Although there has been progress, Swaziland continues to face development challenges. These include: slow economic growth; high levels of inequality and poverty; high unemployment rates especially among youth; high incidence and prevalence of communicable (HIV and TB) and non-communicable diseases in the face of health system constraints; high maternal mortality; high levels of chronic malnutrition;  increasing numbers of vulnerable households; low participation of women in decision-making; high incidence of violence, particularly gender based violence against children and women; high rates of teenage pregnancy; limited research and technical capacity to generate timely and quality data to inform the integration of risks and climate change adaptation; capacity constraints on implementing pro-poor policies and strategies effectively, especially in education, health and agriculture; and corruption.

A theme that cuts across the development challenges in Swaziland is capacity in both the demand and supply chain. On the supply side, Swaziland does not have sufficient capacity to address the challenges it faces in service delivery while, on the demand side service, delivery is affected by limited awareness, uptake and utilization of services by citizens. Although the country has produced legislation and numerous policies, implementation of these policies is hampered by the lack of adequate capacity.

Slow economic growth, poverty, inequality and unemployment

Swaziland attained impressive economic growth rates of not less than 6.5 per cent a year in the 1980s and the early part of the 1990s. However, in the second half of the 1990s and particularly since 2000, growth decelerated.  It was around 1.9 per cent in 2010 and the economy shrank by 0.6 per cent in 2011, compared with a targeted average growth rate of 5 per cent a year. Swaziland has also experienced a fiscal crisis owing to the decline in revenue, in particular in SACU revenues.

The poverty level is estimated at 63 per cent. Income inequality, measured by the Gini coefficient at nearly 0.52 (in 2009), is high. The persistence of poverty in Swaziland is exacerbated by, among others, the impact of HIV/AIDS, the global economic financial crisis, and over-reliance on SACU revenues. The sluggish economic growth observed in recent years also continues hamper the implementation of social policies as well as to affect the labour market. Unemployment stood at 41.7 per cent for the overall population in 2013 with youth and women more adversely affected by unemployment.

Rural households involved in non-commercial farming activities are the poorest, followed by self-employed headed households. Poverty is closely correlated to the extent of food security mainly due to unsustainable farming techniques, low rainfall and limited arable land. The effects of climate change manifested in chronic droughts have significantly constrained the rural population, which is largely dependent on agriculture. In 2014, the number of people requiring food assistance was estimated at 67,592. In addition, an estimated 223,249 people required livelihood support such as inputs, cash transfers and institutional support. In order to mitigate the impact of these trends on vulnerable groups, the Government is implementing various social protection schemes, using resources estimated at 2.2 per cent of GDP.

Social Development - Health, HIV and AIDS, Education and Nutrition

The health sector is faced with a shortage of qualified health professionals. The World Health Organization (WHO) recommendation on the ratios of doctors and nurses and midwives to population are 0.55/1,000 and 1.73/1,000 respectively; in Swaziland the ratio falls below this at 0.126/1,000 for doctors and 1.5/1,000 for nurses and midwives. Swaziland also faces Health Management Information System (HMIS) constraints, it relies heavily on paper-based tools and there is fragmentation and lack of interoperability of health information databases. There are also constraints in Procurement and Supply Management (PSM) for drugs, equipment and supplies, with warehousing storage constraints and limited capacity for distribution of commodities due to inadequate transportation systems.

Swaziland has a high HIV prevalence at 26 per cent among 15-49 year olds. Women bear the brunt of the epidemic with 31 per cent prevalence compared to 20 per cent for men. HIV prevalence amongst female adolescents (15-19) and youths (20-24) attending ANC increased from 17.8 per cent  and 18.8 per cent  in 1994 to 20.4 per cent and 40.8 per cent  respectively in 2010. HIV prevalence among women aged 15-24 years was 14.4 per cent % in 2011, significantly higher than the 5.9 per cent reported among men of the same age. HIV incidence is 2.38 per cent in the age group 18-49 year olds; 1.7 per cent for men and 3.1 per cent for women. Incidence peaks amongst men aged 30-34 (3.12 per cent ) and there are three peaks for women, 3.8 per cent in 18-19 year olds, 4.2 per cent  in 20-24 year olds and 4.1 per cent in 30-35 year olds. Gender inequality presents complex challenges for the country. The burden of caring for the sick and orphaned also falls primarily on women, further entrenching gender stereotypes and economic reliance by women on men. The HIV epidemic has also given rise to a severe Tuberculosis (TB) co-epidemic, with an estimated TB incidence of 1,287/100,000 people.  Maternal mortality remains high at 593 deaths per 100,000 live births, also exacerbated by HIV.

The education system still faces challenges as only 29 per cent of children aged 36–59 months attend early childhood care and education while 15 per cent of primary school children repeated their class and 4 per cent dropped out of school in 2012. Less than 50% of those who enter grade one do not reach grade seven. Contributing factors to low enrolment and retention rates include the cost of lower secondary education, the need to support the family in household chores and high teenage pregnancies. Whilst education has been more accessible to all, women’s representation in the field of science and technology remains low, thus affecting their employment opportunities in high earning and influential positions.

Swaziland is faced with chronic child malnutrition. At a national level, 26 per cent of children under the age of five are stunted, while 2 per cent are wasted and 6 per cent are underweight. The causes of childhood stunting are complex and relate to maternal and child health, low consumption of vitamin A, infant and young child feeding, water sanitation and hygiene, access to nutritious foods, caregivers’ practices and poverty .

Micronutrient malnutrition also exists particularly among pregnant and lactating mothers and children below five years of age. Thirty percent of women aged 15-49 have some degree of anaemia, with pregnant women more likely to be anaemic at 40 per cent. Approximately 42 per cent of children aged 6-59 months suffer from some degree of iron deficiency anaemia and only 68 per cent of children aged 6-59 months received Vitamin A. Forty eight percent of children are breastfed within the first hour of birth and 64 per cent of children less than six months old are exclusively breastfed.