Following the appointment of a parliamentary committee to investigate challenges at Mbabane Government Hospital, including issues of understaffing, the committee has found critical staff shortages affecting nearly every department at the facility.
This was revealed by the committee in their report that was tabled by Mayiwane Member of Parliament (MP) Sicelo Dlamini in Parliament on Wednesday on behalf of the select committee Chairperson Lomahasha MP Zanele Mashaba. The report is yet to be debated.
Mashaba stated in the report that the hospital’s doctor-to-patient ratio of approximately 1:100, coupled with understaffed nursing units, reflects a workload far beyond sustainable limits.
Swaziland Democratic Nurses Union (SWADNU) President Mayibongwe Masangane stated that the number of patients that nurses and doctors have to attend to daily depends on the region where the facility is located. He said in the country, a single nurse has to attend to 12 patients a day. He, however, noted that nurses were attending to more patients than these numbers. He stated that doctors had to attend to more patients than nurses.
She said the vacant posts often remained unfilled for over 18 months, primarily due to Circular No. 3 of 2018 which came with a hiring freeze and a slow, centralised replacement process within government. Mashaba added that they also observed that this shortage was not unique to Mbabane Government Hospital, but was symptomatic of a nationwide human resource crisis.
She stated that at the Mbabane Public Health Unit (PHU), the staffing deficit undermined the facility’s ability to perform its core public health mandate, particularly community outreach, health education, and preventive interventions.
“The staff at the Mbabane Public Health Unit is far below the operational requirements. The unit currently employs 27 staff members against an establishment of 97, leaving key functions under-resourced. The laboratory is run by a single technician, who also serves as a counsellor, which delays turnaround times for test results. Staff morale is low, as many nurses are working double shifts to make up for staffing shortages,” reads the report.
She added that some employees reported having to personally fund minor operational needs, such as batteries for blood pressure monitors. She stated that these challenges closely reflect those at Mbabane Government Hospital and demonstrate that understaffing, fatigue and low morale are systemic across the health sector.
She stated that there was a severe shortage of clinical and support staff at the hospital. She said in the children’s ward, patients complained of long waiting times and the unavailability of doctors. Mashaba added that in the laboratory, the manager reported a critical shortage of technologists, resulting in delays in test turnaround times before treatment can begin.
“In Ward 15, nurses reported being overworked, fatigued and demoralised due to chronic understaffing. Some reported working double shifts to cover vacant posts, compromising both morale and service quality. We noted incidents of inattention to patients, especially in waiting areas, where individuals were advised to return on later dates because specific staff members were unavailable,” she said.
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She stated that this reflected the hospital’s operational overstretch and a lack of supervision. She added that the staff attributed their frustrations to high workloads, limited career progression and inadequate welfare support.
Mashaba added that whilst management outlined ongoing efforts to mitigate shortages through workforce planning and vacancy submissions, both management and practitioners agreed that the workload at Mbabane Government Hospital remained unsustainable without broader reforms to the referral system and the strengthening of regional health facilities.
She added that the committee also noted emerging proposals to convert the outpatient department into a filter clinic to better manage patient flows and preserve the facility’s role as the national referral hospital.
She stated that at Hlatikulu Government Hospital, the shortage of nurses and clinical staff has become so severe that management has been forced to close private wards and merge departments, further constraining service delivery.
Mashaba said there was a critical staffing shortage at Hlatikulu Government Hospital. With a required nursing complement of 115, the hospital operates with less than half that number, forcing the merger of departments and the closure of the High Dependency Unit (HDU). She said the Senior Pharmacist reported that a single pharmacist manages the workload, with limited support for heavy lifting and loading, resulting in delays in drug distribution.
“The committee also noted widespread fatigue and low morale among health workers, attributed to excessive workloads and deteriorating staff housing. Nurses reported that understaffing compromises quality care, with single nurses attending to large patient loads, while clinical support and maintenance staff remained insufficient. These findings mirror the staff challenges observed at Mbabane Government Hospital, reinforcing that human resource constraints are systemic across the health sector,” she added.
Mashaba stated that the problem extends upstream to the Central Medical Stores (CMS), where several employees have remained on renewable contracts for over 10 years, creating institutional instability and low morale. CMS continues to operate without a substantive director or human resources, resulting in inconsistent oversight and high staff turnover.
