appear to test for antimicrobial organisms. ¹⁴ The National Antimicrobial Resistance Containment Strategic Plan 2018–2022, published in October 2020, includes a provision for environmental residue monitoring and testing related to pharmaceutical manufacturers. However, there is no publicly available evidence, whether from media reports, academic research, or other online sources, that the government has conducted environmental detection or surveillance activities (e.g., in soil or waterways) for antimicrobial residues or AMR organisms. ¹⁵

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is publicly available evidence that Eswatini has national legislation place requiring prescriptions for antibiotic use in humans, but there is evidence the legislation is not being adequately enforced. According to the Joint External Evaluation (JEE), conducted in April 2018, under the P.3.4 Antimicrobial stewardship activities, it was stated that "prescriptions are a requirement for the acquisition of antibiotics used" in the public health sector. It is, however, possible for antibiotics to be purchased without one due to poor enforcement of the relevant legislation. The report also states that there is a national policy document promoting the appropriate use of antibiotics in Eswatini; the Standard Treatment Guidelines to Regulate and Promote Rational Use of Antibiotics (2012), but there is no other public evidence of this document. ¹⁶ There is no indication that prescriptions are required through the Ministry of Health's Department of Pharmaceuticals and Medicines, its list of regulations, or its documents section. ¹⁷¹⁸¹⁹ There is no other information regarding a national requirement for prescriptions for antibiotic use in humans through the Ministry of Health or the Swaziland Legal Information Institute. ²⁰²¹ The Pharmacy Act, 1929 does not include any provision regarding prescriptions for antibiotic use. ²² There is no other publicly available evidence in media sources to show that legislation is now being adequately enforced.

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is publicly available evidence that Eswatini has national legislation place requiring prescriptions for antibiotic use in animals, but there is evidence the legislation is not being adequately enforced. According to the Joint External Evaluation (JEE), conducted in April 2018, under the P.3.4 Antimicrobial stewardship activities, it was stated that "prescriptions are a requirement for the acquisition of antibiotics used" in the animal health sector. It is, however, possible for antibiotics to be purchased without one due to poor enforcement of the relevant legislation. The report also states that there is a national policy document promoting the appropriate use of antibiotics in Eswatini; the Standard Treatment Guidelines to Regulate and Promote Rational Use of Antibiotics (2012), but there is no other public evidence of this document. ²³ The website of the Ministry of Agriculture's Department of Veterinary and Livestock Production does not include any indication that prescriptions are required for antibiotics. ²⁴ There is no other information regarding a national requirement for prescriptions for antibiotic use in animals through the Ministry of Agriculture or the Swaziland Legal Information Institute. ²⁵²⁶

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no publicly available evidence that Eswatini has a national law, plan, or equivalent strategy document on zoonotic disease. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini conducts extensive surveillance of many zoonotic diseases, including bovine spongiform encephalopathy, brucellosis, cysticercosis, echinococcosis, rabies, Rift Valley fever, salmonellosis and tuberculosis, but not all of these are considered to be of concern to human health and there seems to be a mismatch between the priorities of the Ministry of Agriculture (MoA) with those of the Ministry of Health. ²⁷ The Ministry of Health maintains a National Malaria Control Programme. ²⁸ The MoA website states that "The mandate of the Department of Veterinary and Livestock Services is to prevent the spread of animal diseases and zoonoses" but there is no mention of a law, plan or strategy upholding this. ²⁹ There is no other evidence of a plan or strategy to address zoonotic diseases through the Ministry of Health or the Ministry of Agriculture. ³⁰³¹ The National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020, published in 2021, does not include any relevant information. ³²

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

There is no publicly available evidence that Eswatini has national legislation, plans or equivalent strategy document(s) which include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans. There is no mention of risk identification or spillover events in the web sites of the ministries of Health or Agriculture, the 2018 Joint External Evaluation (JEE) or in the 2020 World Health Organisation (WHO) National Contigency Plan for Novel Coronavirus for Eswatini. ^33343536 The National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020, published in 2021, does not include any relevant information.

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 0

There is no publicly available evidence that Eswatini has a national plan, guidelines, or laws that account for the surveillance and control of multiple zoonotic pathogens of public health concern. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini conducts extensive surveillance of many zoonotic diseases, including bovine spongiform encephalopathy, brucellosis, cysticercosis, echinococcosis, rabies, Rift Valley fever, salmonellosis and tuberculosis, but not all of these are considered to be of concern to human health, and there seems to be a mismatch between the priorities of the Ministry of Agriculture (MoA) with those of the Ministry of Health. ³⁷ The Ministry of Health maintains a National Malaria Control Program, but this does not appear to extend to other zoonotic diseases generally. ³⁸ There is no other evidence of plans, guidelines or laws to address zoonotic diseases through the Ministry of Health or the Ministry of Agriculture. ³⁹⁴⁰

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no publicly available evidence that Eswatini has a department, agency, or similar unit dedicated to zoonotic disease that functions across ministries. According to the Joint External Evaluation (JEE), conducted in April 2018, both the Ministry of Health and the Ministry of Agriculture conduct separate epidemiological surveillance on zoonoses, but their priorities often differ. Although there is "regular informal collaboration between the epidemiology unit in the animal health sector and the corresponding unit within the Ministry of Health, the Epidemiology and Disease Control Unit (EDCU)," this contact only occurs once a month and only covers three zoonoses. [1] The Ministry of Agriculture Department of Veterinary and Livestock Production Services is in part responsible for "prevent[ing] the spread of animal diseases and zoonoses [and] promoting] animal health and welfare." [2] However, there is no evidence that it functions across ministries. The Epidemiology Department in the Ministry of Health tracks the spread of infectious diseases, but there is no specific reference to zoonoses or a cross-ministry function. [3] Neither the World Organisation for Animal Health (OIE) Performance of Veterinary Services report for Swaziland (now Eswatini), drafted in September 2007, or the follow-up report, drafted in May 2015, indicate that there is a governmental ministry or agency covering zoonoses in Eswatini that functions across ministries. [4,5] There is no other indication of an agency that covers zoonoses across ministries through the Ministry of Health and Ministry of Agriculture. [6,7]

1.2.1e Presence of One Health strategic plan

Score: 0

There is no evidence that Eswatini has a One Health strategic plan in place. ⁴¹

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

Eswatini does have a national mechanism for owners of livestock to report on disease surveillance to a central government agency. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini conducts its animal health disease surveillance through the Eswatini Livestock Identification and Traceability System, now known as Swaziland Livestock Information and Traceability System (SLITS), which coordinates regional and national reporting with international public health authorities. ⁴²⁴³ According to the World Organisation for Animal Health (OIE) Performance of Veterinary Services (PVS) evaluation report follow-up from May 2015, the SLITS database is also used by owners of livestock to identify and trace their animals and also report on their health to central authorities. ⁴⁴ All owners of livestock are required to report to certain "diptank" centres for disease inspection under supervision of specially trained animal health technicians, and they are subject to criminal penalty for failing to comply under the Livestock Identification Act (2001). ⁴⁵⁴⁶

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available information regarding legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners) in Eswatini. The Eswatini Data Protection Act No. 5 of 2022 does not mention any regulations regarding safeguard the confidentiality of information generated by animal owners. ⁴⁷ The Veterinary Public Health Act (2013), which establishes some surveillance programs for animal health, contains a general confidentiality provision safeguarding information related to the "business or affairs of a person"" in furtherance of the act, but it is not clear how the exemptions allowing for confidentiality to be breached "as may be necessary for the proper application of the provisions of the act" and "where the minister authorises the disclosure" would affect rights arising under SLITS surveillance. ⁴⁸ None of the national 'Swaziland Livestock Information and Traceability System' (SLITS) website, the Joint External Evaluation (JEE), conducted in April 2018, nor the World Organisation for Animal Health (OIE) Performance of Veterinary Services (PVS) mission report (September 2007) or follow-up report (May 2015) mention any safeguards for the owners of animals when conducting animal health surveillance activities. ^49505152 There is no other information regarding a safeguard for information gathered through surveillance activities through the Ministry of Health, Ministry of Agriculture, or the Swaziland Legal Information Institute. ⁵³⁵⁴⁵⁵

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no publicly available evidence that Eswatini conducts surveillance of zoonotic disease in wildlife. The Joint External Evaluation (JEE), conducted in April 2018, states that the Aquatic Animal Diseases and Wildlife Surveillance within the Ministry of Agriculture coordinates disease surveillance in wildlife, however there is no additional information. The report also states, however, that "Collaboration needs to be strengthened between all stakeholders involved in zoonotic diseases surveillance and control, in particular between the MoH and the MoA". ⁵⁶ The World Organisation for Animal Health (OIE) Performance of Veterinary Services (PVS) follow-up report, published in May 2015, states that the Ministry of Agriculture's Department of Veterinary and Livestock Services "conduct[s] active surveillance in compliance with scientific principles and OIE standards for some relevant diseases and apply it to all susceptible populations but do[es] not update it regularly." In addition, this Department performs some surveillance functions on wildlife in coordination with two private sector organisations dedicated to wildlife conservation; Big Game Parks and the Swaziland National Trust Commission. ⁵⁷ This coordination, however, appears to be largely on an ad hoc and informal basis, and is limited to foot-and-mouth disease response. According to the report, there is no indication that the electronic animal health disease surveillance system for Swaziland, the Swaziland Livestock Information and Traceability System (SLITS), covers wildlife. ⁵⁸ There is no additional information regarding a wildlife surveillance programme in Swaziland through the Ministry of Health or the Ministry of Agriculture. ⁵⁹⁶⁰

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting one notifiable disease to the World Organisation for Animal Health (WOAH). Eswatini has reported Foot-and-Mouth Disease events to the WOAH, with the first report on 12 May 2025 and the most recent on 20 October 2025, as recorded on the World Animal Health Information System (WAHIS) platform. ⁶¹

1.2.4a Number of veterinarians per 100,000 people

Score: 1.22

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 100

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that Eswatini has a national plan on zoonotic disease or other legislation, regulation, or plan that includes a mechanism for working with the private sector in controlling or responding to zoonoses. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini conducts extensive surveillance of many zoonotic diseases, including bovine spongiform encephalopathy, brucellosis, cysticercosis, echinococcosis, rabies, Rift Valley fever, salmonellosis and tuberculosis, but not all of these are considered to be of concern to human health. There is no mention of inclusion of the private sector. ⁶² The Ministry of Health maintains a National Malaria Control Programme, but this does not appear to extend to other zoonotic diseases or include the private sector. ⁶³ According to the World Organisation for Animal Health (OIE) Performance of effective Veterinary Services report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services "has neither the authority nor the capability to accredit / authorise / delegate the private sector to carry out official tasks." ⁶⁴ The OIE PVS follow-up report, published in May 2015, noted that "[t]here is little opportunity to delegate official tasks to the private sector because of the very small size of the private sector." ⁶⁵ There is no other evidence of a plan or strategy to address zoonotic diseases through the Ministry of Health or the Ministry of Agriculture. ⁶⁶⁶⁷

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Eswatini has a record, updated within the past 5 years, of the facilities in which especially dangerous pathogens and toxins are stored or processed. According to the Joint External Evaluation (JEE), conducted in April 2018, although Eswatini has a number of biosafety containment procedures in place, it does not currently have a biosecurity plan or system in place. ⁶⁸ Although the World Organisation for Animal Health (OIE) Performance of effective Veterinary Services (PVS) evaluation report, conducted in September 2007, noted that the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," there is no indication of a facility in which especially dangerous pathogens and toxins are stored. ⁶⁹ There is no additional information regarding a record in Eswatini of the facilities in which especially dangerous pathogens and toxins are stored and processed through the Ministry of Health, Ministry of Agriculture, Swaziland Health Laboratory Services, or on the VERTIC Legislation Database. ⁷⁰⁷¹⁷² Neither the Ministry of Defence or the national laboratory system has an online presence and there is no existing Public Health Institute. A March 2018 document on laboratory biosafety and biosecurity in the Southern African Development Community (SADC) region makes no mention of such a record. ⁷³ Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC.⁷⁴ The National Laboratory Association of Eswatini (NLAE) does not appear to have a website while there is no evidence of a facility in Eswatini in which especially dangerous pathogens and toxins are stored or processed is available on the Facebook or LinkedIn page of the NLAE. ⁷⁵⁷⁶

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Eswatini has legislation or regulations in place related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, or cybersecurity of facilities in which especially dangerous pathogens or toxins are stored. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has acceded to the Biological and Toxic Weapon Convention (BWC), the Cartagena Protocol on Biosafety, and the Convention on Biological Diversity. ⁷⁷ However, there is no evidence of biosecurity legislation which address the requirements mentioned besides the use of biometrics "to prevent access to biological specimens by unauthorized people." ⁷⁸ Additionally, the Suppression of Terrorism Bill of 2008 prohibits the use of weaponized use of biological pathogens and toxins, but there is no indication that the bill addresses the requirements mentioned. ⁷⁹ The Ministry of Health website provides standard operating procedures for handling medical waste, including guidance on the categories of biohazard, but there is no information regarding physical containment, operation practices, failure reporting systems, or cybersecurity. ⁸⁰ There is no additional information regarding legislation or regulations related to biosecurity in Eswatini through the Ministry of Health, Ministry of Agriculture, Swaziland Health Laboratory Services, the Swaziland Legal Information Institute or on the VERTIC Legislation Database. ^8182838485 Neither the Ministry of Defence or the national laboratory system has an online presence and there is no existing Public Health Institute. It was reported by the African Society for Laboratory Medicine (ASLM) that in May 2025, Eswatini, together with stakeholders such as the Africa CDC and the ASLM, convened to develop a National Legal Framework and Domestication Plan for Biosafety and Biosecurity. However, there is no evidence that the framework or plan has been available and formally enacted. ⁸⁶

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that Eswatini has an established agency responsible for the enforcement of biosecurity legislation and regulations. According to the Joint External Evaluation (JEE), conducted in April 2018, although Swaziland has a number of biosafety containment procedures in place that are organized by the Biosafety Advisory Committee, it does not currently have a biosecurity plan or system. Additionally, the report notes that it is not clear which ministries are the "custodians of the Biological Weapons Convention and Suppression of Terrorism Act (2008)" in Swaziland. ⁸⁷ The Veterinary Public Health Act (2013) includes provisions for adopting "control measures" when creating animal products for human consumption in order to contain animal diseases and prevent the spread of contagious diseases to humans, including taking precautionary measures when introducing new animals to farms and reporting incidences of disease, but there is no indication of a specific regulatory body to direct and oversee these measures. ⁸⁸ According to the World Organisation for Animal Health (OIE) Performance for effective Veterinary Services (PVS) mission report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," but there is no publicly available evidence of these measures. ⁸⁹ There is no additional information regarding an established agency responsible for the enforcement of biosecurity legislation and regulations in Eswatini through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services or on the VERTIC Legislation Database. ^90919293 Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC.⁹⁴

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence that Eswatini has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. According to the Joint External Evaluation (JEE), conducted in April 2018, although Eswatini has a number of biosafety containment procedures in place that are organized by the Biosafety Advisory Committee, it does not currently have a biosecurity plan or system. The report also states that while the National Reference Laboratory and Central Veterinary Laboratory utilize simple physical security measures such as the use of biometrics to "prevent access to biological specimens by unauthorized people," there is no indication of an effort to consolidate inventories of especially dangerous pathogens and toxins. ⁹⁵ The Veterinary Public Health Act (2013) includes provisions for adopting "control measures" when creating animal products for human consumption in order to contain animal diseases and prevent the spread of contagious diseases to humans, including taking precautionary measures when introducing new animals to farms and reporting incidences of disease, but there is no indication of a specific actions taken to consolidate dangerous pathogens. ⁹⁶ According to the World Organisation for Animal Health (OIE) Performance for effective Veterinary Services (PVS) mission report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," but there is no publicly available evidence of these measures. ⁹⁷ There is no additional information regarding an established agency responsible for the enforcement of biosecurity legislation and regulations in Swaziland through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services or on the VERTIC Legislation Database. ^9899100101. There is no relevant information available in the Eswatini Health Laboratory Services Strategic Plan (2021-2023), the National Strategy for Integrated Disease Surveillance and Response (IDSR) 2021-2023, nor the National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020. ^102103104

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is insufficient publicly available evidence that Eswatini has the in-country capacity to conduct polymerase chain reaction (PCR)-based diagnostic testing for anthrax or Ebola. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has simulated Ebola preparedness and response drills in recent years, but there is no indication that its laboratories have the capacity to conduct PCR diagnostic testing for either Ebola or anthrax. ¹⁰⁵ Likewise, there is no information regarding the capacity to conduct PCR-based diagnostic testing for Ebola or anthrax through the Ministry of Health Epidemiology and Disease Control Unit or the Emergency Preparedness and Response Department. ¹⁰⁶¹⁰⁷ While scientific studies have noted Eswatini's ability to conduct PCR-based tests for both malaria and HIV infections, there is no evidence of the capacity to address Ebola or anthrax. ¹⁰⁸¹⁰⁹ There is no additional evidence regarding the in-country capacity to conduct PCR-based diagnostic testing for anthrax or Ebola through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services, or the Eswatini Health Laboratory Services. ^110111112113 The Ministry of Defence has no online presence and there is no existing Public Health Institute.

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Eswatini requires biosecurity training, using a standardized, required approach, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. According to the Joint External Evaluation (JEE), conducted in April 2018, although Eswatini has a number of biosafety containment procedures in place that are organized by the Biosafety Advisory Committee, it does not currently have a biosecurity plan, system, or required trainings. Training on biosafety is conducted at the national laboratory level and within public health units, but there is no indication of specific procedures to biosecurity concerns. The report also states that while the National Reference Laboratory and Central Veterinary Laboratory utilize simple physical security measures such as the use of biometrics to "prevent access to biological specimens by unauthorized people," there is no indication that it mandates standardized trainings. ¹¹⁴ The Veterinary Public Health Act (2013) includes provisions for adopting "control measures" when creating animal products for human consumption in order to contain animal diseases and prevent the spread of contagious diseases to humans, including taking precautionary measures when introducing new animals to farms and reporting incidences of disease, but there is no indication of a specific training required of personnel working in these facilities. ¹¹⁵ The Swaziland Health Laboratory Services also supply "[t]raining and education; oversee provision and facilitation of training courses and workshops for staff in both private and public sector laboratory, developing the knowledge and skills essential for providing quality services across medical, environmental, and public health laboratories," but there is no indication that this training is standardized or regularized. ¹¹⁶ According to the World Organisation for Animal Health (OIE) Performance for effective Veterinary Services (PVS) mission report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," but there is no publicly available evidence of these measures. ¹¹⁷ The Fleming Fund Country Grant to Eswatini, which is running from Mar 2020 – Sep 2021, and focuses on "strengthening surveillance systems for antimicrobial resistance (AMR), antimicrobial use (AMU), and antimicrobial consumption (AMC)", includes in its aims "appropriate training and monitoring systems for biosafety and biosecurity." There is no indication, however, if this training is standardized or has become a national requirement. ¹¹⁸ There is no additional information regarding biosecurity training in Eswatini through the Ministry of Health, the Ministry of Agriculture or on the VERTIC Legislation Database. ^119120121 The Ministry of Defence has no online presence and there is no existing Public Health Institute. The African Society for Laboratory Medicine reported in May 2025 that, between 12 and 16 May 2025, Eswatini officially launched the legal mapping and domestication planning process under the Africa Centres for Disease Control and Prevention (Africa CDC)-led Biosafety and Biosecurity Initiative (BBI), which lists "Establishing recognized professional training and certification programs in BSBS (biosafety and biosecurity)" as one of its core priorities. However, no evidence of biosafety and biosecurity trainings are available. ¹²²

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence of regulations or licensing conditions that specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing, background checks, and psychological and mental fitness checks. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has acceded to the Biological and Toxic Weapon Convention (BWC), the Cartagena Protocol on Biosafety, and the Convention on Biological Diversity. In additional Eswatini's Biosafety Act of 2012 was amended in 2017 to include biosafety regulations. There is, however, no evidence of biosecurity legislation or licensing conditions in place for personnel with access to facilities in which especially dangerous pathogens or toxins are stored besides the use of biometrics "to prevent access to biological specimens by unauthorized people." ¹²³ The Veterinary Public Health Act (2013) includes provisions for adopting "control measures" when creating animal products for human consumption in order to contain animal diseases and prevent the spread of contagious diseases to humans, including taking precautionary measures when introducing new animals to farms and reporting incidences of disease, but there is no indication of specific regulations. ¹²⁴ According to the World Organisation for Animal Health (OIE) Performance for effective Veterinary Services (PVS) mission report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," but there is no publicly available evidence of these measures. ¹²⁵ There is no additional information regarding legislation or regulations related to personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential in Swaziland through the Ministry of Health, Ministry of Agriculture, Swaziland Health Laboratory Services, the Swazi Legal Information Institute or on the VERTIC Legislation Database. ^{126127128129130} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹³¹

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

There is publicly available evidence of national regulations on the safe and secure transport of infectious substances in Eswatini. The National Health Care Waste Management Guidelines, published in 2013, provides guidance and standard operating procedures for the handling of medical waste, including the proper disposal and transportation of Category A and Category B infectious substances in the section 3.3 Waste Handling, Collection, Storage and Transport. This guidance also includes packaging regulations in the section 3.5 Packaging and other best practices. ¹³² The Laboratory Waste Management Guidelines, published in 2013, also provides guidance on packaging chemical wastes in its Section 6.3. ¹³³ There is no additional information regarding the safe and secure transport of infectious substances through the Ministry of Health, Ministry of Agriculture, the Ministry of Public Works and Transport, the Swaziland Health Laboratory Services, or on the VERTIC Legislation Database. ^{134135136137138} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹³⁹

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Eswatini has national legislation, regulation, or other guidance in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has the National Sample Transport System, "a good sample/specimen transport system with dedicated vehicles managed by staff trained in specimen referral and laboratory testing systems for priority diseases." ¹⁴⁰ A courier system is used by the national laboratory to transport infectious substances which is "excellent," but transportation of specimens outside the country for advanced diagnostic testing has been dependent on World Health Organisation (WHO) financial support which was coming to an end in the near future. ¹⁴¹ Additionally, there is no information regarding cross-border transfer of specimens through the Swaziland Health Laboratory Services "National Sample Transportation System (NSTS) Policy and Procedure Manual," dated January 2016, or a focus on the screening of samples containing especially dangerous pathogens and toxins. ¹⁴² There is no additional information regarding national legislation or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential through the Ministry of Health, Ministry of Agriculture, Ministry of Public Works and Transport, Swaziland Health Laboratory Services, or on the VERTIC Legislation Database. ^{143144145146147} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹⁴⁸ The Ministry of Defence has no online presence.

1.4.1a Biosafety laws/regulations

Score: 0

There is insufficient evidence that Eswatini has national biosafety legislation and regulations in place. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini's Biosafety Act of 2012 has been implemented, and subsequently amended to the Biosafety Amendment Act, 2020. ^149150151 This Act empowers the Eswatini Environment Authority to be the national focal point for biosafety and establishes the National Biosafety Advisory Committee to provide guidance to relevant stakeholders. The Act as well as the Draft Biosafety Regulation 2023, however, are specific to genetically modified organisms (GMOs). ^152153154 The JEE also states that the National Reference Laboratory and Central Veterinary Laboratory maintain biosafety containment levels and other physical safety procedures, such as biometric access to their facilities. It notes "Some elements of biosecurity have been incorporated into the biosafety regulations. However, the focus is primarily limited to agricultural interests". ¹⁵⁵ There is no other evidence of biosafety legislation through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services, the Swaziland Legal Information Institute or on the VERTIC Legislation Database. ^{156157158159160} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹⁶¹ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that Eswatini has biosecurity legislation and regulations let alone that it has an established agency responsible for the enforcement of such regulations/legislations. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini's Biosafety Act of 2012 has been implemented, and subsequently amended to the Biosafety Amendment Act, 2020. ^162163164 This Act empowers the Eswatini Environment Authority to be the national focal point for biosafety and establishes the National Biosafety Advisory Committee to provide guidance to relevant stakeholders. The Act as well as the Draft Biosafety Regulation 2023, however, are specific to genetically modified organisms (GMOs). ^165166167 The JEE also states that the National Reference Laboratory and Central Veterinary Laboratory maintain biosafety containment levels and other physical safety procedures, such as biometric access to their facilities. It notes "Some elements of biosecurity have been incorporated into the biosafety regulations. However, the focus is primarily limited to agricultural interests". ¹⁶⁸ There is no other evidence of biosafety legislation through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services, the Swaziland Legal Information Institute or on the VERTIC Legislation Database. ^{169170171172173} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹⁷⁴ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute.

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Eswatini requires biosafety training, using a standardized, required approach for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has the Biosafety Act of 2012 (1) and a number of biosafety containment procedures in place that are organized by the Biosafety Advisory Committee. Training on biosafety is conducted at the national laboratory level and within public health units, but there is no indication of specific procedures that are standardized and regularized. The report notes that "Training on biosafety and biosecurity is not available to all laboratory staff (public health and animal health), including management and support staff." The report also states that while the National Reference Laboratory and Central Veterinary Laboratory utilize simple physical security measures such as the use of biometrics to "prevent access to biological specimens by unauthorized people," there is no indication that it mandates standardized trainings. ¹⁷⁵ The National Health Care Waste Management Guidelines, published in 2013, provides standard operating procedures for handling medical waste, including guidance on the categories of biohazard, but there is no indication that this training is standardized or required. ¹⁷⁶ The Veterinary Public Health Act (2013) includes provisions for adopting "control measures" when creating animal products for human consumption in order to contain animal diseases and prevent the spread of contagious diseases to humans, including taking precautionary measures when introducing new animals to farms and reporting incidences of disease, but there is no indication of a specific training required of personnel working in these facilities. ¹⁷⁷ The Swaziland Health Laboratory Services also supply "[t]raining and education; oversee provision and facilitation of training courses and workshops for staff in both private and public sector laboratory, developing the knowledge and skills essential for providing quality services across medical, environmental, and public health laboratories," but there is no indication that this training is standardized or regularized. ¹⁷⁸ According to the World Organisation for Animal Health (OIE) Performance for effective Veterinary Services (PVS) mission report, published in September 2007, the Ministry of Agriculture Department of Veterinary and Livestock Services has "implemented biosecurity measures that enable it to establish and maintain a disease free zone for selected animals and animal products, as necessary," but there is no publicly available evidence of these measures. ¹⁷⁹

There is no additional information regarding biosecurity training in Eswatini through the Ministry of Health, the Ministry of Agriculture or on the VERTIC Legislation Database. ^180181182 The Ministry of Defence has no online presence and there is no existing Public Health Institute. The African Society for Laboratory Medicine reported in May 2025 that, between 12 and 16 May 2025, Eswatini officially launched the legal mapping and domestication planning process under the Africa Centres for Disease Control and Prevention (Africa CDC)-led Biosafety and Biosecurity Initiative (BBI), which lists "Establishing recognized professional training and certification programs in BSBS (biosafety and biosecurity)" as one of its core priorities. However, no evidence of biosafety and biosecurity trainings are available. ¹⁸³

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Eswatini has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, or pathogens with pandemic potential or other dual use research. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has ratified the Biological Weapons Convention and Suppression of Terrorism Act (2008), but it is not clear which ministries are responsible for implementing it. ¹⁸⁴ There is no additional information regarding whether Eswatini has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, or pathogens with pandemic potential or other dual use research through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services or on the VERTIC Legislation Database. ^185186187188 Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹⁸⁹ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that Eswatini has a national policy requiring oversight of dual use research, such as research on especially dangerous pathogens, toxins, or pathogens with pandemic potential. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has ratified the Biological Weapons Convention and Suppression of Terrorism Act (2008), but it is not clear which ministries are responsible for implementing it or to what extent it requires oversight over dual use research. ¹⁹⁰ The Biosafety Act of 2012 addresses "mechanisms for ensuring the safe handling, transfer and use of products of biotechnology," but there is no indication that it governs dual use research. ¹⁹¹ There is no additional information regarding whether Eswatini requires such oversight through the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services or on the VERTIC Legislation Database. ^192193194195 Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ¹⁹⁶ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute.

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence that Eswatini has an agency responsible for oversight over research with especially dangerous pathogens, pathogens with pandemic potential, or other dual use research. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has ratified the Biological Weapons Convention and Suppression of Terrorism Act (2008), but it is not clear which ministries are responsible for implementing it or to what extent it requires oversight over dual use research. Furthermore, it does not appear that other existing working groups which cover aspects of biosafety and biosecurity (e.g. the National Codex Committee, National Sanitary and Phytosanitary Committee (comprising Animal Health OIE; Plant Health; International Plant protection Convention (IPPC)) are responsible for addressing biosecurity concerns. ¹⁹⁷ The Biosafety Act of 2012 empowers the Eswatini Environment Authority to be the national focal point for biosafety and establishes Biosafety Advisory Committee to provide guidance to relevant stakeholders. There is, however, no publicly available evidence of this organisation. Additionally, while it addresses "mechanisms for ensuring the safe handling, transfer and use of products of biotechnology," there is no indication that it governs dual use research. ¹⁹⁸ Under the terms of The Environment Management Act of 2002, the Ministry of Agriculture is responsible for classifying "hazardous substances," managing the licensing to use toxic and hazardous substances, and issuing other regulations regarding hazardous waste, but there is no indication that this includes pathogens with pandemic potential. ¹⁹⁹ There is no additional information available on the websites of the Ministry of Health, Ministry of Agriculture, the Swaziland Health Laboratory Services or the VERTIC Legislation Database. ^200201202203 Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ²⁰⁴ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute. There is no evidence that the Eswatini Health and Human Research Review Board (EHHRRB), an independent body within the Ministry of Health that regulates health research ethics and approves all health research conducted in the country, has oversight over research involving especially dangerous pathogens, pathogens with pandemic potential, or other dual-use research.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Eswatini has legislation, regulation, policy, or other guidance that requires the screening of synthesized DNA before it is sold. The Biosafety Act of 2012, in part, provides for "the safe handling, transfer and use of genetically modified organisms," but there is no indication that it governs the use of synthesized DNA. ²⁰⁵ There is no other information regarding a legislation, regulation, policy, or other guidance that requires the screening of synthesized DNA before it is sold in Eswatini through the Ministry of Health, Ministry of Agriculture, Swaziland Health Laboratory Services, the Swazi Legal Information Institute or on the VERTIC Legislation Database. ^{206207208209210} Eswatini is a party to the Biological Weapons Convention (BWC), and the country has submitted a Confidence Building Measures report in accordance with decisions of BWC Review Conferences on 12 February 2025. Although the report is not available on the website of the Biological Weapons Convention (BWC) or elsewhere online, it was noted that there is "Nothing to declare" by the country to the BWC. ²¹¹ Neither of the Ministry of Defence or the national laboratory system have an online presence, and there is no existing Public Health Institute.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

There is no publicly available data on official foot-and-mouth disease (FMD) vaccination figures for livestock in Eswatini in the OIE database, on its FMD-specific webpage, or through the WOAH/FAO Reference Laboratory Network for Foot-and-Mouth Disease. ^212213214

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

There is no publicly available evidence that Eswatini has a national immunization strategy/plan, let alone that it includes a plan to ensure equitable distribution or strategies specifically aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination. Neither the Joint External Evaluation (JEE) conducted in April 2018, nor the National Health Sector Strategic Plan 2024/25 – 2027/2028 published in August 2024 mentioned any national plan/strategy specifically dedicated to immunization. ²¹⁵²¹⁶ There is no other information regarding such a plan or strategy through the Ministry of Health, Ministry of Agriculture, nor the Swaziland Health Laboratory Services. ^217218219

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

There is no publicly available evidence that Eswatini has a national immunization strategy/plan, let alone that it includes measures to address vaccine hesitancy and build public trust in vaccines. Neither the Joint External Evaluation (JEE) conducted in April 2018, nor the National Health Sector Strategic Plan 2024/25 – 2027/2028 published in August 2024 mentioned any national plan/strategy specifically dedicated to immunization. ²²⁰²²¹ There is no other information regarding such a plan or strategy through the Ministry of Health, Ministry of Agriculture, nor the Swaziland Health Laboratory Services. ^222223224

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government in Eswatini. According to the WHO's National Immunization Advisory Mechanism, except for 2022, from 2020 to 2024, Eswatini has a standing technical advisory group on immunization (NITAG). ²²⁵ The 2023 WHO Eswatini Annual Results Report states that "the Ministry of Health in Eswatini established the Eswatini National Immunization Technical Advisory Group (ESWANITAG) in 2017, gaining cabinet approval in 2021". ²²⁶

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no publicly available evidence that the country has an immunization programme for Influenzae. According to the Ministry of Health, the Swaziland Expanded Programme on Immunization (SEPI) focuses on preventing childhood vaccine preventable diseases, among them is Haemophilus Influenzae Type B diseases. SEPI is composed of five components, including Programme Management, Service Delivery, Disease surveillance & control. Vaccine supply and cold chain, and Advocacy, communication and social mobilization. ²²⁷ No information regarding an immunization programme for Influenzae is available on the websites of the Ministry of Health, Ministry of Agriculture, nor the Swaziland Health Laboratory Services or media articles. ^228229230

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is no publicly available evidence that Eswatini has a dedicated strategy or plan to develop a health system explicitly framed as resilient to climate change and evolving infectious disease threats, though related initiatives and policies indicate some progress in this direction. The Initial Adaptation Communication to the United Nations Framework Convention on Climate Change (2021) lists various national health sector adaptation measures in Table 4, linking them to the SDGs and Sendai Framework targets, but does not mention any specific plan issued by health sector authorities. ²³¹ More recently, the National Health Sector Strategic Plan 2024/25 – 2027/2028 published in August 2024 includes, in Table 22 on page 69, the objective of enhancing climate risk mitigation along with corresponding priority strategic interventions. ²³²

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

There is no publicly available evidence that the national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests. There is evidence that Eswatini has the capacity to conduct 3 out of six testing methods selected according to the IHR immediately notifiable list and the WHO Top Ten Causes of Death in low-income countries, including polymerase chain reaction (PCR) testing for Influenzae virus, serology for HIV, and rapid diagnostic testing for plasmodium spp.

According to a June 2024 media article, in Eswatini, "Influenzae A is diagnosed through a PCR test," but which means that the country is capable of PCR testing for Influenzae virus. ²³³ In section 5.9 Basic package of care for children and adolescents living with HIV, on page 86, the 2022 Integrated HIV Management Guidelines mentions that the country has the capacity to conduct "Syphilis serology for sexually active or pregnant adolescent". ²³⁴ The country has the capacity to conduct rapid diagnostic testing for plasmodium spp. as per an academic research published in 2017, it is stated in the Summary that "In a low-endemicity/malaria elimination setting, we demonstrate limited sensitivity of Plasmodium falciparum–specific rapid diagnostic testing for suspected malaria". ²³⁵

From the Eswatini Health Laboratory Service (EHLS)'s website, the National TB Reference Laboratory offers the following test menu: Culture (MGIT 960 liquid culture), Smear microscopy, Drug Susceptibility Testing (DST) (First Line(FL) and Second Line(SL) Drug Susceptibility Testing (DST) (First Line(FL) and Second Line(SL) & Line Probe Assay(LPA) (FL and SL LPA). The National Referral Laboratory, Central Laboratory offers the following testing menu: Clinical chemistry, Flow cytometry (CD4), and Immunochemistry, Serology testing and other tests relevant to medicine and/or disease surveillance to physicians, health care providers, and epidemiologists for the benefit of the patient and population. As part of the diagnostic service, Regional Hospital Laboratories and Health Centre Laboratories offer the following testing menue: clinical chemistry, bacteriology, parasitology, Tuberculosis microscopy and GeneXpert, Haematology Testing and other tests relevant to medicine and/or disease surveillance to physicians, health care providers, and epidemiologists for the benefit of the patient and population. The catchment area is not limited to the Hospital only, the services are also offered to peripheral facilities namely; Tuberculosis Clinic, Voluntary Counselling Testing/Ant-Retroviral Therapy Centre and the Public Health Unit. ²³⁶ Among six testing methods selected according to the IHR immediately notifiable list and the WHO Top Ten Causes of Death in low-income countries, it appears that the EHLS is capable of conducting only the Tuberculosis microscopy, however, there is no evidence that EHLS is capable of conducting microscopy for mycobacterium tuberculosis.

No publicly available evidence is found that Eswatini has the capacity to conduct virus culture for poliovirus, microscopy for mycobacterium tuberculosis and bacterial culture for Salmonella enteritidis serotype Typhi.

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a national plan, strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing. No mention of any of these three criteria is made in the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, the websites of the Ministries of Health or Agriculture or Emergency Preparedness and Response (EPR), the 2018 Development of Swaziland's National Antimicrobial Resistance Containment Strategic Plan, the 2020 National Contingency Plan for Novel Coronavirus, the National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020 or the Eswatini Health Laboratory Services Strategic Plan (2021-2023). ^{237238239240241242243244} There is no existing Public Health Institute.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is a national laboratory that serves as a reference facility which is accredited. According to the HIV/AIDS Network Coordination, the Eswatini Health Laboratory Service is accredited with the Southern African Development Community Accreditation Service (SADCAS), though no specific type of accreditation was specified. ²⁴⁵ In its website, the Eswatini Health Laboratory Service states that it complies with the ISO 15189.²⁴⁶

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is a national laboratory in Eswatini that serves as a reference facility which is subject to external quality assurance review. The website of the Eswatini Health Laboratory Service (EHLS) mentions that it provides "reliable test results through internal and external quality assurance" though no further details are provided. ²⁴⁷ On page 25, the National Strategic Plan for The Prevention and Control of Non-Communicable Diseases (NCD) 2021 – 2023 report states that the "EHLS has a quality unit that coordinates External Quality Assurance activities", including producing External Quality Assurance (EQA) panels, distributing them to testing facilities, and managing registration, distribution, and reporting for EQA from external sources. It also oversees reagent quality assurance, post-market surveillance, mentorship, training and competency programs, and laboratory document control. ²⁴⁸

2.2.1a Nationwide specimen transport system

Score: 100

There is publicly available evidence that Eswatini has a nationwide specimen transport system in place. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has the National Sample Transport System, "a good sample/specimen transport system with dedicated vehicles managed by staff trained in specimen referral and laboratory testing systems for priority diseases." The report also states that although the national laboratory has an "excellent" courier system in place for specimen transport, transportation of specimens outside the country for advanced diagnostic testing has been dependent on WHO financial support, which will be ending in the near future. Additionally, there is no dedicated transport system in place for veterinary specimens like that used for public health facilities. ²⁴⁹ The Eswatini Health Laboratory Service's website states that the National Sample Transportation System (NSTS) is a government managed sample transportation system that creates a link between the laboratories and health facilities aiming to improve health care service delivery by increasing access to laboratory diagnostics through provision of an effective laboratory sample transportation system in The Kingdom of Eswatini. ²⁵⁰ There is no additional evidence regarding a nationwide specimen transport system through the Ministry of Health or the Ministry of Agriculture. ²⁵¹²⁵²

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no publicly available evidence that Eswatini has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. There is no information through the Ministries of Health or Agriculture, the Eswatini Health Laboratory Service, the Joint External Evaluation report (JEE) for Eswatini, conducted in April 2018, the 2020 National Contingency Plan for Novel Coronavirus (Eswatini) or the Eswatini Health Laboratory Services Strategic Plan (2021-2023). ^{253254255256257258}

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is publicly available evidence that Eswatini conducts event-based surveillance and analysis for infectious disease, but it is unclear whether this data is being analysed on a daily basis. According to the Joint External Evaluation (JEE), conducted in April 2018, Indicator D.2.1 Indicator- and event-based surveillance systems are scored 4. On pages 25 and 26 of the report, it is stated that indicator and event based surveillance systems are operational for both animal health and public health sectors at all levels in Eswatini, with the adoption of the Integrated Diseases Surveillance and Response (IDSR) in 2012. The event-based surveillance system relies on a morbidity register, patient care files, department daily reports, a client management information system, a laboratory information system, health workers and members of the public to make use of immediate disease notification system. Although there are daily department reports, it is unclear whether this surveillance data is being analysed on a daily basis. ²⁵⁹ There is no other evidence of an event-based surveillance system in Eswatini through the Ministry of Health, Ministry of Agriculture, the Eswatini Health Laboratory Services or in the 2020 National Contingency Plan for Novel Coronavirus. ^260261262263

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is available evidence of a mechanism (such as IHR focal point) but there is no evidence of it being used for reporting notifiable diseases to the WHO within the set timeline. According to the Joint External Evaluation (JEE), conducted in April 2018, "a fully staffed IHR National Focal Point (NFP) Secretariat has been established and operates continuously". ²⁶⁴ An article by the World Health Organization (WHO) dated 9 October 2024 reports that there is "strong technical leadership by the IHR focal point", indicating the IHR focal point is still active in the country by 2024. ²⁶⁵ However, there is no evidence that the country reports notifiable diseases to the WHO within the set timeline through an IHR focal point or other types of mechanism through the Joint External Evaluation (JEE), the the Ministry of Health, Ministry of Agriculture, the Eswatini Health Laboratory Services. ^266267268269

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

There is insufficient evidence that Eswatini currently operates an electronic reporting surveillance system at both the national and sub-national level. According to the Joint External Evaluation (JEE), conducted in April 2018, indicator and event-based surveillance systems are operational for both animal health and public health sectors at all levels in Eswatini. Indicator-based surveillance through the CMIS gathers information from regional officers and aggregates that data to submit to the national office. ²⁷⁰ The Swaziland Livestock Information and Traceability System (SLITS), a system relying on both paper and electronic data, which gathers animal health epidemiological data from individual owners, sub-regional offices, four regional offices, and the national level epidemiology unit, also integrates data coming from meat inspections, laboratory services, quarantine stations and points of entry. ²⁷¹²⁷² The Ministry of Health Emergency Preparedness and Response (EPR) Department "coordinates and delivers pre-hospital medicine, epidemic preparedness and response and disaster risk management for health to victims of sudden and serious illness or injury," including pandemic events, but it does not appear to have an electronic reporting system in place. ²⁷³ There is no other information regarding an electronic reporting surveillance system through the Eswatini Health Laboratory Services. ²⁷⁴

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no publicly available evidence that there is an electronic event-based surveillance system in Eswatini that collects ongoing, real-time laboratory data. According to the Joint External Evaluation (JEE), conducted in April 2018, indicator and event-based surveillance systems are operational for both animal health and public health sectors at all levels in Eswatini. Indicator-based surveillance through the CMIS gathers information from regional officers and aggregates that data to submit to the national office. ²⁷⁵ The Swaziland Livestock Information and Traceability System (SLITS), a system relying on both paper and electronic data, which gathers animal health epidemiological data from individual owners, sub-regional offices, four regional offices, and the national level epidemiology unit, also integrates data coming from meat inspections, laboratory services, quarantine stations and points of entry. ²⁷⁶²⁷⁷ The Ministry of Health Emergency Preparedness and Response (EPR) Department "coordinates and delivers pre-hospital medicine, epidemic preparedness and response and disaster risk management for health to victims of sudden and serious illness or injury," including pandemic events, but it does not appear to have an electronic reporting system in place. ²⁷⁸ There is no other information regarding an electronic reporting surveillance system through the Eswatini Health Laboratory Services. ²⁷⁹

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 4 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²⁸⁰ According to a 2023 Facebook post by WHO, "Eswatini has established its first 4 environmental surveillance sites which help monitor potential poliovirus transmission in humans by examining sewage or wastewater samples — a significant milestone for polio eradication in Africa.".²⁸¹

Moreover, in 2022, the WHO reported that while Eswatini had established AFP surveillance, the country still needs to establish environmental surveillance to ensure that the detection of cases is improved.²⁸²

According to the WHO, expansion of environmental surveillance in the African Region in 2023 resulted in the initiation in four additional countries, (Eswatini, Mauritius, Seychelles and Zimbabwe). However, there is no further information about this.²⁸³

2.4.1a Common usage of electronic health records

Score: 100

There is publicly available evidence that electronic health records are commonly in use in Eswatini. According to the Joint External Evaluation (JEE), conducted in April 2018, on page 25, Eswatini utilizes the CMIS for public health records, which aims to encourage better data accuracy and interoperability between public and private clinics. ²⁸⁴ On page 29 of the 2022-2023 Eswatini Biennial Report, the WHO states that "Eswatini utilises an Electronic Client Management Information System (CMIS) to track individual testing history, clinical care, and prevention services across health care facilities." ²⁸⁵ An article by FEI Systems states that by March 2022, the CIMS had been actively used at 219 of the national health care facilities, both urban and remote, to help facilitate the care of more than 1.3 million registered patients. ²⁸⁶ As per World Population Review, Eswatini's population is 1.3 million. ²⁸⁷ A 15 April 2025 news article notes that the CMIS is currently functioning optimally, and now operational in over 80% of health care facilities across the country, reaching over 200 facilities across all regions. ²⁸⁸

2.4.1b Public health system access to individual electronic health records

Score: 100

There is publicly available evidence that the national public health system has access to electronic health records of individuals in Eswatini. According to a report dated 2017, on page 7, the country uses the Client Management Information System (CMIS) as the standard Electronic Health Records (EHR) system. ²⁸⁹ The CMIS project, backed by the Global Fund, USAID, and MEASURE Evaluation, aimed to tackle Swaziland’s prevalent HIV epidemic. The CMIS leverages national identification numbers and unique patient identifiers to facilitate accurate patient identification. ²⁹⁰ According to the Eswatini Communications Commission, the CMIS, managed by the Eswatini Ministry of Health, has been implemented in over 220 health facilities nationwide, ensuring that health workers across regional and local levels can access patient data and health care information. ²⁹¹

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that there are data standards in Eswatini to ensure data is comparable (e.g., ISO standards). According to a report by Measure Evaluation dated 2017, on page 7, the country uses the Client Management Information System (CMIS) as the standard Electronic Health Records (EHR) system. ²⁹² Beside the CMIS, Eswatini’s District Health Information Software 2 (DHIS2) implementation forms the backbone of the country’s routine health data infrastructure. As of late 2024, the Kingdom has actively integrated DHIS2 across the health sector to enhance data capture, utilization, and management at national and subnational levels. ²⁹³ There is no evidence that either or both the CMIS or DHIS2 follow data standards is found through the reports of the WHO 2024 Q4 Eswatini Newsletter, Country Cooperation Strategy 2022–2026 Eswatini, Eswatini's Digital Transformation: Progressing Systematically Towards a Digital Future, Eswatini Country Operational Plan (COP) 2023 Strategic Direction Summary, Eswatini 2024 Annual Report, WHO 2022-2023 Eswatini Biennial Report or on the websites of the Ministry of Health, Ministry of Agriculture, nor the Swaziland Health Laboratory Services or media articles. ^294295296

2.4.2a Data sharing mechanisms

Score: 0

There is evidence that Eswatini has established mechanisms for multi sector data sharing across human and animal health surveillance systems, however, integration with wildlife data remains limited. Since 2016, Eswatini has maintained an AMR Containment Committee that brings together the Ministry of Health, Ministry of Agriculture, Ministry of Natural Resources and Energy, WHO, and Food and Agriculture Organization (FAO) to collaboratively address antimicrobial resistance. ²⁹⁷ According to a reseach in 2017, the Epidemiology and Disease Control Unit (EDCU) is mandated to coordinate efforts and strengthen public health surveillance through implementing Integrated Disease Surveillance and Response (IDSR) to fulfill requirements of International Health Regulations (2005) (IHR[2005]), and the Global Health Security Agenda (GHSA). ²⁹⁸ The IDSR system provides coordinated, comprehensive and integrated surveillance system for all diseases, health conditions and events to improve early detection and response strategies to attain health for all people using the One Health Approach. ²⁹⁹ However, there is no further evidence that the IDSR system include surveillance for multi sector data sharing across animal, human, and wildlife sectors found from the websites of Ministry of Health, Ministry of Agriculture, nor the Epidemiology and Disease Control Unit (EDCU). ^300301302

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is evidence that Eswatini makes de-identified health surveillance data on disease outbreaks publicly available via reports on government websites. According to page 28 of the Joint External Evaluation (JEE), conducted in April 2018, the Ministry of Health reports daily cases of infectious disease through the Immediate Disease Notification System (IDNS) while monthly reporting is through the Health Management Information System (HMIS), resulting in weekly and monthly bulletins. "For case identification, a standard immediate disease notification system (IDNS) form has been developed; health facilities/practitioners are required to fill this in and thereafter call the 977 hotline to report to the IDNS database and consult on further steps to be taken. The information fed into the I[D]NS database is then communicated to the relevant task forces and units, such as the Regional Epidemic Task Force (RETF), Emergency Preparedness and Response Unit (EPRU), the Health Management Information System (HMIS) and the Epidemiology and Disease Control Unit (EDCU)." ³⁰³ The Swaziland Livestock Information and Traceability System (SLITS) conducts animal health surveillance, tracking, and identification, but it does not appear that this information is de-identified or made public. ³⁰⁴ There is no other evidence of de-identified health surveillance data through the Ministry of Health, Ministry of Agriculture, the Epidemiology & Disease Control Unit, or the Eswatini Health Laboratory Services. ^305306307308

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is evidence that Eswatini has a legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals. Enacted on 4 March 2022, the Data Protection Act, 2022 (No. 5 of 2022) governs the collection, processing, storage, and disclosure of personal data, explicitly including health information as a form of "sensitive personal data". The Article 22 under the Part II. Processing of personal information addresses the "prohibition against processing of sensitive personal information", stating that "Unless specifically permitted under this Act, a data controller shall not process sensitive personal information". ³⁰⁹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

Though Eswatini has a legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, there is no evidence that the legislation include mentions of protections from cyber attacks (e.g., ransomware). The Data Protection Act, 2022 (No. 5 of 2022) does not include anything regarding protection from cyber attacks. ³¹⁰ The Eswatini Data Protection Authority (EDPA), charged with the mandate to administer and foster compliance under the Data Protection Act, 2022, designates the Eswatini Communications Commission as the National Data Protection Authority (EDPA) to regulate how personal information is handled, investigate breaches in the handling of information, and resolve any complaints relating to data breaches. ³¹¹ Although not a law or regulation, Eswatini has adopted a National Cybersecurity Strategy 2022–2027, which includes Specific Objective 4.2 aimed at “creating a secure environment for e-government services in Eswatini.” The strategy outlines the government’s commitment to addressing risks associated with e-government and e-commerce services, including those related to data confidentiality for users and organizations. ³¹² No relevant information or legislation is available in the websites of the Eswatini Data Protection Authority (EDPA), the Eswatini Communications Commission, or the Swaziland Legal Information Institute (SWAZILII). ^313314315

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no publicly available evidence that the government of Eswatini has made a commitment via public statements, legislation, or other agreements to share surveillance data on one, or more, diseases during a public health emergency with other countries in the region.

Eswatini participates in the South African Development Community (SADC), an international body that encourages economic opportunity in Southern Africa, including the sharing of health research and surveillance information. ³¹⁶ According to the SADC Protocol on Health (1999), member states are obliged to "(i) co-operate and assist each other in the co-ordination and management of disaster and emergency situations; (ii) collaborate and facilitate regional efforts in developing awareness, risk reduction, preparedness and management plans for natural and man-made disasters; and (iii) develop mechanisms for co-operation and assistance with emergency services." However, there is no indication that this general commitment has been transferred into a concrete plan for active cooperation during an emergency. ³¹⁷ According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, Eswatini is a member state of the International Health Regulations (IHR), and also participates in the Global Outbreak Alert and Response Network, which is intended to "pool human and technical resources for rapid identification, confirmation and response to outbreaks of international importance," and the African Union – Interafrican Bureau for Animal Resources (AU-IBAR), but it is unclear if this effort includes public health emergency response. ^318319320 There is no other evidence of the government of Eswatini making public commitments to share surveillance data during a public health emergency through the Ministry of Health, Ministry of Agriculture, or the Eswatini Health Laboratory Services. ^321322323 There is no existing Public Health Institute.

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a national system in place to provide support at the sub-national level (e.g. training, metrics standardization and/or financial resources) to conduct contact tracing in the event of an active or future public health emergency. The 2020 National Contingency Plan for Novel Coronavirus (Eswatini) states that "surveillance objectives focus on rapid detection of imported cases, comprehensive and rapid contact tracing, and case identification. In a scenario in which sustained community transmission has been detected, objectives expand to include monitoring the geographical spread of the virus, transmission intensity, disease trends, characterization of virologic features, and the assessment of impacts on health care services." Furthermore, under an 'Implementation framework' header, guidelines for enhancing contact tracing include "Adapt/domesticate and implement existing WHO guidelines and SOPs for contact tracing". This plan is, however, both disease and event specific. ³²⁴ There is no further information through the Ministry of Health, the National Disaster Management Department (NDMD), the Eswatini Health Laboratory Service, the USAID's Eswatini Public Health Emergency Operations Centre PHEOC, or the Public Health Emergency Operations Centre. ^325326327328 There is no existing Public Health Institute.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is insufficient publicly available evidence that Eswatini provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention. A Ministry of Labour and Social Security statement, dated 8 April 2020, contains many mitigating measures regarding job and salary retention which employers "are to consider", but this is not compulsory, nor is there any commitment by the Eswatini government. ³²⁹ An Independent Online (IOL) article, dated 24 March 2020, quotes King Msawti III on some tax and other financial relief measures to be put in place, but these cannot qualify as comprehensive 'wraparound' services. ³³⁰ A July 2020 International Monetary Fund (IMF) Request for Purchase Under the Rapid Financing Instrument (RFI), commits USD 110.4 million to address the COVID-19 Pandemic in Eswatini, but there is no specific mention of this being used for wraparound services. ³³¹ Nothing further on wraparound services could be found on the Ministry of Health website, the Eswatini Health Laboratory Service website, in the 2020 National Contingency Plan for Novel Coronavirus (Eswatini) or the Eswatini Covid-19 Emergency Response Project (P173883). ^332333334335 There is no existing Public Health Institute.

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence of a joint plan or cooperative agreement between the Eswatini public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of an active or future public health emergency. The Joint External Evaluation (JEE), conducted in April 2018, states that public health coordinates with the Ministry of Agriculture, Ministry of Home Affairs (border control) and the Royal Eswatini Police Service as well as the customs officials at points of entry, but there is no MoU in place between public health and security authorities. ³³⁶ The 2020 National Contingency Plan for Novel Coronavirus includes in its guidance "Enhance health surveillance measures at POE by referring febrile inbound travellers with or without other symptoms and had travel history to the affected area(s) to public hospitals for isolation and further management; Closely follow the WHO's recommendations on port health measures." However this does not constitute a joint plan. ³³⁷ Nothing further could be found on the web pages of the Ministry of Health or the Ministry of Home Affairs, or the Measures To Be Taken Following The National Emergency Declaration. ^338339340

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Eswatini does not have an applied epidemiology training program (such as FETP) available in country but it does provide resources to send citizens across regions to participate in applied epidemiology training programs (such as FETP). According to the Joint External Evaluation (JEE), conducted in April 2018, there is no Field Epidemiology Training Program (FETP) or other applied epidemiology training programmes in Eswatini. ³⁴¹ There is no mention of Eswatini in the website of the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), a global professional network of Field Epidemiology Training Programs (FETPs). ³⁴² While the country does not host its own full in-country applied epidemiology training program (like a stand-alone Field Epidemiology Training Program, FETP), the government supports and provides resources for citizens to participate in regional training initiatives. Eswatini engages in regional Field Epidemiology Training Program (FETP) activities in June 2025 through AFENET (African Field Epidemiology Network). ³⁴³ The U.S. Centers for Disease Control and Prevention (CDC), through its programs in Eswatini, has supported the Ministry of Health in strengthening disease detection skills via FETP. This suggests that the country allocates resources for training health workers in applied epidemiology through regional or international programs. ³⁴⁴

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is evidence that Eswatini actively includes animal health professionals in its applied epidemiology training through fellowship programs though it does not host a standalone animal health Field Epidemiology Training Program for Veterinarians (FETPV) in-country. Under the Fleming Fund professional fellowship scheme, Eswatini’s Ministry of Health's Epidemiology Unit, Department of Veterinary and Livestock Services conduct AMR Surveillance Fellowship, aimed at strengthening epidemiology skills and surveillance systems in the animal sector. ³⁴⁵ Additionally, regional One Health Field Epidemiology Training Programs (One Health FETP) are being implemented. In June 2025, Eswatini participated in a One Health FETP Mentor of Trainers Workshop, which brought together mentors from the human, animal, and environmental health sectors.³⁴⁶

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is public evidence that the country has at least 1 trained field epidemiologist per 200,000 people. The National Coronavirus Disease (Covid-19) Resurgence Plan August 2021 – January 2022, published in 2021, mentioned the names of the Ministry of Health three trained field epidemiologist.³⁴⁷ A Facebook post in May 2025 of the Ministry of Health reported the graduation of 30 health workers who undertook the Field Epidemiology Training Programme (FETP) for frontline workers.³⁴⁸ As per World Population Review, Eswatini's population is 1.3 million. This means that with 33 trained field epidemiologists, the ratio is around 5 field epidemiologists per 200,000 people.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

There is evidence that Eswatini has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has a National Disaster Management Agency (NDMA) established by the Disaster Management Act (2006) and an Emergency Preparedness and Response Unit within the Ministry of Health, which is guided by the "Emergency Preparedness and Response Strategy 2017-2020." This strategy, however, is not publicly available and currently outdated. ^349350351 The Emergency Preparedness and Response (EPR) system, in line with the National Health Sector Strategic Plan (NHSSP), "aims at enhancing the MOH Emergency, Epidemic and Disaster Preparedness and Response capacity at all levels in order to prevent and respond effectively and in a timely manner, to both natural and man-made health emergencies including outbreaks." ³⁵² In addition, the The National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 and the National Multi-Hazard Contingency Plan 2019-2020 are also in place. ^353354355 The National Health Sector Strategic Plan 2024/25–2027/2028 outlines objectives and strategic interventions for the control and management of non-communicable diseases in Section 4.3.4. Nevertheless, the Plan contains no dedicated section or strategy for epidemic- or pandemic-prone diseases. ³⁵⁶ The National Multi-Hazard Contingency Plan 2019–2020 includes estimated costs for epidemic and pandemic response within the Health and Nutrition Sector Preparedness, Humanitarian Response, and Recovery Plan in Table 5 from page 37–42. However, it does not provide a strategic framework for addressing diseases with epidemic or pandemic potential. ³⁵⁷ Similarly, the National Health Sector Policy 2016–2026 does not include relevant provisions or planning for diseases with epidemic or pandemic potential. ³⁵⁸ The National Emergency Response Standard Operating Procedures 2018, which provides "a management structure for emergency response for both small and major emergencies, covering slow and sudden onset hazards" and "operationalize(s) the multi hazard contingency plan (MHCP)", is publicly available. However, it does not specifically address diseases with pandemic potential. ³⁵⁹

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

There is no publicly evidence that Eswatini has a national public health emergency response plan in place and no evidence that it has been updated in the last 3 years. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has a National Disaster Management Agency (NDMA) established by the Disaster Management Act (2006) and an Emergency Preparedness and Response Unit within the Ministry of Health, which is guided by the "Emergency Preparedness and Response Strategy 2017-2020." This strategy, however, is not publicly available and currently outdated. ^360361362 The Emergency Preparedness and Response (EPR) system, in line with the National Health Sector Strategic Plan (NHSSP), "aims at enhancing the MOH Emergency, Epidemic and Disaster Preparedness and Response capacity at all levels in order to prevent and respond effectively and in a timely manner, to both natural and man-made health emergencies including outbreaks." ³⁶³ In addition, the The National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 and the National Multi-Hazard Contingency Plan 2019-2020 are also in place. ^364365366 The National Health Sector Strategic Plan 2024/25–2027/2028 outlines objectives and strategic interventions for the control and management of non-communicable diseases in Section 4.3.4. Nevertheless, the Plan contains no dedicated section or strategy for epidemic- or pandemic-prone diseases. ³⁶⁷ The National Multi-Hazard Contingency Plan 2019–2020 includes estimated costs for epidemic and pandemic response within the Health and Nutrition Sector Preparedness, Humanitarian Response, and Recovery Plan in Table 5 from page 37–42. However, it does not provide a strategic framework for addressing diseases with epidemic or pandemic potential. ³⁶⁸ Similarly, the National Health Sector Policy 2016–2026 does not include relevant provisions or planning for diseases with epidemic or pandemic potential. ³⁶⁹ The National Emergency Response Standard Operating Procedures 2018, which provides "a management structure for emergency response for both small and major emergencies, covering slow and sudden onset hazards" and "operationalize(s) the multi hazard contingency plan (MHCP)", is publicly available. However, it does not specifically address diseases with pandemic potential. ³⁷⁰

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no evidence that Eswatini has a national public health emergency response plan in place and it follows one health principles by covering multiple threat types, e.g. antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has a National Disaster Management Agency (NDMA) established by the Disaster Management Act (2006) and an Emergency Preparedness and Response Unit within the Ministry of Health, which is guided by the "Emergency Preparedness and Response Strategy 2017-2020." This strategy, however, is not publicly available and currently outdated. ^371372373 The Emergency Preparedness and Response (EPR) system, in line with the National Health Sector Strategic Plan (NHSSP), "aims at enhancing the MOH Emergency, Epidemic and Disaster Preparedness and Response capacity at all levels in order to prevent and respond effectively and in a timely manner, to both natural and man-made health emergencies including outbreaks." ³⁷⁴ In addition, the The National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 and the National Multi-Hazard Contingency Plan 2019-2020 are also in place. ^375376377 The National Health Sector Strategic Plan 2024/25–2027/2028 outlines objectives and strategic interventions for the control and management of non-communicable diseases in Section 4.3.4. Nevertheless, the Plan contains no dedicated section or strategy for epidemic- or pandemic-prone diseases. ³⁷⁸ The National Multi-Hazard Contingency Plan 2019–2020 includes estimated costs for epidemic and pandemic response within the Health and Nutrition Sector Preparedness, Humanitarian Response, and Recovery Plan in Table 5 from page 37–42. However, it does not provide a strategic framework for addressing diseases with epidemic or pandemic potential. ³⁷⁹ Similarly, the National Health Sector Policy 2016–2026 does not include relevant provisions or planning for diseases with epidemic or pandemic potential. ³⁸⁰ The National Emergency Response Standard Operating Procedures 2018, which provides "a management structure for emergency response for both small and major emergencies, covering slow and sudden onset hazards" and "operationalize(s) the multi hazard contingency plan (MHCP)", is publicly available. However, it does not specifically address diseases with pandemic potential. ³⁸¹

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no evidence that Eswatini has a national public health emergency response plan in place and it includes consideration of the impact of health equity and/or a mechanism for identifying and considering the needs of vulnerable populations. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has a National Disaster Management Agency (NDMA) established by the Disaster Management Act (2006) and an Emergency Preparedness and Response Unit within the Ministry of Health, which is guided by the "Emergency Preparedness and Response Strategy 2017-2020." This strategy, however, is not publicly available and currently outdated. ^382383384 The Emergency Preparedness and Response (EPR) system, in line with the National Health Sector Strategic Plan (NHSSP), "aims at enhancing the MOH Emergency, Epidemic and Disaster Preparedness and Response capacity at all levels in order to prevent and respond effectively and in a timely manner, to both natural and man-made health emergencies including outbreaks." ³⁸⁵ In addition, the The National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 and the National Multi-Hazard Contingency Plan 2019-2020 are also in place. ^386387388 The National Health Sector Strategic Plan 2024/25–2027/2028 outlines objectives and strategic interventions for the control and management of non-communicable diseases in Section 4.3.4. Nevertheless, the Plan contains no dedicated section or strategy for epidemic- or pandemic-prone diseases. ³⁸⁹ The National Multi-Hazard Contingency Plan 2019–2020 includes estimated costs for epidemic and pandemic response within the Health and Nutrition Sector Preparedness, Humanitarian Response, and Recovery Plan in Table 5 from page 37–42. However, it does not provide a strategic framework for addressing diseases with epidemic or pandemic potential. ³⁹⁰ Similarly, the National Health Sector Policy 2016–2026 does not include relevant provisions or planning for diseases with epidemic or pandemic potential. ³⁹¹ The National Emergency Response Standard Operating Procedures 2018, which provides "a management structure for emergency response for both small and major emergencies, covering slow and sudden onset hazards" and "operationalize(s) the multi hazard contingency plan (MHCP)", is publicly available. However, it does not specifically address diseases with pandemic potential. ³⁹²

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no publicly available evidence that Swaziland has a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response. The 2020 National Contingency Plan for Novel Coronavirus only states that private sector hospitals and medics need to be kept updated on all epidemic developments, without any details of specific mechanisms. ³⁹³ According to the Joint External Evaluation (JEE), conducted in April 2018, there are "no mechanisms in place to facilitate collaboration (i.e. secondment of staff) between the private and public sector for surveillance and response to health emergencies" in Eswatini. ³⁹⁴ The Emergency Preparedness and Response Unit and National Disaster Management Agency, which coordinate emergency response in Eswatini, do not indicate that there is any mechanism for cooperating with the private sector. ³⁹⁵³⁹⁶ There is no additional evidence of special considerations in emergency preparedness for paediatric or other vulnerable populations through the Ministry of Health, or the Eswatini Health Laboratory Service. ³⁹⁷³⁹⁸

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no publicly available evidence that Eswatini has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic for one or more diseases. There is general advice on social distancing and hand hygiene in the Ministry of Health website, but no specific plan or criteria for when NPIs should be implemented. ³⁹⁹ There is no NPI specific information through the 2018 Joint External Evaluation (JEE), the National Disaster Management Department (NDMD), in the 2020 Contingency Plan for Novel Coronavirus or the Coronavirus (Covid-19) Regulations, 2020. ^400401402403

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is public evidence that Eswatini has activated their national emergency response plan for an infectious disease outbreak in the past year, but no evidence that it has completed a national-level biological threat-focused exercise. According to a media article dated January 2024, since 2023, the country had been positioning itself to be ready to respond to a cholera outbreak, with interventions including an updated and approved Cholera Preparedness and Response Plan. In November 2023, Eswatini conducted a Cholera National Full-Scale Simulation Exercise (SIMEX) to test its preparedness and response capacity for a large-scale infectious disease outbreak. ⁴⁰⁴

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no publicly available evidence that Eswatini in the past year has identified a list of gaps and best practices in response and developed a plan to improve response capabilities. There is no after action review conducted in 2024 and 2025 by Eswatini is available through the WHO's After-Action Review. ⁴⁰⁵ No infectious disease response, after action review or a biological-threat focused exercise of the country is available through the Ministry of Health, or the Eswatini Health Laboratory Service. ⁴⁰⁶⁴⁰⁷ According to the WHO's Simulation Exercise Activities page, Eswatini has conducted a simulation exercise on 28 May 2025; however, no further details of the exercise is available. ⁴⁰⁸

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that the country in the past year has undergone a national-level biological threat-focused exercise that has included private sector representatives. Eswatini completed a cholera Cholera National Full-Scale Simulation Exercise (SIMEX) in November 2023, achieving a self-assessed readiness level of 72%. The exercise included health workers, emergency response officials, and support from World Health Organisation (WHO) Africa Region Office and Africa Centre for Disease Control (ACDC), but there is no mention of private sector inclusion. ⁴⁰⁹⁴¹⁰ There is no additional evidence of a national-level biological threat-focused exercise conducted in the past year through the Ministry of Health, or the Eswatini Health Laboratory Service. ⁴¹¹⁴¹²

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Yes. Eswatini has an Emergency Operations Center (EOC) in place. The Public Health Emergency Operations Center (PHEOC) was established under the Ministry of Health. It comprises of the Health and Nutrition Cluster under the umbrella of National Disaster Management Authority (NDMA). ⁴¹³ The public website of the Eswatini PHEOC is available. ⁴¹⁴

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no publicly available evidence that the Eswatini Public Health Emergency Operations Center (PHEOC) is required to conduct a drill for a public health emergency scenario at least once per year or that they conduct a drill at least once per year. No relevant information is available from the public websites of the Ministry of Health, the Eswatini Health Laboratory Service, the USAID's Eswatini Knowledge Hub, the Eswatini PHEOC or other open sources. ^415416417418

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no public evidence to show that the Eswatini Public Health Emergency Operations Center (PHEOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. According to an article published in July 2024 by the WHO, Eswatini conducted an Emergency Preparedness and Response (EPR) Scoping Exercise in July 2024. The EPR Scoping exercise is a component of the Regional Strategy for Health Security and Emergencies 2022–2030, aimed at assisting WHO Regional Committee member states in preparing for, detecting, responding to, and recovering from outbreaks and other emergencies. However, there is no indication it involved a real-time activation of the EOC within a specified timeframe. ⁴¹⁹ No relevant information is available through the Ministry of Health, the Eswatini Health Laboratory Service, the USAID's Eswatini Knowledge Hub, the Eswatini PHEOC, the WHO's Eswatini News portal or other open sources. ^{420421422423424}

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that public health, animal health, the private sector and national security authorities have carried out an exercise to respond to a potential deliberate biological event or that there are standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event.
According to the Joint External Evaluation (JEE), conducted in April 2018, "[t]here is a need for formal multi sectoral coordination structures and mechanisms," particularly in the areas of "preparedness, emergency response operations; linking public health and security authorities and risk communication." Although the Public Health Act (1969) does provide some legal basis to engage security authorities in public health issues, there is no formal mechanism for engagement between them. However, despite this lack of a formal agreement, "annual simulation exercises and joint trainings are taking place, for example by simulating various infectious disease outbreaks (e.g. Ebola virus disease) and the role of relevant actors in the response to these public health events." ⁴²⁵ The Emergency Preparedness and Response system can respond to both "natural and man-made health emergencies including outbreaks," but there is no evidence that it has carried out an exercise with national security authorities or has guidelines in place for bioterrorism response. ⁴²⁶ Likewise, there is no indication that the National Disaster Management Department has carried out an exercise with national security authorities in response to a potential biological event. ⁴²⁷ There is no additional evidence of an exercise between public health and national security authorities or standard operating procedures for responding to biological events through the Ministry of Health or the Eswatini Health Laboratory Service. ⁴²⁸⁴²⁹

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has in place, either in the national public health emergency response plan or in other legislation, regulation, or strategy documents, a section detailing a risk communication plan that is specifically intended for use during a public health emergency. According the Joint External Evaluation (JEE), conducted in April 2018, risk communication activities in Swaziland are ad hoc and not well coordinated at all levels. The report notes that there is neither a national risk communication strategy nor any formal agreements that guide officers when they carry out such activities, and "[i]n case of an emergency the ministries and/or directorates responsible for those specific public health emergencies are designated to be the key spokespersons for initial information dissemination to the public about health risks and events, working in collaboration with the National Disaster Management Agency." Some disease specific preparedness guidelines, such as for malaria and Influenzae, include provisions regarding risk communication, but these provisions appear to be limited in scope. ⁴³⁰ According to the "Swaziland National Progress Report on the implementation of the Hyogo Framework for Action (2013 – 2015," the country's risk management agency, the National Disaster Management Agency, has limited communication capabilities, and there is a need for "effective communication and collaboration between data and information producers and users in order to empower communities under threat from natural and other hazards to take effective and timely decision-making to protect lives, property and the environment from the effects of disasters." ⁴³¹ The 2020 National Contingency Plan for Novel Coronavirus contains several references to risk communication, and it is one of the 8 pillars that the plan is structured under. It is, however, both disease and event specific so cannot be classed as standard national reference for public health emergencies. ⁴³² There is no detailed risk communication plan included in the National Strategic Plan for The Prevention and Control of Non-Communicable Diseases (NCD) 2021 – 2023, the National Strategy for Integrated Disease Surveillance and Response (IDSR) 2021-2023, the National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020, the National Disaster Management Agency Strategic Plan 2017-2021, the National Disaster Risk Management Policy 2010, the Disaster Management Act, 2006, or the Disaster Management (Coronavirus – Covid – 19) Regulations, 2020. ^{433434435436437438439} There is no additional information regarding a risk communication plan in place in Eswatini through the Ministry of Health, the National Disaster Management Agency, or the Swaziland Legal Information Institute (SWAZILII). ^440441442

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

There is publicly available evidence that Eswatini has a risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) outlining how messages will reach populations and sectors with different communications needs. The 2020 National Contingency Plan for Novel Coronavirus contains several references to risk communication, and it is one of the 8 pillars that the plan is structured under. ⁴⁴³

According the Joint External Evaluation (JEE), conducted in April 2018, risk communication activities in Swaziland are ad hoc and not well coordinated at all levels. The report notes that there is neither a national risk communication strategy nor any formal agreements that guide officers when they carry out such activities, and "[i]n case of an emergency the ministries and/or directorates responsible for those specific public health emergencies are designated to be the key spokespersons for initial information dissemination to the public about health risks and events, working in collaboration with the National Disaster Management Agency." Some disease specific preparedness guidelines, such as for malaria and Influenzae, include provisions regarding risk communication, but these provisions appear to be limited in scope. ⁴⁴⁴ According to the "Swaziland National Progress Report on the implementation of the Hyogo Framework for Action (2013 – 2015," the country's risk management agency, the National Disaster Management Agency, has limited communication capabilities, and there is a need for "effective communication and collaboration between data and information producers and users in order to empower communities under threat from natural and other hazards to take effective and timely decision-making to protect lives, property and the environment from the effects of disasters." ⁴⁴⁵ There is no detailed risk communication plan included in the National Strategic Plan for The Prevention and Control of Non-Communicable Diseases (NCD) 2021 – 2023, the National Strategy for Integrated Disease Surveillance and Response (IDSR) 2021-2023, the National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020, the National Disaster Management Agency Strategic Plan 2017-2021, the National Disaster Risk Management Policy 2010, the Disaster Management Act, 2006, or the Disaster Management (Coronavirus – Covid – 19) Regulations, 2020. ^{446447448449450451452} There is no additional information regarding a risk communication plan in place in Eswatini through the Ministry of Health, the National Disaster Management Agency, or the Swaziland Legal Information Institute (SWAZILII). ^453454455

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) that designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency. According the Joint External Evaluation (JEE), conducted in April 2018, risk communication activities in Swaziland are ad hoc and not well coordinated at all levels. The report notes that there is neither a national risk communication strategy nor any formal agreements that guide officers when they carry out such activities, and "[i]n case of an emergency the ministries and/or directorates responsible for those specific public health emergencies are designated to be the key spokespersons for initial information dissemination to the public about health risks and events, working in collaboration with the National Disaster Management Agency." Some disease specific preparedness guidelines, such as for malaria and Influenzae, include provisions regarding risk communication, but these provisions appear to be limited in scope. ⁴⁵⁶ According to the "Swaziland National Progress Report on the implementation of the Hyogo Framework for Action (2013 – 2015," the country's risk management agency, the National Disaster Management Agency, has limited communication capabilities, and there is a need for "effective communication and collaboration between data and information producers and users in order to empower communities under threat from natural and other hazards to take effective and timely decision-making to protect lives, property and the environment from the effects of disasters." ⁴⁵⁷ The 2020 National Contingency Plan for Novel Coronavirus contains several references to risk communication, and it is one of the 8 pillars that the plan is structured under. It is, however, both disease and event specific so cannot be classed as standard national reference for public health emergencies. ⁴⁵⁸ There is no detailed risk communication plan included in the National Strategic Plan for The Prevention and Control of Non-Communicable Diseases (NCD) 2021 – 2023, the National Strategy for Integrated Disease Surveillance and Response (IDSR) 2021-2023, the National Strategic Plan for Epidemiology and Disease Control Unit (EDCU) 2016 – 2020, the National Disaster Management Agency Strategic Plan 2017-2021, the National Disaster Risk Management Policy 2010, the Disaster Management Act, 2006, or the Disaster Management (Coronavirus – Covid – 19) Regulations, 2020. ^{459460461462463464465} There is no additional information regarding a risk communication plan in place in Eswatini through the Ministry of Health, the National Disaster Management Agency, or the Swaziland Legal Information Institute (SWAZILII). ^466467468

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is evidence that the public health system has actively and regularly shared messages via online media platforms (e.g. social media, website) to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation. For instance, in July 2025 the Ministry of Health posted on Facebook to correct an implausible rumor, stating: “Beware of misleading information. There is no way that an entire hospital, one as big as Mbabane Government Hospital, can service just 50 clients a day.” ⁴⁶⁹ In another post in June 2024, the Ministry addressed a fake poster, which is not the work of the Ministry of Health, urging people to get COVID-19 vaccination. ⁴⁷⁰ The Ministry’s Facebook page is regularly updated, with new posts typically published on a weekly basis. ⁴⁷¹

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that senior leaders in Eswatini (such as the President or Ministers) have shared misinformation or disinformation about infectious diseases in the past two years. There is no relevant information available from The Deputy Prime Minister's Office Eswatini's website, X or Facebook accounts nor from the Prime Minister Russell Mmiso Dlamini's Facebook and Instagram accounts or elsewhere online. ^{472473474475476}

3.6.1a Percentage of households with Internet

Score: 63.96

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 69.44

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 66.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 58.33

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Eswatini has, in the past year, has the country implemented restrictions on export/import of medical goods (e.g. medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak. In fact, the Eswatini Revenue Authority (SRA) is "implementing provisions that provide for a rebate of Customs duty on goods imported for the relief of distress of persons where there is a national disaster." The SRA is implementing the fast tracking of the clearance of goods like medicaments for the fight of COVID-19. ⁴⁷⁷ No information on this could be found on the websites of the ministries of Health, Agriculture, or Foreign Affairs. ^478479480 Nothing further could be found on media sources.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available information that Eswatini has, in the past year, has the country implemented restrictions on non-medical goods (e.g. food, textiles, etc) due to an infectious disease outbreak. A Ministry of Commerce, Industry and Trade press statement, dated 25 March 2020 (8 days after the COVID-19 State of Emergency was declared), states that cross-border trade will continue as normal. ⁴⁸¹ The World Organisation for Animal Health (OIE) weekly disease monitor has 3 notifiable outbreaks of African horse sickness reported by Eswatini, but there is no indication that this resulted in restrictions of the movement of non-medical goods across the border. ⁴⁸² There is no additional information regarding a restriction on the movement of people or goods due to risk of infectious disease through the Ministry of Health, Ministry of Agriculture, or the WHO Country site. ^483484485

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence from the past year (2024–2025) that Eswatini has implemented inbound or outbound travel restrictions due to an infectious disease outbreak. As of November 2022, all COVID-related restrictions and requirements for entry in to Eswatini, including requirements for vaccination proof, negative tests, and mask mandates, had been removed. ⁴⁸⁶ No evidence suggests that travel limitations—either inbound or outbound—have been imposed due to other infectious disease outbreaks in the last year through the websites of the Government of Eswatini, or media sources. ⁴⁸⁷

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is no publicly available evidence that Eswatini uses a risk-based approach to international travel-related measures. The Article 16. Cross-border travel of the Coronavirus (Covid-19) Regulations, 2020 states that "A person traveling from a country that has been classified as high risk by the World Health Organisation (WHO), is prohibited from entering the Kingdom of Eswatini."and "A visa and entry permit that has already been issued to a traveller from a high risk country is, at the commencement of these Regulations, revoked." ⁴⁸⁸ However, there is no evidence that the country uses a risk-based approach to international travel-related measures with other infectious diseases through the National Disaster Management Agency Strategic Plan 2017-2021, the National Disaster Risk Management Policy 2010, the Disaster Management Act, 2006, the National Contingency Plan for Novel Coronavirus (Eswatini) or through the websites of the Ministry of Health, or the Emergency Preparedness and Response (EPR) Department. ^{489490491492493494}

4.1.1a Doctors per 100,000 people

Score: 7.91

4.1.1b Nurses and midwives per 100,000 people

Score: 42.88

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is no publicly available evidence that the country has a health workforce strategy in place which has been updated in the past five years that identifies fields where there is an insufficient workforce and strategies to address these shortcomings. In April 2024, the Ministry of Health launched the Human Resources for Health Strategic Plan 2025–2030 alongside the Essential Health Care Package. ⁴⁹⁵⁴⁹⁶ However the report is not publicly available through the website of the Ministry of Health or elsewhere online.⁴⁹⁷ The latest publicly available plan is the Human Resources for Health Strategic Plan 2012-2017 which was published in October 2012.⁴⁹⁸

4.1.1d Health system capacity for essential health services

Score: 0

There is no evidence that Eswatini has sufficient capacity within the health system to deliver essential health services.

The WHO Joint external evaluation of the International Health Regulations (23–27 September 2024) explains that a package of EHS and plans/guidelines on the continuity of EHS in emergencies was developed and a mechanism for monitoring service continuity during emergencies was in place. However, this document is still in the draft phase and is yet to be fully implemented. According to the JEE, collaboration in Eswatini is limited between clinical care and public health emergency management services. There is no guiding document for essential health care continuation during emergencies (only a draft document is available).⁴⁹⁹

Moreover, according to a media article dated July 2024, a 2024 Health Labour Market Analysis revealed a profound staffing deficit: Eswatini needed at least 20,272 health workers but faced a shortfall of 10,531 positions, reflecting nearly half of required staff being unfilled. The gap is projected to widen to 14,125 by 2032. ⁵⁰⁰ A WHO assessment using the Hospital Emergency Unit Assessment Tool (HEAT) identified that only one of three referral hospitals had a dedicated emergency or resuscitation area. Facilities lacked training, resources, clinical protocols, and necessary emergency capabilities.⁵⁰¹ According to a media article in July 2024, Eswatini has been urged by the WHO to step up domestic investment in its health sector to build a resilient, well-equipped, and sustainable workforce by 2030. ⁵⁰² The Eswatini Human Resources for Health (HRH) Strategy 2025–2030, launched in 2025, outlines five strategic priorities, including "expanding employment opportunities to meet service delivery needs and national health targets" and "improving workforce management for better retention, distribution, and performance". However, there is no available evidence indicating that the health system currently has sufficient capacity to deliver essential health services. ⁵⁰³ According to a media article in October 2025, the Ministry of Health has proposed filling 408 vacancies across various positions, including 123 support staff and 104 nursing roles. According to the 2025/26 Second Quarter Performance Report, in progress of addressing staff shortages across Eswatin's health sector, over 90 positions have already been filled, and several health professionals have been promoted to enhance service delivery. This recruitment and promotion initiative supports the implementation of the Human Resources for Health (HRH) Strategy 2025–2030, aimed at developing a resilient, well-distributed, and motivated health workforce. ⁵⁰⁴

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no public evidence that Eswatini has a plan to ensure continuity of essential health services during a public health emergency. Though the WHO Eswatini Country Office Biennial Report 2020–2021 mentioned that " the Essential health care Package was reviewed and guided the development of a strategy for the continuity of Essential Health Services during the COVID 19 pandemic", there is no evidence that a specific plan for continuity of essential health services during a public health emergency is available. ⁵⁰⁵ Though Essential Health Services was mentioned in reports such as the Country Cooperation Strategy: Eswatini 2022–2026 or the National Health Sector Strategic Plan 2024/25 – 2027/2028, no additional information of the continuity of essential health services during a public health emergency is available. ⁵⁰⁶⁵⁰⁷ No evidence is available through the websites of the Ministry of Health, the Emergency Preparedness and Response (EPR) Department or the Joint External Evaluation of the Kingdom of Eswatini. ^508509510

4.1.2a Hospital beds per 100,000 people

Score: 52.48

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is insufficient publicly available evidence that Eswatini has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation facility located in the country. The Eswatini Government Gazette Extraordinary, dated 27 March 2020, stated that "The Minister of Health shall identify and make available sites to be used as isolation and quarantine facilities". ⁵¹¹ Similarly, the Eswatini Contingency Plan for Novel Coronavirus stated that since the majority of points of entry, hospitals and health centers do not have designated isolation areas, and there was an urgent need for "Identified and designated isolation units need to be adequately equipped (8 hospitals)". ⁵¹² In both these cases, however, there is no further information on where these units have been established, or if they are permanent installations. According to the Joint External Evaluation (JEE), conducted in April 2018, there are existing isolation units in hospitals in Eswatini. However, the report also notes that there was a need to "[u]pgrade existing isolation units in tertiary hospitals and put in place isolation units in regional public health hospitals, at least one per region." ⁵¹³ There is no other publicly available information regarding the specifications of these isolation units. There is no other evidence of such units through the Ministry of Health. ⁵¹⁴ The Eswatini Covid-19 Emergency Response Project (P173883) mentions that the country has Isolation Centres, however, there is no evidence that there is a biocontainment patient care unit a biocontainment patient care unit exisiting within these centers. ⁵¹⁵ The Mbabane Government Hospital has no public website.

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no evidence that Eswatini has demonstrated capacity or developed, updated or tested a plan to expand isolation capacity in response to an infectious disease outbreak in the past two years. There is no inclusion or mention of isolation capacity expansion in the World Health Organization's Country Cooperation Strategy: Eswatini 2022–2026 report, the National Health Sector Strategic Plan 2024/25 – 2027/2028, the Annual Budget Performance Report For Financial Year 2024 – 2025 or through the websites of Ministry of Health, or the Emergency Preparedness and Response (EPR) Department. ^{516517518519520}

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 0

There is no publicly available evidence of a procurement protocol in place that can be utilized by the Ministry of Health or Ministry of Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) or medical supplies (e.g. equipment, PPE) for routine needs. According to the Joint External Evaluation (JEE), conducted in April 2018, there are dedicated procurement units that are responsible for the procurement of medical countermeasures and vaccines respectively, however, it is unclear to what extent these units cover equipment needs or operate according to a protocol. ⁵²¹ The Central Medical Stores, within the Ministry of Health, is responsible for the supply chain management of all health commodities including medicines in the public sector, however, there is no indication that it manages the procurement process. ⁵²² There is no other evidence of a procurement protocol in place through the Ministry of Health, Ministry of Agriculture, or the Eswatini Health Laboratory Services. ^523524525 The Eswatini Health Laboratory Services Strategic Plan (2021-2023) also mentions that "Currently the procedure for equipment procurement is not outlined". ⁵²⁶ There is no existing Public Health Institute.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that the country has a stockpile of medical supplies (e.g. MCMs, medicines, vaccines, medical equipment, PPE) for national use during a public health emergency defined by the overarching national public health emergency response plan (from 3.1.1a). Though Eswatini has a national public health emergency response plan in place, there is no evidence that the plan is publicly available. According to the Joint External Evaluation (JEE), conducted in April 2018, Eswatini has a National Disaster Management Agency (NDMA) established by the Disaster Management Act (2006) and an Emergency Preparedness and Response Unit within the Ministry of Health, which is guided by the "Emergency Preparedness and Response Strategy 2017-2020." This strategy, however, is not publicly available. ^527528529 The Emergency Preparedness and Response (EPR) system, in line with the National Health Sector Strategic Plan (NHSSP), "aims at enhancing the MOH Emergency, Epidemic and Disaster Preparedness and Response capacity at all levels in order to prevent and respond effectively and in a timely manner, to both natural and man-made health emergencies including outbreaks." ⁵³⁰ In addition, the The National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 and the National Multi-Hazard Contingency Plan 2019-2020 are also in place. ^531532533 The National Emergency Response Standard Operating Procedures 2018, which provides "a management structure for emergency response for both small and major emergencies, covering slow and sudden onset hazards" and "operationalize(s) the multi hazard contingency plan (MHCP)", is publicly available. However, it does not specifically address diseases with pandemic potential. ⁵³⁴

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence of a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency. In the Ministry of Health 2012 'Guidelines on Import Procedures for Medicines' document, in which it states that the Medicine Regulatory Authority (MRA) is the national agency "responsible for the registration of, and other regulatory activities concerning, pharmaceutical and veterinary products." there is no mention of stockpiles. ⁵³⁵ No evidence could be found via the Joint External Evaluation (JEE), conducted in April 2018 or the Central Medical Stores webpage. ⁵³⁶⁵³⁷ No further information could be found through the Ministry of Health, the Eswatini Health Laboratory Services, the Disaster Management Agency, or in the National Health Sector Strategic Plan 2024/25 – 2027/2028, the National Health Sector Policy 2016-2026 or the Annual Budget Performance Report For Financial Year 2024 – 2025. ^{538539540541542543} The Ministry of Health lists Medicine Regulatory Authority (MRA) as one of its regulatory bodies, however, does not provide any details of its responsibilities. ⁵⁴⁴

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available that the country conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency. According to the Joint External Evaluation (JEE), conducted in April 2018, "there are no stockpiles of supplies at the local level" in Eswatini.⁵⁴⁵ No evidence of the annual review of the national stockpile could be found through the Ministry of Health, Ministry of Agriculture, the National Disaster Management Agency, the Eswatini Health Laboratory Service or the Central Medical Stores. ^{546547548549550}.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is insufficient publicly available evidence that Eswatini has plans, strategy, or similar documents or mechanisms either to leverage domestic manufacturing capacity to produce, procure or expedite medical supplies (e.g. MCMs, medicines, vaccines, equipment, PPE) through points of entry for use during a public health emergency. The Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, states that there are both a dedicated procurement unit responsible for the procurement of MCM and supply infrastructure to run the supply chain system for MCM. An established routine system is in place for sending and receiving medical countermeasures. A regulatory authority overseeing medical countermeasures is in the process of being established. However, included in recommendations is the development and adoption of a plan which includes establishing regional and international agreements such as MoUs, for sending and receiving MCM and personnel for support during a public health emergency. Also noted as areas which need strengthening are that there are no formal agreements/MoUs with neighbouring countries (i.e. the Southern African Development Community) and regional/international organizations (e.g. the Global Outbreak Alert and Response Network) to ensure timely mutual cross-border aid (personnel and medical countermeasures); the system of sending, receiving and distributing medical countermeasures during a public health emergency needs to be strengthened, to ensure that this can occur at any time, and that there are currently barriers to acquiring MCM quickly during an emergency, including products that fall outside the routine supply chain of the country (i.e. that address issues such as product registration and potentially lengthy customs procedures). ⁵⁵¹ There is no evidence of such plans in Ministry of Health documents "Personal Protective Equipment for Waste Handlers", "Swaziland National Implementation Strategy: Improving Health Care Waste Management Systems" or “National Health Sector Strategic Plan 2024/25 – 2027/2028." ^552553554 No further information could be found through the National Disaster Management Agency, the Ministry of Labour and Social Affairs, the Central Medical Stores or the Eswatini Health Laboratory Service webpage ^555556557558

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has plans, strategy, or similar documents either to leverage domestic manufacturing capacity to produce, or has a mechanism to procure or expedite laboratory supplies through points of entry during a public health emergency. There is no evidence of such plans in the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018. ⁵⁵⁹ There is no evidence of such plans in Ministry of Health documents "Personal Protective Equipment for Waste Handlers", "Swaziland National Implementation Strategy: Improving Health Care Waste Management Systems" or “National Health Sector Strategic Plan 2024/25 – 2027/2028." ^560561562 No further information could be found through the National Disaster Management Agency, the Ministry of Labour and Social Affairs, the Central Medical Stores or the Eswatini Health Laboratory Service webpage ^563564565566

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is no publicly available evidence that Eswatini has a system or mechanism for national and subnational levels for emergency logistics and supply chain management. According to the Southern African Development Community Disaster Risk Reduction Unit (SADC DRR) Project Inception Workshop's Eswatini Disaster Risk Reduction Baseline in 2020, "during an emergency logistics are planned and managed by sectors & [the National Disaster Management Agency] NDMA". ⁵⁶⁷ No additional information regarding a plan, system or mechanism for emergency logistics and supply chain management is available through the websites of the National Disaster Management Agency, the Eswatini Health Laboratory Service or the Ministry of Health.^568569570

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a plan, program, or guidelines in place for dispensing medical countermeasures during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics). According to the Joint External Evaluation (JEE), conducted in April 2018, provision of medical countermeasures is the responsibility of the Central Medical Stores (CMS) within the Ministry of Health for public health and the Ministry of Agriculture for animal health. There is a dedicated procurement unit and supply infrastructure (warehouse and transport fleet) with permanent staff to run the supply chain system for the deployment of medical countermeasures with an "established routine system" for sending and receiving medical countermeasures. However, the report also notes that there is no plan for emergency deployment, and "[t]he system of sending, receiving and distributing medical countermeasures during a public health emergency needs to be strengthened, to ensure that this can occur at any time" because there are currently barriers to acquiring medical countermeasures during an emergency.⁵⁷¹ The National Multi-Hazard Contingency Plan 2019-2020 does not mention anything relevant. ⁵⁷² There is no other evidence of a plan, program, or guidelines in place for dispensing medical countermeasures during a public health emergency through the Ministry of Health, Ministry of Agriculture, National Disaster Management Agency or the 2020 National Contingency Plan for Novel Coronavirus. ^{573574575576577}

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a public plan in place to facilitate workforce surge in an emergency. There is no mention of plans or strategies to facilitate workforce surge in an emergency included in the Human Resources For Health Strategic Plan 2012-2017, the National Disaster Management Agency Strategic Plan 2017-2021, the Disaster Management (Coronavirus – Covid – 19) Regulations 2020, the National Health Sector Strategic Plan 2024/25 – 2027/2028, or the National Multi-Hazard Contingency Plan 2019-2020. ^{578579580581582} Nothing relevant is available from the Ministry of Health, Ministry of Agriculture or National Disaster Management Agency. ^583584585 The Joint External Evaluation (JEE), conducted in April 2018, only mentions that "Mechanisms for surge staff for risk communication during emergencies are ad hoc" without including any public plan in place to facilitate workforce surge in an emergency. ⁵⁸⁶

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence that Eswatini has a plan in place to receive health personnel from other countries to respond to a public health emergency. According to the Joint External Evaluation (JEE), conducted in April 2018, there is no system in place for personnel deployment during emergencies. Currently, there are "no formal agreements with neighbouring countries (i.e. the Southern African Development Community) and regional/international organizations (e.g. the Global Outbreak Alert and Response Network) to ensure timely mutual cross-border aid (personnel and medical countermeasures)." ⁵⁸⁷ Although the Southern African Development Community (SADC), of which Eswatini is a member, binds state parties to cooperate and assist each other in the coordination and management of disaster situations under the terms of the Protocol on Health (1999), it is unclear to what extent this would extend to the supply of personnel across borders during public health emergencies. ⁵⁸⁸ There is no other publicly available evidence of such a plan through the Ministry of Health, the Ministry of Foreign Affairs and International Co-operation, the National Disaster Management Agency, the Human Resources For Health Strategic Plan 2012-2017, the National Disaster Management Agency Strategic Plan 2017-2021, the Disaster Management (Coronavirus – Covid – 19) Regulations 2020, the National Health Sector Strategic Plan 2024/25 – 2027/2028, or the National Multi-Hazard Contingency Plan 2019-2020. ^{589590591592593594595596}

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence that Eswatini has a public plan in place to redeploy existing health personnel within the country, either geographical or role redeployment. There is no other publicly available evidence of such plan through the Ministry of Health, the National Disaster Management Agency, the Human Resources For Health Strategic Plan 2012-2017, the National Disaster Management Agency Strategic Plan 2017-2021, the Disaster Management (Coronavirus – Covid – 19) Regulations 2020, the National Health Sector Strategic Plan 2024/25 – 2027/2028, the National Multi-Hazard Contingency Plan 2019-2020, the World Health Organization's Health Labour Market Analysis For Eswatini or the Joint External Evaluation of the Kingdom of Eswatini. ^{597598599600601602603604605}

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

Eswatini’s Constitution (2005) does explicitly guarantee citizens’ right to health, including medical care. Specifically, the Section 60(8) of the Constitution of the Kingdom of Eswatini (2005) states that "Without compromising quality the State … shall take all practical measures to ensure the provision of basic health care services to the population." ⁶⁰⁶

4.4.1b Access to skilled birth attendants (% of population)

Score: 89.71

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 89.48

4.4.1d Coverage of essential health services through universal health coverage

Score: 60.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 82.39

4.4.1f Rate of mortality amenable to health care

Score: 58.29

4.4.2a Guaranteed paid sick leave

Score: 66.67

There is evidence that workers are guaranteed paid sick leave, and sick leave is explicitly available for physical health problems. According to the Section 129. (1) of the Employment Act 1980, "After three months continuous employment with the same employer, an employee shall be eligible, in each year of employment with that employer, for a maximum of fourteen days sick leave on full pay and a maximum of fourteen days sick leave on half pay." The law does not explicitly differentiate between mental and physical health but the entitlement depends on a medical certificate issued by a registered medical practitioner as per the Section 103(1)'s provision "Payment in respect of sick leave shall be subject to the employee producing a certificate of incapacity covering the period of sick leave claimed signed by a medical practitioner and no employee shall be entitled to paid sick leave unless this section has been complied with." No mention of mental health problems covered under paid sick leave conditions.⁶⁰⁷

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that Eswatini has issued legislation, a policy or a public statement committing to provide prioritized health care services to health care workers who become sick as a result of responding to public health emergency. The Occupational Safety and Health Act of 2001 provides for the wellbeing and safety of employees in the public sector, but there is no evidence of any particular provisions relevant to the public health workforce or public health emergency care. ⁶⁰⁸ There is no information on prioritizing health care services for health care workers responding to public health emergency through any of; the 2018 Joint External Evaluation (JEE), the Emergency Preparedness and Response (EPR) Department, the National Health Sector Strategic Plan 2024/25 – 2027/2028, the National Health Sector Policy 2016-2026, the Ministry of Health, the National Disaster Management Agency or the Eswatini Health Laboratory Services. ^{609610611612613614615}

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is no publicly available evidence that Eswatini has a system in place for public health officials and health care workers to communicate during a public health emergency. According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, "[m]echanisms for surge staff for risk communication during emergencies are ad hoc." As a result, the report recommended that Eswatini "[d]evelop a communication strategic plan, which includes a monitoring and evaluation (M&E) framework and standard operating procedures (SOPs)," as well as mechanisms for internal and multi sectoral routine and emergency response communications. ⁶¹⁶ Although the Emergency Preparedness and Response Unit is responsible for "[e]stablishing communication mechanisms and systems for transmitting information between the national and local levels and health-care facilities during health emergencies," neither the National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 nor the National Multi-Hazard Contingency Plan 2019-2020 have any details on communication between public health officials and health care workers. ^{617618619620621} There is no additional evidence of a system in place for public health officials and health care workers to communicate during a public health emergency through the Ministry of Health or the National Disaster Management Agency. ⁶²²⁶²³

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no publicly available evidence that Eswatini has a system in place for public health officials and health care workers to communicate during a public health emergency, let alone that it covers both the public and private sector. According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, "[m]echanisms for surge staff for risk communication during emergencies are ad hoc." As a result, the report recommended that Eswatini "[d]evelop a communication strategic plan, which includes a monitoring and evaluation (M&E) framework and standard operating procedures (SOPs)," as well as mechanisms for internal and multi sectoral routine and emergency response communications. ⁶²⁴ Although the Emergency Preparedness and Response Unit is responsible for "[e]stablishing communication mechanisms and systems for transmitting information between the national and local levels and health-care facilities during health emergencies," neither the National Health Sector Policy 2016-2026, the National Health Sector Strategic Plan 2024/25 – 2027/2028 nor the National Multi-Hazard Contingency Plan 2019-2020 have any details on communication between public health officials and health care workers. ^{625626627628629} There is no additional evidence of a system in place for public health officials and health care workers to communicate during a public health emergency through the Ministry of Health or the National Disaster Management Agency. ⁶³⁰⁶³¹

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no publicly available evidence that the national public health system of Eswatini is monitoring for and tracking the number of health care associated infections that take place in health care facilities. According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, Eswatini has had comprehensive infection prevention control (IPC) guidelines in place since 2014 for health care facilities and personnel, but these have not yet been incorporated into a national implementation plan for antimicrobial resistance (AMR) or health care associated infection awareness. The report noted that the public health system of Eswatini did not actively conduct standardized surveillance and management of health care associated infections. ⁶³² There is no other evidence of a system for monitoring and tracking the number of health care associated infections in Eswatini through the Ministry of Health, Eswatini Health Laboratory Services, the World Health Organisation (WHO) country page for the Kingdom of Eswatini, the 2020 National Contingency Plan for Novel Coronavirus, the Eswatini Health Laboratory Services Strategic Plan (2021-2023), the National Health Sector Strategic Plan 2024/25 – 2027/2028 or the National Health Sector Policy 2016-2026. ^{633634635636637638639}

4.6.1b Infection prevention and control programme

Score: 100

There is public evidence that the country has an infection prevention and control programme in place nationally. According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, on page 9, Eswatini has comprehensive and commendable Infection Prevention Control (IPC) 2014 guidelines. ⁶⁴⁰ However, this document is not publicly available. The country has also published the Quality/IPC Programme Infection Prevention and Control activities in response to COVID-19 in November 2023. ⁶⁴¹

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

There is no publicly available evidence of a plan to ensure a safe environment in health facilities nationally. The Eswatini Health Laboratory Services Strategic Plan (2021-2023) has the Strategic Objective 2 which aims "To implement and strengthen a laboratory quality management system in a safe working environment towards accreditation." On page 25, it was stated that "EHLS has a mandate to ensure that all laboratory personnel, contractors, and clients are working in a safe environment." ⁶⁴² However, there is no additional information regarding a plan to ensure a safe environment in other health facilities nationally through the Ministry of Health, the Eswatini Health Laboratory Services or the National Health Sector Strategic Plan 2024/25 – 2027/2028 or the National Health Sector Policy 2016-2026. ^643644645646 According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, on page 9, Eswatini has comprehensive and commendable Infection Prevention Control (IPC) 2014 guidelines. ⁶⁴⁷ However, this document is not publicly available, and therefore it is unknown if they have isolation/sterilization capacity.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 0

There is no publicly available evidence that Eswatini requires ethical review board approval prior to the beginning of a clinical trial. Although the Ministry of Health maintains a Department of Pharmaceuticals and Medicines and a Department of Clinical Services, there is no evidence of an approval process prior to clinical trials for either new drugs or for research. ⁶⁴⁸⁶⁴⁹ According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, the Central Medical Stores, within the Ministry of Health, provide and distribute medical countermeasures during emergencies, but there is no information regarding a review process prior to approval. ⁶⁵⁰⁶⁵¹ The Medicines and Related Substances Control Act (2016) regulates the control of medicines and related substances in Eswatini. Section 56 of the Act (Clinical trials) makes no mention of ethical review. ⁶⁵²⁶⁵³ One of the roles of the Swaziland Health Laboratory Services is to provide guidelines for clinical trials and set quality assurance standards, but there is no evidence of an ethical review process. ⁶⁵⁴ According to the National Health Research Policy, published in 2013, under the section 3.1.8 Clinical Trials, Article 4 mentions that "A clinical trial on human beings shall only be conducted … [if] ethical approval granted by the Board". However, there is no mention of ethical review/approval for other types of clinical trials mention in this document. ⁶⁵⁵ There is no other evidence of an ethical review board approval process for clinical trials through the Ministry of Health or the Eswatini Health and Human Research Review Board (EHHRRB). ⁶⁵⁶⁶⁵⁷

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no publicly available evidence of an expedited process for approving clinical trials for unregistered medical countermeasures to treat ongoing pandemics. Although the Ministry of Health maintains both a Department of Pharmaceuticals and Medicines and a Department of Clinical Services, there is no evidence of an approval process prior to beginning clinical trials for unregistered medical countermeasures. ⁶⁵⁸⁶⁵⁹ According to the Joint External Evaluation (JEE), conducted in April 2018, the provision and deployment of medical countermeasures is the responsibility of the Central Medical Stores, within the Ministry of Health, but there is no publicly available indication of an expedited process for approval during ongoing pandemics. ⁶⁶⁰⁶⁶¹ The Medicines and Related Substances Control Act (2016) regulates the control of medicines and related substances in Eswatini but there is mention of an expedited process during pandemics. ⁶⁶²⁶⁶³ The JEE does note, however, that Eswatini is currently in the process of establishing a regulatory authority to oversee medical countermeasures. ⁶⁶⁴ One of the roles of the Swaziland Health Laboratory Services is to provide guidelines for clinical trials and set quality assurance standards, but there is no evidence of an expedited process for approving clinical trials. ⁶⁶⁵ There is no other evidence of an expedited process for clinical trials for unregistered medical countermeasures to treat ongoing pandemics through the Ministry of Health, the Emergency Preparedness and Response Department, the National Disaster Management Agency, or the Eswatini Health and Human Research Review Board (EHHRRB). ^666667668669

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is no publicly available evidence that there is a government agency responsible for approving new medical countermeasures for humans in Eswatini. According to the Joint External Evaluation (JEE), conducted in April 2018, the provision and deployment of medical countermeasures is the responsibility of the Central Medical Stores, within the Ministry of Health, but there is no publicly available indication that it regulates new medical countermeasures. ⁶⁷⁰⁶⁷¹ The Medicines and Related Substances Control Act (2016) regulates the control of medicines and related substances in Eswatini, but there is no mention of countermeasures in the Act. ⁶⁷²⁶⁷³ The JEE does note, however, that Eswatini is currently in the process of establishing a regulatory authority to oversee medical countermeasures. ⁶⁷⁴ One of the roles of the Swaziland Health Laboratory Services is to provide guidelines for clinical trials and set quality assurance standards, but there is no evidence that this currently includes the approval of new countermeasures. ⁶⁷⁵ There is no other evidence of a government agency responsible for approving new medical countermeasures (MCM) for humans through the Ministry of Health, the Emergency Preparedness and Response Department, or the National Disaster Management Agency. ^676677678 The website of the Promoting of Quality of Medicines Plus (PQM+) program under the USAID notes that the Eswatini Ministry of Health (MOH) oversees the regulation of health products through the Medicines Regulatory Unit (MRU). Although the Medicines & Related Substances Control Act of 2016 provides for the creation of an independent National Medicines Regulatory Agency (NMRA), progress has been slow. The MRU currently functions to expedite the NMRA’s establishment.⁶⁷⁹

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no publicly available evidence that Eswatini has an expedited process for approving medical countermeasures for human use during public health emergencies. According to the Joint External Evaluation (JEE), conducted in April 2018, the provision and deployment of medical countermeasures is the responsibility of the Central Medical Stores within the Ministry of Health, but there is no indication of an expedited process for approval for human use during public health emergencies. ⁶⁸⁰⁶⁸¹ The Medicines and Related Substances Control Act (2016) regulates the control of medicines and related substances in Eswatini, but there is no mention of countermeasures in the Act. ⁶⁸²⁶⁸³ The JEE does note, however, that Eswatini is currently in the process of establishing a regulatory authority to oversee medical countermeasures. ⁶⁸⁴ One of the roles of the Swaziland Health Laboratory Services is to provide guidelines for clinical trials and set quality assurance standards, but there is no evidence of an expedited process for approving medical countermeasures for human use during public health emergencies. ⁶⁸⁵ There is no other evidence of such a process through the Ministry of Health, the Emergency Preparedness and Response Department, or the National Disaster Management Agency. ^686687688

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

eSwatini has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶⁸⁹

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is evidence that epidemics and pandemics are integrated into Eswatini’s national risk reduction strategy. The National Multi-Hazard Contingency Plan (2019–2020) sets an overall objective of “strengthening] national capacity to prepare for and respond to epidemics, outbreaks, malnutrition, and providing integrated health services, surveillance, and medical supplies for the affected population in a timely and coordinated manner.” In Table 5 of the plan, epidemics and pandemics are listed alongside other major risks such as drought, floods, and extreme temperatures. The table outlines preparedness and response activities, strategies, and associated costs for managing these hazards, demonstrating that epidemics and pandemics are embedded within the country’s broader disaster risk management framework.[1] No additional evidence is available through the National Disaster Management Agency Strategic Plan 2017-2021, the National Disaster Risk Management Policy 2010, the Disaster Management Act, 2006, the National Health Sector Strategic Plan 2024/25 – 2027/2028, the Ministry of Health, the Emergency Preparedness and Response Department, or the National Disaster Management Agency. [2, 3, 4, 5, 6, 7]

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 0

There is no publicly available evidence that Eswatini has cross-border agreements, protocol, or memoranda of understanding (MOUs) with neighbouring countries with regards to public health emergencies. According to the Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, "[t]here are no formal agreements/MoUs with neighbouring countries (i.e. the Southern African Development Community) and regional/international organizations (e.g. the Global Outbreak Alert and Response Network) to ensure timely mutual cross-border aid (personnel and medical countermeasures)." ⁶⁹⁰ Although Eswatini is a member of the Southern African Development Community (SADC), the Protocol on Health (1999) between member countries does not explicitly address cooperation during public health emergencies. ⁶⁹¹ There is no other evidence of a cross-border agreement, protocol, or MOUs between Eswatini and neighbouring countries regarding public health emergencies through the Ministry of Health, the Ministry of Foreign Affairs and International Co-operation, the Emergency Preparedness and Response Department, or the National Disaster Management Agency. ^692693694695

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

There is publicly available evidence that Eswatini has cross-border agreements, protocol, or memoranda of understanding (MOUs) with neighbouring countries with regards to animal health emergencies. Eswatini participates in regional collaboration on animal health emergencies through its involvement in the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). In March 2025, the country hosted the 12th Regional Steering Committee meeting (RSC12) in Mbabane, which brought together veterinary officials and stakeholders from across Africa to strengthen cooperation in managing transboundary animal diseases such as Foot-and-Mouth Disease, African Swine Fever, and Rift Valley Fever. During the event, Eswatini reaffirmed its commitment to regional disease surveillance, information sharing, and coordinated response mechanisms, which are the key components of cross-border and regional collaboration under GF-TADs and the African Union Interafrican Bureau for Animal Resources (AU-IBAR). ⁶⁹⁶

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Eswatini (formerly Swaziland) is a State Party to the Biological Weapons Convention (BWC). It formally acceded to the Convention on 18 June 1991. ⁶⁹⁷

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

There is publicly available evidence that Eswatini has submitted Confidence-Building Measure (CBM) reports for the Biological Weapons Convention (BWC) in the past three years (2022–2025). The Eswatini CBM report was submitted on 12 February 2025. ⁶⁹⁸

5.3.1c Submission of UNSCR 1540 reports

Score: 0

There is no publicly available evidence that Eswatini has submitted a national implementation report under UN Security Council Resolution 1540 (2004) to the 1540 Committee in the United Nations in recent years. No available evidence is available through the webpages of the UN Security Council Resolution 1540 (2004), U.S. Department of State's UNSCR 1540 or media articles.⁶⁹⁹⁷⁰⁰

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Eswatini does not meet at least 2 of the criteria (in fact, none of the three). Eswatini is not listed among the partner countries in the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP). ⁷⁰¹ The official list of Australia Group participants does not include Eswatini, which confirms the country is not a member. ⁷⁰² The Proliferation Security Initiative (PSI) Endorsing States List does not feature Eswatini, indicating it has not endorsed or joined the initiative. ⁷⁰³

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

There is evidence that Eswatini has completed a Joint External Evaluation (JEE) of its public health capacities within the past five years, in 2024, however, there is no evidence that the full report is publicly available. According to a World Health Organization's article on 09 October 2024, Eswatini successfully completed its second Joint External Evaluation in October 2024, assessing its ability to prevent, detect, and respond to public health risks under the International Health Regulations (2005). ⁷⁰⁴ There is no evidence that the full report is publicly available through the World Health Organization, the Ministry of Health or the WHO Regional Office for Africa. ^705706707 The first Joint External Evaluation (JEE) of Eswatini was published in 2018, which falls outside the timeframe of 5 years. ⁷⁰⁸

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Eswatini has not completed and published a Performance of Veterinary Services (PVS) assessment, either initial or follow-up, within the past five years. The Swaziland: Tool for the evaluation of Performance of Veterinary Services: Final Report was published in 2007 while the Swaziland: OIE PVS Evaluation Follow-Up Mission Report was in 2015. ⁷⁰⁹⁷¹⁰

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Eswatini has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. The Swaziland: PVS Gap Analysis report was published in 2015 with no update since then. ⁷¹¹

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is no public evidence that the country has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years (2022-2025). A media article reports that In the 2022/23 fiscal year, Eswatini’s government allocated approximately SZL 2.42 billion (~USD 139 million) to the Ministry of Health, however, it does not explicitly designate funds for epidemic preparedness or response. ⁷¹² According to a post by the Facebook of Eswatini Government, the Ministry of Health was allocated a budget of SZL 2.76 billion (~USD 158 million) for the year 2023/2024 but there is no mention of a specific fund dedicated to address pandemic or epidemic threats. ⁷¹³ No evidence is identified from the National Health Sector Strategic Plan 2024/25 – 2027/2028, the Annual Budget Performance Report For Financial Year 2024 – 2025 or the Ministry of Health website. ^714715716

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no publicly available indication that Eswatini’s Joint External Evaluation, National Action Plan for Health Security, or any Global Health Security Agenda (GHSA) roadmap allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. The Joint External Evaluation (JEE) for Eswatini, conducted in April 2018, does not include any relevant information while there is no National Action Plan for Health Security, or any GHSA roadmap publicly available for Eswatini. ⁷¹⁷

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no evidence that Eswatini’s Performance of Veterinary Services (PVS) Gap Analysis or PVS Assessment allocate or describe specific funding from the national budget (either for the past five years or projected into the future) to address identified gaps. While Section VI.3 – Financial Resources Analysis of the 2015 Swaziland: PVS Gap Analysis discusses financial considerations, it only outlines operational funding, emergency funding, and capital investment needs. These references do not constitute a dedicated allocation of national budgetary resources to address the identified gaps.⁷¹⁸ No relevant information is included in the Swaziland: Tool for the evaluation of Performance of Veterinary Services: Final Report and the Swaziland: OIE PVS Evaluation Follow-Up Mission Report. ⁷¹⁹⁷²⁰

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is a publicly identified special emergency public financing mechanism and funds which Eswatini can access in the face of a public health emergency. Eswatini is a member of the African Public Health Emergency Fund (APHEF), which mobilizes "financial resources and "disburse them for interventions against priority disease outbreaks and other public health emergencies in Member States". The fund is financed by contributions from member states and from external donors. APHEF covers requests and proposals for assistance from member countries during outbreaks and public health emergencies. ⁷²¹ It should be noted that the World Health Organization has reported in July 2025 that the total contributions of contributions of Member States to APHEF during the period 2018–2024 is USD 15 million ⁷²² Eswatini is among the countries eligible to borrow from the World Bank's International Development Association (IDA). It is classified as country under Class 2: IDA-eligible but also creditworthy for some International Bank for Reconstruction and Development (IBRD) borrowing and Class 3: Borrowing on small economy terms, when applicable. ⁷²³ According to the Eswatini: Disaster Risk Finance Diagnostic report published in 2022, on page 9, it is stated that the Eswatini government "has no financing instruments in place to finance disaster response; it is fully reliant on budget reallocations and ex post borrowing". ⁷²⁴ There is no other publicly available evidence that Eswatini has a dedicated national reserve fund. The Ministry of Health does not share relevant information via its public website. ⁷²⁵ There is no evidence of media reports or academic studies with additional relevant information.

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

There is no evidence that senior Eswatini leaders have, in the last three years (2022-2025), made a public commitment either to improve the country's own domestic capacity to address epidemic threats by expanding financing or requesting support to improve capacity; or support other countries to improve capacity to address epidemic threats by providing financing or support. There is no mention of such a commitment in the World Health Organization's Country Cooperation Strategy: Eswatini 2022–2026 published in 2022, the National Health Sector Strategic Plan 2024/25 – 2027/2028 or the Ministry of Health. ^726727728 There is no evidence in international news media or from United Nations or WHO press releases that Eswatini leaders have made a request for such funding in the last three years. There is no relevant information available from The Deputy Prime Minister's Office Eswatini's website, X or Facebook accounts nor from the Prime Minister Russell Mmiso Dlamini's Facebook and Instagram accounts or elsewhere online. ^{729730731732733}

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is no publicly available evidence indicates that Eswatini has offered financing or technical assistance to other nations to improve capacity to address epidemic threats during the past three years. There is publicly available evidence that Eswatini requested financing or technical support from donors to improve the country’s domestic capacity to address epidemic threats. For instance, in September 2024, The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the government of Eswatini launched the implementation of three new grants worth a total USD 46.7 million for the period 2024-2027. The funding aims to sustain and expand Eswatini’s progress against AIDS, tuberculosis (TB) and malaria, and strengthen health and community systems across the country over the 2024-2027 period. ⁷³⁴

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

There is public evidence that Eswatini fully met its assessed contributions to the World Health Organization (WHO) for 2024. According to the WHO’s Status of Collection of Assessed Contributions, including Member States in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution (dated 7 May 2024), Annex 1 shows that, for two fiscal periods, as of 31 December 2023 and as of 31 December 2022, Eswatini had no arrears in its assessed contributions. ⁷³⁵ No other assessed contributions reports are available on the WHO website.⁷³⁶

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available plan or policy for sharing genetic data, epidemiological data, clinical specimens, or isolated specimens (biological materials) with international organisations and/or other countries that goes beyond Influenzae. There is no mention of such data sharing on the public websites of the Ministry of Health, the Eswatini Health Laboratory Service and the National Health Sector Strategic Plan 2024/25 – 2027/2028, the National Health Sector Policy 2016-2026, the Eswatini Health Laboratory Services Strategic Plan (2021-2023), and the Country Cooperation Strategy: Eswatini 2022–2026. ^{737738739740741742}

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Eswatini has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years. Publicly available PIP's reports between 2023 and 2025, including the Six-month progress report for the period of 1 January– 30 June 2024 published on 17 October 2024, the Partnership Contribution High-Level Implementation Plan III 2024-2030 published on 19 June 2024, and the Partnership Contribution High-Level Implementation Plan III 2024–2030: At a Glance published on 16 July 2023, do not include any relevant information. ^743744745 There is no evidence of such a plan in media, academic studies, or other external documentation.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that the country has not shared pandemic pathogen samples during an outbreak in the past two years. The WHO’s Pandemic Influenza Preparedness (PIP) system makes virus transfers traceable via the Influenzae Virus Traceability Mechanism (IVTM); there are no public notes flagging Eswatini for non-sharing in this period. ⁷⁴⁶ There is no reference to sharing pandemic pathogen data on the Ministry of Health website, and there have not been any reports of Eswatini not sharing samples in either national and international media. ⁷⁴⁷ Likewise, there is no relevant information shared via the World Health Organization (WHO) International Health Regulations Strategic Partnership Portal; in the WHO Eswatini country profile; in the WHO Regional Office for Africa website; the WHO COVID-19 dashboard for Eswatini; or the WHO Eswatini News site. ^{748749750751752} There is no relevant information shared via the World Health Organization (WHO) Disease Outbreak News website. ⁷⁵³

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 27

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 25

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 75

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 96.27

6.2.2a UNDP Gender Inequality Index score

Score: 43.96

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 45.92

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 33.33

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 45.4

6.3.1a Adequacy of road network

Score: 50

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 50

6.4.1a Urban population (% of total population)

Score: 87.06

6.4.2a Change in forest area (percentage points)

Score: 84.66

6.4.3a Natural disaster risk

Score: 50

6.5.1a Total life expectancy (years)

Score: 43.82

6.5.1b NCD mortality rate

Score: 24.71

6.5.1c Population aged 65+

Score: 80.01

6.5.1d Tobacco use (% of adults)

Score: 64.75

6.5.1e Level of adult obesity (%)

Score: 47.61

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 51.83

6.5.2a Access to potable water

Score: 79.97

6.5.2b Access to at least basic sanitation facilities

Score: 63.95

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 29.5

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50