Eswatini is currently spending USD37.2 million (about E645.8 million) annually on diabetes-related care, and projections show that this figure could surge to USD62.9 million (about E1.09 billion) by 2050.
This is according to Dr. Nongabisa Mkhabela, the Ministry of Health’s Technical Advisor in the Non-Communicable Diseases Integrated Management and Health (NCDIMH) programme. She was speaking during the second session of the Metabolic Crossroads: Prevention and Treatment of Diabetes, Hypertension and Their Complications forum.
Dr. Mkhabela revealed that the annual health expenditure per person living with diabetes in Eswatini is estimated at E15,830, a steep sum for a low and middle-income country — especially when multiplied across tens of thousands of affected individuals.
The key cost drivers include medications for glycemic control, frequent lab tests, hospital admissions for acute episodes, and long-term care for complications such as kidney failure, cardiovascular disease, amputations, and blindness.
“We are paying a heavy price for delayed detection; the later patients present, the more complex and costly their care becomes,” said Dr. Mkhabela.
She emphasised the need for people to get regular health check-ups, even when they are not sick, to enable early detection and management of diseases like diabetes.
A Growing National Health Burden
Dr. Mkhabela noted that diabetes is emerging as one of Eswatini’s most expensive non-communicable diseases (NCDs), putting immense pressure on the health system.
Globally, NCDs claimed at least 43 million lives in 2021, representing 75% of non-pandemic-related deaths. Diabetes alone contributed to over 2 million deaths, including those caused by diabetes-related kidney disease.
In Eswatini, the 2024 STEPS Survey revealed that the prevalence of raised blood glucose has increased to 3.7% among adults, up from 3.1% in 2014. Some studies suggest that when undiagnosed cases are included, the true figure could be as high as 14%.
This means that thousands may be living with diabetes unknowingly, only seeking treatment once complications become advanced and costly.
The ministry’s presentation further indicated that over 90% of the population has at least one major risk factor for NCDs — including poor diet, physical inactivity, or obesity. About one in four adults is living with diabetes or pre-diabetes.
Among women, 66% are overweight or obese, compared to 37% of men, increasing vulnerability to metabolic diseases.
“An estimated 61% of people with diabetes remain undiagnosed — a hidden burden that silently drives future costs and worsens health outcomes,” said Dr. Mkhabela.
‘Early Screening Saves Lives, Livelihoods’
Diabetes primarily affects people in their most productive years, leading to loss of income, disability, and poverty for many households.
Dr. Mkhabela explained that diabetes is not only a health challenge but also a major economic threat, draining household wealth and weakening national productivity. Many people living with diabetes are forced to take extended sick leave, reduce working hours, or stop working entirely due to complications affecting vision, mobility, and overall health.
“Every time someone delays diagnosis, we risk losing both a life and a livelihood,” she said, urging citizens to seek early screening and regular check-ups.
Complications such as blindness, stroke, kidney failure, and amputations often push people into early retirement or permanent disability, removing skilled workers from the labour force and depriving families of their breadwinners.
The result is a ripple effect — reduced productivity, higher poverty levels, and greater strain on the economy.
Prevention Over Cure
For many families, the financial toll of diabetes is devastating. Eswatini continues to experience high out-of-pocket health spending, forcing households to shoulder most of their medical expenses.
Some families resort to selling property or taking on debt to afford medication, hospital transport, and long-term care. In addition, relatives — particularly women — often become informal caregivers, losing income and further straining household finances.
“When a single illness consumes a family’s income, the entire household becomes more vulnerable,” said Dr. Mkhabela.
She said the Ministry of Health is shifting focus from treatment to prevention, through early detection, community screening, and health education under the NCDIMH Programme.
The national strategy also includes strengthening primary healthcare by integrating diabetes and hypertension screening into all routine services. Community health workers and rural health motivators are being deployed to rural areas for outreach and early referral.
“For every person we diagnose early, we prevent years of suffering and save thousands of Emalangeni that would have gone into hospital care,” Mkhabela concluded.
