This study addresses a current research gap in Medicine concerning Indigenous Knowledge Systems in Medicine Practice in Eswatini. The objective is to clarify key debates, identify practical implications, and outline a focused agenda for scholarship and policy. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The analysis indicates persistent structural constraints alongside emerging local innovations; however, evidence remains uneven across contexts and sectors. The paper argues for context‑specific approaches and stronger empirical foundations in future research. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Indigenous Knowledge Systems in Medicine Practice, Eswatini, Africa, Medicine, systematic review This structured abstract provides a standardised summary to support rapid screening, indexing, and assessment of scholarly contribution.