From Paper to Pixels: Driving the Digital Transformation of Community Health Services in Eswatini

Lomagugu Khumalo once spent hours each month completing health registers and summary reports as part of her work as a Rural Health Motivator (RHM) in Eswatini. The administrative demands of the role extended beyond paperwork. To submit her reports for consolidation, she often had to travel—at her own expense—to the chiefdom, Inkhundla, and consequently to the nearest health facility, or regional health offices. In some cases, she was required to complete multiple forms, particularly when reporting to different funding partners. For Lomagugu and other RHMs, these reporting requirements made data collection both time‑consuming and financially burdensome, especially in the context of the modest stipends they receive. Poor data quality and the lack of real-time access limit effective supervision, analysis, and timely health interventions. With timely and quality data, frontline health workers can better assist in prevention, early detection, and community outreach—services that help people stay healthy and support families so they are able to learn, work, and pursue economic opportunities.

Rural Health Motivators play a central role in Eswatini’s health service delivery, where an estimated 77% of the population lives in rural areas. They account for nearly 22% of the national health workforce and support communities through health promotion activities, education sessions, and preventive services such as screenings for conditions like malnutrition. Acting as a first point of contact within the health system, RHMs help drive the uptake of essential services—including immunization and antenatal care—and guide community members to the most appropriate level of care. By strengthening primary healthcare at the community level, RHMs are contributing to the building of human capital in the country.

To address the data collection and reporting challenges faced by RHM—and to improve the quality and use of community‑level data—the Ministry of Health, with support from the World Bank under the Health Systems Strengthening for Human Capital Development Project, introduced the electronic Community‑Based Health Information System (CBHIS) covering key modules such as non-communicable diseases (diabetes and hypertension), antenatal care, nutritional screening for children under five years, health education, malaria, HIV, among other key priorities

CBHIS is designed to streamline data management, strengthen decision‑making, and support the delivery of quality health services at the community level. It covers the full cycle of community health information—from data collection and management to analysis and use—and operates on a handheld device that functions offline, allowing data to be synchronized once network connectivity becomes available. CBHIS is also integrated with the national electronic health record management system (Client Management Information System) ensuring consistency and accuracy across different platforms which is crucial for comprehensive patient care and effective health management. Stronger data systems improve service delivery and support better planning, resource allocation, and accountability, helping build a well-functioning health system.

The Ministry of Health has successfully completed a pilot in the Mpolonjeni Inkhundla in Lubombo region and is training Rural Health Motivators as it starts to roll out CBHIS across the country. By addressing long-standing challenges related to fragmented health information systems and limited availability of timely data, CBHIS has the potential to strengthen the quality and responsiveness of health services. In doing so, it reinforces investments in human capital—an essential building block for inclusive growth and employment. For RHMs like Lomagugu, the benefits are already becoming evident, offering a glimpse of how digital tools can ease administrative burdens and support better service delivery at the community level.