Getting the jab made simple in Eswatini – Gavi, the Vaccine Alliance

In March this year, Eswatini launched the integration of COVID-19 vaccines into routine immunisation, making them readily available at the more than 200 public clinics in the tiny kingdom.

The goal was simple: make access to the jab a cakewalk for all citizens.

Seven months later, Swati people both urban and rural tell VaccinesWork that getting the jab has never been easier.

Mankayane, located in the north-eastern part of Eswatini, 42 kilometres from the country's capital city, Mbabane, is a small, rural town in the midst of an agricultural region. It's the kind of out-of-the-way place where one might expect public services to be thinner on the ground but COVID-19 vaccination is so easy to access, according to 32-year-old Bongiwe Dlamini, that you can literally stumble onto it.

Dlamini, who lives a few kilometres away from the Mankayane Government Hospital, says it took her less than 20 minutes to get vaccinated at the Public Health Unit housed inside the facility.

She had not planned to get vaccinated for COVID-19, she explains. Her sister was delivering a baby, and she had simply accompanied her to the hospital.

"While the doctors were busy with her, I got bored and I took a walk to the gate," she says. "As I walked past the gate to buy fruits, I noticed the many screening rooms by the gate and the PHU [public health unit] on the right side of the facility. I was noticed by a staff member reading the COVID-19 vaccine posters that were all over the screening rooms. She asked me if I was interested in any of the COVID-19 services.

"She then told me that I can further protect myself from effects of the virus by getting vaccinated. I laughed my lungs out when she said I will be done in less than 10 minutes. She simply walked me into the PHU where I was taken to one of the rooms, where I found a nurse who vaccinated me and I was done," she says.

Dlamini said she was inoculated with the Pfizer vaccine. "The cherry on top was that just after I was vaccinated, I received an SMS [text] that notified me that I was vaccinated, and gave me a return date," she says. Eswatini administers the Pfizer and AstraZeneca COVID-19 vaccines.

Nurse Tetty Dlamini of the Mankayane PHU said her team also does outreach to nearby communities, to make sure that disadvantaged people for instance, those who suffer mobility challenges aren't left out.

"Our vaccination for COVID-19 does not start and end in the facility; we also visit nearby communities. We reach our communities through conducting health road shows (mobile units designed to deliver health services) where we sensitise the community members about health issues including coronavirus, HIV and TB, among others. During health road shows and sporting activities we also conduct COVID-19 vaccination. These health road shows have made it easy for us to vaccinate the youth as well as people with disabilities," she said.

Tetty said they also liaise with bagcugcuteli (primary health motivators) to give them a list of people with mobility challenges around those particular areas where they will be conducting the road shows and sporting days.

"As part of the team is busy with the health education and providing health services, other teams, through the help of bagcugcuteli, visit the homesteads of these individuals and vaccinate them against the virus," she said.

"We also visit schools around the communities to vaccinate scholars that are eligible to get vaccinated," she added.

Each week in Mankayane, about 20 people are vaccinated in the hospital, while more than 50 people are vaccinated via outreach programmes, Nurse Dlamini explains. A further 70 booster shots are administered each week.

Even facilities not run by the government offer the jab as a public service. The Salvation Army Clinic in Mbabane, Msunduza is among them. The clinic's nursing sister, Nompumelelo Tfwala, also stated that they still offer COVID-19, together with TB screening, for all people who visit the facility.

"We are known for our outstanding health services and in order to keep our reputation it was imperative for us to heed the government call and incorporate COVID-19 vaccines in our immunisation programme," she said.

Tfwala mentioned that all vaccines including COVID-19 jabs are free here. She explained that vaccines were provided by the government, alongside COVID-19 testing kits.

"Government provides the vaccines, and we provide the resources such as human resources and storage," she says.

"We are not a huge health facility, but on a daily basis we attend to almost 100 clients, being children and adults. This means we conduct around COVID-19 screenings, since they are a requirement, of which 10% or less of those people, depending on the day, might be interested in the vaccine or have booster shots. Of late we have seen more people taking booster shots," she adds.

Tfwala also said the clinic staff also take their services out into the community: once a month they join the Municipal Council of Mbabane and provide health care services at public gatherings like flea markets.

Nomile Nxumalo from Msunduza, a township located within the capital city, Mbabane, recalled that when she took her jab in the clinic, she didn't feel any different from people who had come for other vaccinations.

"I thought I was supposed to tell the nurses at the reception that I wanted to vaccinate for COVID-19. Surprisingly, when I entered the clinic, I had all my screenings as usual, and I was asked which section I intended to visit. I told the nurse I wanted to get vaccinated, and she told me to join the immunisation queue, which wasn't long. I tried to tell her that I wanted to get the COVID jab, but she told me everything was under one roof," she said.

"It felt decent to have the vaccines within health facilities compared to them being at taxi ranks and bus stops like before. The reason I took longer to take the jab was because I didn't want to be seen by people in the vaccination spots, and there were a lot of theories about vaccines. I needed to be convinced that the vaccines were indeed effective and there were no deaths caused by them," she added.

Nxumalo lauded government for making COVID-19 part of the vaccines administered within health facilities, because it would provide the privacy people need when accessing health services.

Eswatini's COVID-19 roll-out began in April 2021. As of October 20, 2023, 36.9% (428,261) of the population and nearly 52% of the eligible population, people from 12 years old was vaccinated against COVID-19, according to data presented at a briefing by WHO Eswatini.

The statistics further show that 8.5% (98 612) were partially vaccinated while 179,458 (15.5%) had received their booster dose.

Director of Health Services within the Ministry of Health, Fortunate Bhembe, stated that the aim was to vaccinate 70% of the eligible population.

The briefing, conducted in collaboration with the Ministry of Health and other partners, concerned the comprehensive post-introduction evaluation (cPIE) of Eswatini's COVID-19 vaccine roll-out.

WHO country representative Dr Susan Tembo called the cPIE a "milestone" in the national response to the pandemic.

"We are encouraged that the kingdom has built in a strong evidence-based monitoring element of the roll-out, starting with real-time data collection that provides daily updates, conducting two intra-action reviews at strategic points and right now the cPIE. Embracing the COVID-19 vaccine by Eswatini as key response measure in reducing the impact of the virus was a plausible step in the right direction," she said.

"We note with pride that this is the first ever cPIE in the region and would like to congratulate the ministry for such leadership," she concluded.

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Getting the jab made simple in Eswatini - Gavi, the Vaccine Alliance