NO: 28/2019

Eswatini Pledge to the Global Fund

Following a pledge of $6million dollars made by the Kingdom of Eswatini to the Global Fund, Government wishes to state the following;

  1. It is important to note that this is a pledge. No money has yet been released by the Government to the Global Fund. The eventual release of funds will cover a three year period.
  2. This pledge is an investment in our citizens’ health and a commitment of solidarity to a noble cause with the global community.
  3. To-date the Global Fund has disbursed to the Kingdom of Eswatini US$265,893,078 to implement activities under the AIDS, Tuberculosis, Malaria and Health Systems Strengthening Programs.
  4. Currently Eswatini is implementing HIV/AIDS, TB and Malaria activities that are supported by Global Fund to the tune of $51million for a period of 3 years, 2018-2021.
  5. A new phase of funding is expected to start in 2022 where Eswatini stands to receive more money from the Global Fund in accordance to a submitted proposal.
  6. The pledge by Eswatini is an investment and a way of building sustainability of health programmes in the country.

Percy N. Simelane

Government Spokesman

11 October 2019



  • The Kingdom of Eswatini has signed a total of 14 grants with the Global Fund to Fight AIDS, TB and Malaria (GFATM) accelerate local programs aimed at ending AIDS, Tuberculosis and Malaria epidemics;
  • Since signing the first grants in 2003, to-date the Global Fund Eswatini has disbursed to the Kingdom of Eswatini US$265,893,078 to implement activities under the AIDS, Tuberculosis, Malaria and Health Systems Strengthening Programs.
  • The cumulative disbursement split for the 3 diseases, including Health Systems strengthening is as follows:
    1. HIV/AIDS          US$192,644,814
    2. TB/HIV          US$  16,347,645
    3. Tuberculosis US$  35,593,268
    4. Malaria          US$  13,094,389
    5. Health Systems Strengthening US$    8,212,962



  1. 1. HIV and AIDS
  1. Treatment Care and Support
  • Procurement of Anti-Retroviral Drugs. The Government of Eswatini has been the main funder for ARVs in the last 10 years and through the Global Fund ARV buffer stock for adults and treatment for Opportunistic Infection (OI) Medication is procured. Our partners PEPFAR has played a role in the procurement of Pediatric ARVs drugs.
  • Procurement of Health Products, such as Laboratory Reagents, HIV testing Kits and other Laboratory Consumables.
  • The Global Fund has contributed to the national Laboratory Sample Transportation system. In addition to the vehicles that were procured through the Global Fund funding, a courier service company has been contracted to transport samples from peripheral health facilities to the main laboratories. This has improved the results turn-around time from 1 month and facilities are now able to provide treatment within 3 days. Secondly, clients now receive all lab services in their domicile health facilities instead of travelling to main laboratories for viral load testing, for example. 
  • Prevention of Mother to Child Transmission of HIV (PMTCT). The Global Fund has contributed immensely to the procurement of Laboratory Reagents and payment of stipends for Expert Clients (Mentor Mothers) who do door-to-door visits to HIV positive pregnant and new mothers, encouraging them to adhere to treatment
  1. Prevention

GF has supported the country in areas of Social Behavior change interventions through

  • the provision of HIV Prevention sessions for youth out of school, such as Health clubs where the youth talk about health issues and how to access health services;
  • provision of menstrual hygiene packs to adolescents in school, which has improved retention of girls in schools
  • roll-out of life skills education to all secondary and high schools in Eswatini. The Eswatini Government has approved life skills training in schools and the Global Fund is responsible for the training of Teachers and printing of material to be used during the training of the youth in schools
  • The Ministry of Health, through the National AIDS Program is providing male circumcision to young boys between the ages 10 – 14 years.

New HIV Infections among adolescents and Young girls aged 15 to 24 years declined from 3,000 in 2017 to 2,700 in 2018 and is projected to further decline to 2,400 in 2024.

And an evaluation on adolescents and youth, in and out of school, which included a study to determine if education incentives have any impact on new HIV infections among adolescent girls and young women (Sitakhela Likusasa Impact Evaluation Study) will be finalized in 2020.


The Global Fund support over the years has played a critical role in TB control in Eswatini since the Declaration of TB as a National Emergency on 24 March 2011. The provided funding has allowed the country to address the following interventions:

  1. TB Case Detection and Diagnosis, which includes;
    • the engagement of communities who in the communities to identify people suspected to be having TB and referred to health facilities for diagnosis and treatment;
    • demand creation and literacy, through the distribution of IEC material and commemoration of World TB Day.


  1. Multi-Drug Resistance-Tuberculosis Treatment (MDR-TB)
  • provision of comprehensive patient support (food parcels and transport stipend) to all TB patients undergoing treatment;
  • Procurement of TB Drugs.
  1. 3. Malaria
  2. Vector Control
  • Surveillance has been the cornerstone towards the reduction of malaria cases in the country. This is attributed to a functional and robust Malaria Surveillance Database (MSDS) as well as a real time notification system; the Immediate Disease Notification System (IDNS). This has enabled the Malaria Program to be more effective case investigation and detection.
  • Eswatini’s chosen vector management intervention is Indoor Residual Spraying (IRS). It is important that any country in elimination can determine the vectors that are prevalent in the country setting and as such Eswatini, through Global Fund support has established a Malaria Insectary to routinely monitor insecticide resistance and to ascertain the most effective chemical that would fight the vector.
  1. Case Management
  • Through the Global Fund, the Malaria Program has been able to procure Health Equipment and Consumables for case management, diagnosis and treatment.
  1. 4. Health Systems Strengthening (HSS)/ Resilient and Sustainable Systems for Health (RSSH)
  2. The Global Fund has continuously funded health systems strengthening interventions in the 3 programs, including the Health System, as follows:
    • Employment of Human Resource; Doctors, Nurses, Laboratory personnel, and other Program staff necessary to scale-up the implementation of activities funded through the Global Fund grant.
    • Training of both professional and community Health Care Workers, such as Doctors, Nurses, Laboratory personnel, Rural Health Care Motivators (RHMs), TB Active Case Finders (ACFs), TB/HIV Expert Clients/ Mentor Mothers.
    • Procurement of vehicles and equipment, computers and printers
    • Refurbishment of the Eswatini Central Medical Stores and Procurement of Central Medical Stores delivery vehicles
    • Support for the creation of the Client Management Information System (CMIS) and Monitoring and Evaluation reporting Systems
    • Funding of periodic disease Program Reviews (TB/HIV Program Review, Malaria Program Review), including national Surveys, such as the TB Prevalence Survey, and the Drug Resistance Survey.



The Impact of the Global Fund grants to Eswatini has been tremendous and we have noted more gains across of 3 diseases. 

  1. 1. HIV
  2. The Kingdom of Eswatini has dropped new infections from 7,000 in 2017 to 6,400 in 2018 and is estimated to reach 6,000 in 2024. The 2010 estimates and projections report had indicated that new infections would be around 11,000. This has been through high uptake of ARV treatment and aggressive campaigns on behavior change including male circumcision.
  3. More HIV positive patients are on ART and as at 31 December 2018, patients enrolled on ART were 172,904. This has been made possible through the allocation of funding for Laboratory Strengthening, that is, procurement of Lab Reagents, HIV Test Kits, Equipment and additional Lab personnel. This has resulted in the country reaching 90.90.90. Targets
  4. 2. TB

The Global Fund support over the years has played a critical role in TB control in Eswatini since the Declaration of TB as a National Emergency on 24 March 2011.

More TB patients are now referred to health facilities for treatment and this has been made possible through use of community systems, Active Case Finders (ACFs), Rural Health Motivators (RHMs), and TB/HIV Expert Clients.

  1. More patients are now enrolled in the TB Patient support and receive monthly food parcels and transport stipend.
  2. The Regional Doctors and Nurses hired through the grants have ensured that TB services are decentralized to the regions and patients receive immediate service from facilities.

Some key achievements of the collaboration between the Global Fund, Eswatini Government and in-country partners include:

  • A gradual decline in TB cases from 11,000 in 2010 to 3,000 in 2018
  • An increase in TB case finding/detection from 56% in 2015 to 84% in 2018
  • Doubled TB testing (bacteriological confirmation) from 30% in 2011 to 61% in 2018.
  • Reduction in TB/HIV co-infection from 80% in 2012 to 66% in 2018.
  • Great improvement in TB treatment success from 72% in 2013 to 86% in 2018.
  • The successful conduct of the first ever Eswatini National TB Prevalence Survey in 2018 to scientifically measure the true burden of TB disease among emaSwati
  1. 3. Malaria
  1. Through the Global Fund the country has successfully transitioned from malaria control continuum to pre-elimination and eventually malaria elimination with a set date of the 2020 season. This required extensive investment especially during the transitioning from control to pre-elimination.
  2. As a result of the Global Fund’s investment, the country has seen a significant decline of malaria cases as well as incidence attributed to the uptake of the various key interventions within the Malaria National Strategic Plan.
  1. Malaria case investigation period has reduced from 7 days to 48 hours from curbing onward transmission.
  1. The continuous capacity building of Health Care Workers across the country on the evolving Diagnosis and Treatment guidelines has enabled health workers to respond aptly to malaria cases, saving lives of patients.
  1. Ownership of the malaria elimination agenda is paramount in the pursuance of elimination and through the Global Fund the country has the most effective Advocacy Strategy which has also attributed to the reduction of cases.
  1. Furthermore, the introduction of regional Global Fund grants through (E8 and MOSASWA) has been effective in regional collaboration. This collaboration has ignited a practical collaboration in shared interventions between bordering countries targeting a highly mobile population that poses a risk to the elimination agenda.
  1. 3. Health Systems Strengthening
    • Timely delivery of medical supplies to health facilities.
    • The installation of Client Management Information System (CMIS) in some facilities has improved data reporting timelines, as more of the facilities are now reporting real time.


Most of the gains are a result of collaboration with other stakeholders who have invested immensely in the 3 diseases. To sustain these gains the following actions are necessary:

  • The country under the Prime Minister office has established a sustainable funding committee to set up national mechanisms to sustain and surpass gains we have made through the external support.
  • The Ministry of Health has created efficiency systems such as Procurement and Supply Chain Management and the Procurement and Supply Chain Management.

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