According to Sibusiso Dlamini, ethical issues relating to palliative care cluster around notions of acceptability and accessibility. He writes:

Swaziland ’s health care system is basically divided into two. There is the modern western health system and the traditional indigenous system. Though this is not based on any research or survey in Swaziland, a majority of our terminally ill clients attend traditional healers either before or after attending the western or modern hospitals. In general, according to research, more than 70% of Swazis attend to the traditional healers either before or after attending the modern western health system.

The question could be: what role do our traditional healers play in palliative care? How is palliative care interpreted in the Swazi or African context? Does the Swazi traditional system have a palliative care concept?

Most clients with terminal illnesses might believe they were bewitched or possibly believe they are being punished by their ancestors for some wrong doings. That challenges the acceptability of the palliative care concept in the country. Though the government is now fully accepting the concept, clients fight for their lives till the end. Swaziland is one of the leading countries in Africa who are holding on to culture and traditions.

With approximately 200 000 HIV positive people and 20 000 terminally ill due to AIDS in the country, the health system is now overstretched. The country has approximately 2000 hospital beds in total. Approximately 18 000 of these clients are discharged home, while the home-based care programme is very poor. Though a number of nurses have been trained on basic palliative care, most of them have left the country or are in the hospitals. Home-based palliative care is highly compromised. At the same time those nurses who are trained on basic palliative care in the hospital have been allocated to other wards eg maternity hence their effect is questionable. In general only a few clients have access to palliative care.²⁹