Eswatini health licensing: a home-built nursing exam and a mostly foreign-trained medical workforce

Medical and health education in Eswatini

Eswatini has long relied on training abroad. Many doctors qualified in South Africa, and others in Cuba, Russia, Nigeria, India and elsewhere, then returned for internship. At home the main academic provider for nursing and allied health is the University of Eswatini, together with the Southern Africa Nazarene University and nursing colleges linked to the Ministry of Health and mission hospitals. A private medical school, Eswatini Medical Christian University, has also been established; check its accreditation status with the council before relying on it.

English is the language of instruction at home, and the medical degree abroad takes five to seven years depending on the country. In Eswatini a graduate normally completes an internship year at a government hospital, such as Mbabane Government Hospital or the Raleigh Fitkin Memorial Hospital in Manzini, before full registration.

Graduation connects to registration through the councils. For nurses, the Nursing Council stands between a graduate and the register, and its work on an entry-to-practice exam was designed to make that step consistent and fair across schools.

What makes the nursing exam project distinctive

Most countries inherit a licensing exam from a former colonial power or buy one from the United States. Eswatini built its own. According to a Seed Global Health account, the Nursing Council started in 2017 to develop an Entry-to-Practice Examination covering general nursing together with either midwifery or mental health, built on a blueprint of seven competency domains. The aim was to show that new graduates meet a minimum standard, whichever school they attended.

What we know for certain is limited: the project started in 2017, a pilot was run and national roll-out was planned for 2020. Whether the exam has operated every year since, how many items it has and what the pass mark is were not confirmed in our research. The COVID-19 period interrupted many planned reforms across the region, so do not assume.

1. Write to the Nursing Council to confirm whether the exam is in force for your cohort.
2. Obtain the blueprint and map each domain to your study plan.
3. Register for the sitting through your nursing school or directly, as the council directs.
4. Sit the multiple-choice exam for general nursing plus your chosen component.
5. Apply for registration with the pass result and your certificates.

Midwifery within the same exam

Our data places midwifery inside the same project: the entry-to-practice exam includes a midwifery component, so a graduate qualifies in general nursing and midwifery in one structure. That is different from systems where midwives sit a separate paper. Status is unconfirmed, as for nursing. Prepare for antenatal assessment, normal labour, management of obstetric emergencies, newborn care and prevention of mother-to-child HIV transmission, which the Eswatini health system has prioritised for years.

Doctors

The Eswatini Medical and Dental Council registers doctors after the internship. We found no confirmed MCQ licensing exam for doctors, which means the main hurdles are verification of your degree and the supervised year. Because so many Eswatini doctors qualified in different countries, the council looks closely at school recognition. Ask whether your university appears on the list it accepts, and whether your internship can be completed locally.

Pharmacists, dentists and physiotherapists

For these professions our data lists registration by qualification through the Ministry of Health and the relevant council, and no confirmed exam. Foreign-trained applicants should expect credential checks and possibly a local assessment. We did not verify the details, so write to the registrar with your qualification and ask what applies.

What to prepare while the exam's status is confirmed

Do not wait for certainty before you study. The seven-domain structure described in the Entry-to-Practice project follows a pattern common to modern nursing exams: clinical judgement, safe care, communication, professional conduct and leadership are tested through scenarios rather than recall of lists. If you prepare for that style, you will be ready whether the Nursing Council uses the exam or an alternative assessment.

• Practise patient-safety scenarios: identification, medication checks, falls, pressure injury and infection control.
• Rehearse prioritisation questions in which several patients need help at once.
• Learn the national HIV, TB and maternal health guidelines, since Eswatini has one of the highest HIV prevalence rates in the world and the curriculum reflects it.
• Study professional conduct, consent and confidentiality under Eswatini law and council rules.

Keep your own record of correspondence with the council. If the exam has been suspended or replaced, a written reply protects you against being asked to repeat steps later.

Exam comparison

Language and recognition

The working language in clinics is English, mixed with siSwati. Eswatini is a member of the Southern African Customs Union and of SADC, and many of its clinicians move between Eswatini and South Africa. That does not give automatic recognition. If you intend to work in South Africa, the Health Professions Council of South Africa has its own rules for foreign graduates, and our South Africa page covers them. A licence from Eswatini should be treated as a domestic credential.

Last reviewed October 2026