Questions over vaccine readiness in rural EC areas

Healthcare service shortcomings in rural Eastern Cape are well documented and will affect the province’s vaccine rollout plan.

Some leaders in the Eastern Cape say the temporary suspension of the AstraZeneca/Oxford University vaccine rollout “has come as a blessing in disguise for the province”.

With the much anticipated first batch of the AstraZeneca/Oxford University vaccine delivered to South Africa on 1 February, provinces were gearing up to start vaccinating people as soon as two weeks later. But on the evening of Sunday 7 February, Minister of Health Zweli Mkhize announced that the rollout of this vaccine to the country’s health workers was temporarily suspended after preliminary data showed the vaccine had low efficacy against the variant now dominant in South Africa.

“Having to wait for a week or two weeks for the vaccine could provide salvation for the province because there are gaps in the provincial rollout plan, such as proper training of staff,” chairperson of the health committee in the Eastern Cape legislature, Mxolisi Dimaza, told Spotlight.

According to Dimaza, councillors and traditional leaders in some districts in the rural areas were not included in the planning process.

“Fortunately, no one will be vaccinated this week [that ended on 12 February]. This gives the department time to finalise the vaccine rollout plan. We want councillors, unions, church leaders and traditional leaders to be part and parcel of the coordinating teams. These people are crucial in helping to spread the correct information about the vaccine, as there was a lot of misinformation,” he said.

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“Imagine if the rollout was going to take place this week as it was planned. That was going to be a disaster. Really, this is a blessing in disguise,” he said at the time. “The department have an opportunity now to quickly try to sort out some of their weaknesses. At the end of the day, the vaccine will arrive and we expect when the vaccines arrive preparations have been done correctly.” 

Eastern Cape member of the executive council for health Sindiswa Gomba, during a press briefing week before last, said the province is prepared for the rollout. “We are in the process of identifying and training 571 inoculators. At this stage we are also investigating the cost and evaluating the 1 158 sites where vaccination will be carried out. Our committee is checking whether our sites have capacity and the fridges to keep the specimens because we’ve never had mass vaccination before.”

The provincial department set itself a target of vaccinating 3.7 million people and aims to roll out all three phases of the vaccine rollout in six to nine months. South Africa’s vaccination programme is divided into three phases, with the first phase comprising healthcare workers.

In the dark

Despite assurances by provincial health authorities that the vaccine rollout is going according to plan, secretary of the Xhora Mouth community health committee, Phumzile Msaro, remains sceptical. Msaro’s health committee has been campaigning for ambulance services in the Xhora Mouth area.

Msaro is concerned over what he says is a lack of consultation with rural communities such as Xhora Mouth. “We only hear on the news that the vaccine is coming to South Africa, but we have never been consulted. There are no explanations.” Msaro also told Spotlight he is worried that rural communities will be made “guinea pigs” because they are not informed properly.

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“It is well known that residents of urban areas are ahead of those in the rural areas when it comes to developmental issues. There is a need for a comprehensive awareness campaign to inform and educate rural communities about the importance of getting vaccinated against Covid-19,” Msaro said.

“I foresee some people getting discouraged due to long distances [they have to travel] to reach health facilities to get the vaccine shot. Think about a person who needs to walk two to three hours for a shot. If those people think that is not important or has some misperception or misinformation about the vaccine, this is going to be extremely challenging,” he said.

“The Department of Health needs to come up with a clear plan for local chiefs and ward councillors as they have a clout over their subjects. This lack of an informed planning compounded with the way officials will disseminate information in our villages will give rise to opportunities for individuals to jump the queue, and that alone would be the root cause for corruption,” he said.

Undated: Travelling 15km on foot in rural areas is vastly different to traversing that same distance in an urban area. When the Xhora River is in flood, villagers cannot cross it to get to the clinic.

‘Reliable transport’

A community health committee member from the Amathole District, Xolisile Sam, said he, too, does “not know anything about this vaccine”.

“The information I have is from the media. Other than that, I don’t know how it works and who will be responsible for its distribution. The major challenge will be that of long distances between communities and the health facilities.” Sam said it will be important that the government provide reliable transport for people to get to the vaccination points.

Another clinic committee member from Joe Gqabi district, Mzoxolo Bhoyana, told Spotlight they have not had any healthcare workers conducting public information campaigns about the vaccine. Bhoyana expressed concern that if not done right, the government may “repeat the mistakes of the ARV rollouts” when people also had limited information owing to stigma and misinformation, and take-up was slow.

“It’s rare to find community healthcare workers in rural areas educating people about Covid-19 compared to what they do in urban areas,” he said. These campaigns, Bhoyana said, are often concentrated in urban areas where logistics are available. “There are villagers who have never used an ambulance or have mobile clinics in their areas. Hence it will be very interesting to know how government will approach the distribution of the vaccines in rural communities in light of these challenges.”

Undated: Wheelbarrows are a vital mode of transport for sick residents in Xhora Mouth. From left, Phumzile Msaro, Noluthando Mbele and Nokubonga Nkasithu show how they transport patients.

Elements of the plan

Briefing Parliament’s portfolio committee on health last month, the acting superintendent general for the Department of Health in the Eastern Cape, Sibongile Zungu, said the province would receive the first batch of vaccine from the national central distribution centre when it became available.

Zungu told members of Parliament (MPs) in the first phase, they are estimating 200 000 healthcare workers and support staff would be prioritised. The second phase of the mass rollout will target about 1.5 million people, including essential workers, people in congregate settings, people above 60 years and those older than 18 with comorbidities. In the third phase, the province intends to target about two million people older than 18.

“Because of the rural nature of our province,” Zungu told MPs, “and challenges we have in terms of the capacity of the health system, we would use schools and community halls as vaccination sites.

“The province has 2 873 communities that have to travel more than 5km to the nearest healthcare facility. Amathole and OR Tambo health districts are the worst affected, hence we want to utilise schools and community halls to avert problems that may arise,” Zungu said. “The Department of Education’s database reveals that there is a primary school or a high school in a community. But we will wait for the national department to guide us about the requirements to ensure safety of [the] vaccine roll out in temporary sites such as schools and community halls.”

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Addressing the Eastern Cape vaccine coordinating committee in January, premier Oscar Mabuyane appointed a Covid-19 vaccine coordinating committee led by Thobile Mbengashe, assisted by Kholeka Mlisana, Welile Shasha, Sibongile Zungu, Thuthula Balfour, Siyabulela Tsengiwe and Bruce Janssens. 

“The vaccination programme will be conducted over a six to nine-month period depending on the delivery schedules of the vaccines. Similar to the IEC [Independent Electoral Commission] election programme, the Department of Education will make schools accessible while churches and community centres will also be used as vaccination sites,” Mabuyane said. 

“Temporary vaccination centres will also be established at key points such as municipal offices, malls, taxi ranks, pharmacies, private hospitals, NGOs [non-governmental organisations] and clinics, to make it more accessible. Mobile services will also be used. The vaccine rollout will be led nationally in close coordination with the provincial health and the private healthcare sector,” the premier said. 

Zungu also told MPs that the committee will be responsible for the development and implementation of a provincial plan based on the national implementation plan, procurement of needles, syringes, swabs, medical waste disposal, as well as liaising with national government on the availability of vaccine and monitoring the coverage at the command centre.

Denosa in the dark on finer details

The Democratic Nursing Organisation of South Africa’s (Denosa) provincial secretary, Khaya Sodidi, told Spotlight their nurses are also in the dark about the Eastern Cape’s Covid-19 vaccine rollout plan.

“We have not yet seen the strategy on how the rollout plan will be carried out. However, the Department of Health engaged us in the last two weeks regarding their ambitious plan, but when it comes to the finer details of the plan, we are still in the dark. The only thing that the department told us is that healthcare workers will be the first in line for the jab,” Sodidi said.

“It concerns us that our members are first in line, but they still don’t know the pros and cons of these vaccines and some workers are refusing to be vaccinated,” Sodidi said. “We only heard that the province would need 571 inoculators for vaccine rollout, but where will those workers come from? Are they going to employ new staff or will they train the existing staff, because our hospitals and clinics are already buckling under the pressure?”

Unique challenges in rural areas

Director of the Rural Health Advocacy Project Russell Rensburg told Spotlight that at this stage, the government’s plan does not consider the unique challenges rural communities are facing. “People are expected to register for the vaccine slots and it is done online, meaning officials presume people have internet accessibility. The only reference to the rolling out programme in rural areas is the confirmation that local pharmacists and doctors will be contracted to do the job. Hopefully, as the programme goes out in phases, our healthcare workers will have an opportunity to overcome these challenges,” he said.

“Rural communities, particularly those in the former homelands, experience challenges of accessing their healthcare services. This has been proven by existing health programmes, particularly involving HIV and TB [tuberculosis] treatment whose uptake has been declining. The vaccine rollout presents an opportunity to reconnect communities with the health system,” he said.

“Rural provinces should invest in training of community healthcare workers on vaccines and how they work so [everyone can understand] why it’s important that as many people as possible agree to be vaccinated,” said Rensburg. “Community health worker teams should prioritise training traditional leaders because they are close to the people. It is imperative to maintain a good working relationship with traditional leaders by hosting community imbizos where vaccination days and venues are explained to the people. It is also important for teams of vaccinators to be sent deep in rural villages where transport and accessibility is a challenge to villagers rather than expecting people themselves to come to healthcare facilities.”

This article was first published by Spotlight.

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