THE JOB BLOODBATH ON SWAZILAND'S HEALTH SYSTEM AND LOOMING COLLAPSE
Trump’s Executive Order Could has pushed the country into a Public Health Catastrophe – Are We Ready for the Next Crisis?
On January 20, 2025, U.S. President Donald Trump issued an executive order halting all foreign assistance for 90 days. For Eswatini, a country where 80% of HIV/AIDS funding is donor-dependent, this move was a near-death experience for the public health sector. This order has been enforced indefinitely and this means the country’s health system will collapsed in a matter of weeks, leading to massive job losses, supply chain breakdowns, and a reversal of decades of health gains.
The funding freeze has exposed the country’s dangerous over-reliance on external funding. If nothing changes, the next funding crisis could be the one that breaks the system for good. We are speaking of a silent genocide taking place in our current healthcare system. This was mentioned by the current GS of the nurses’s union in one of the Twitter space discussions "The Unsustainable Reality: A Health System Run by NGOs The country’s public health sector is not truly public".
USAID, the main funder of the health sector in eSwatini.
Our health system is an NGO-driven system, propped up by external donors like PEPFAR, The Global Fund, and USAID.
• 15+ international NGOs are responsible for implementing essential health services.
• Over 200,000 people rely on donor-funded ART programs.
• The Ministry of Health itself depends on donor funds to run national HIV and TB programs.
This means the government does not fully control its own healthcare system—a dangerous position for any nation.
The ongoing jobs bloodbath
Using conservative figures from the 15 major NGOs (The Luke Commission, ICAP, EGPAF, NERCHA, FLAS, George Town University, AMICAAL, World Vision etc) as listed by government in her public statement, who are beneficiaries of the US donor aid I can project that if the PEPFAR freeze continues beyond 90 days, the country wilk lose an estimated 4,500–6,500 health sector jobs.
These include:
1. 300-400 Medical Officers
2. 1000-1500 Nurses and Clinical Officers
3. 800-1200 Community Health Care Workers 4. 500-700 Lab Techs and Supply Chain Staff 5. 1500-2000
Admin and Logistics staff With no salaries for thousands of health workers, hospitals and clinics would shut down within weeks.
Hypothetically we can put a timeline of How Long it Would Take for the System to Collapse?_
If the funding freeze persists, I estimate:
• Day 1–7: Delayed salary payments for NGO and donor-funded health workers. Some clinics reduce services.
• Day 8–14: ART supply chain disruptions begin, affecting over 200,000 people on treatment.
• Day 15–30: Full-scale crisis. Major HIV/TB services, institutions shut down. Thousands of patients default on treatment, risking drug resistance and surges in new infections.
• Day 31–60: Our hospitals overwhelmed experiences a rise in preventable deaths, undoing two decades of progress in HIV/AIDS control.
By Day 90, the country’s health system would be in total collapse, with rising mortality, drug shortages, and international humanitarian emergency intervention required.
A Ticking Time Bomb
This crisis exposed an uncomfortable truth: We are not in control of our healthcare system.
• A single foreign policy decision nearly erased decades of progress.
• The government’s budget priorities remain skewed, with millions allocated to the monarchy and military while health remains donor-funded.
• Swaziland must invest in sustainable health financing—or risk another near-collapse when the next funding crisis arrives.
American President Donald Trump who has frozen USAID funding to eSwatini and other parts of the world.
A Lesson We Cannot Ignore
The rescinding of Trump’s executive order saved Mswati this time—but what about the future? Swaziland must act now to:
1. Reduce donor dependence by increasing local health sector investment. There is no nation that can have a sense of pride if it outsources its health sovereignty. Current projections can show that nearly 50% of our health system financing is from external sources.
2. Reform budget priorities to put citizens’ health before luxury spending.
3. Create a national health fund to safeguard essential services from external funding shocks. Tibiyo and Tisuka are institutions that were created through the blood and sweat of ordinary Swazis, it has since become the Kings piggy bank. The next funding crisis may not come with a warning.
If we do not learn from this scare, the job bloodbath and health system collapse will become a reality, not just a projection.
NB: Most of the projections were made using the most conservative figures. The purpose of the above is to try illuminate the severity of the crisis. Numbers usually do the trick.