Eswatini: Vaccinating people against COVID-19 in hard-to-reach communities

With COVID-19 vaccination rates hovering around only 28 percent in Eswatini, Doctors Without Borders/Médecins Sans Frontières (MSF) is supporting the Ministry of Health’s national campaign to increase coverage in the country’s Shiselweni region through mobile vaccination sites. This is an area with many vulnerable people living in remote and rural communities cut off from health facilities.

“After seeing the increase in the number of people dying from COVID-19, I took the decision to vaccinate my entire family,” said Nonhlanhla Motsa, while waiting to get vaccinated at the mobile MSF vaccination site in the village of Mhlwahlweni in Shiselweni. “We hitchhiked for about an hour to our nearest clinic, but when we got there, we were turned away as the clinic did not have any COVID-19 vaccines.”

Nonhlanhla’s experience isn’t uncommon; people often travel more than two hours to access even basic health care. Limited availability of public transport adds an extra barrier to reach medical services, including COVID-19 vaccinations.

''Some people tell us they worry the vaccine might impact their mental and sexual health, but we reassure them that the vaccine has not, and will not, interfere with either."
Fikile Mabuza, MSF health promoter

Combating vaccine hesitancy

Access to vaccines isn’t the only issue, however, as there is a lot of fear and stigma around COVID-19 and many people are hesitant to get vaccinated. In response, MSF teams have put in place health promotion activities to dispel myths about vaccines and provide correct information.

“Some people tell us they worry the vaccine might impact their mental and sexual health, but we reassure them that the vaccine has not, and will not, interfere with either,” said Fikile Mabuza, an MSF health promoter in Shiselweni. “We also see people who are concerned about mixing different vaccines. Before, the recommendation was not to mix vaccines, but now the Eswatini Ministry of Health recommends a different vaccine for the booster shot.”

To promote public awareness, MSF teams go door-to-door across the rural community to share information about COVID-19 and encourage people to get vaccinated at MSF’s mobile vaccination sites. We also have a toll-free telephone line and a dedicated WhatsApp line to allow community members to contact our staff and have more private conversations about their concerns regarding COVID-19 vaccines and their health.

Continuing care in a pandemic

MSF has been providing HIV and tuberculosis services to rural communities in the Shiselweni region since 2007 as Eswatini has the highest HIV prevalence in the world and high rates of tuberculosis.

Since the COVID-19 pandemic started, we have worked to adapt our HIV/TB activities to the particular needs of vulnerable patients and ensure continued access to essential health services without exposing them to COVID-19. This adaptation includes providing home-based care for our patients who test positive for the virus. Our teams also offer COVID-19 vaccination to patients in our HIV/TB program.

To help people who contract COVID-19, we’ve expanded the COVID-19 ward at Nhlangano health center—the main health facility in the region—and provided oxygen concentrators, enabling medical teams there to admit and care for more COVID-19 patients.

After two weeks of vaccinating people against COVID-19 in the Shiselweni region, MSF mobile teams have administered a total of 7,025 vaccine doses.