\n min read<\/li>\n
A rural health monitor at work. Credit: Eswatini MOH<\/p>\n
Morning dew carpets the rugged hills of the Shiselweni region insouthern Eswatini,as ZaneleMbatha begins to stroll fromhomestead tohomestead<\/p>\n
She has been a Rural Health Motivator (RHM) \u2013 a community health worker \u2013 here for seven years. This is one of the poorest parts of the country, with more than 65% of households living hard off subsistence farming<\/p>\n
Eswatini\u2019s army of RHMs is vital to health delivery in the tiny kingdom, since 75% of the 1.2 million-strong population live in rural regions. \u201cPeople like us are usually the only bridge between a family and a proper doctor,\u201d Mbatha explains<\/p>\n
It\u2019s tiring work, but a little less tiring today than it used to be. For years, Mbatha hauled a leather-and-canvas shoulder bag as she walked the steep hill paths. Stuffed with paper ledgers documenting every childbirth, fever, persistent cough, bout of unusual diarrhoea and critical vaccine dose, the bag was heavy<\/p>\n
It was also insecure. Heavy rains could soak and destroy the paper records in an instant, she recalls, dabbing her fingers on the screen of the handheld device that has changed everything<\/p>\n
She types in the clinical and biographical information of every child she visits \u2013 skin condition, temperature, eyes health, every immunisation given and its date. \u201cIt\u2019s easier now, enjoyable,\u201d she says<\/p>\n
\u201cInvisible\u201d children<\/h3>\n
Mbatha and her fellow community health workers are unsung heroes on the frontlines of global health security. They are bringing the millions of unimmunised and under-immunised children across sub-Saharan Africa into care and reducing, with every child protected, the risk of large-scale disease outbreaks<\/p>\n
Eswatini\u2019s progress on vaccination over the last several years has been somewhat wavering, with the latest annual World Health Organization and UNICEF immunisation statistics showing 84% of eligible children protected with the first dose of the basic diphtheria, pertussis and tetanus-containing vaccine, a conventional indicator for vaccination coverage in general<\/p>\n
Meanwhile, the 2021\u20132022 Eswatini Multiple Indicator Cluster Survey showed 77% of 12- to 23-month-old children had received all their recommended vaccines, while just 66% in the 23- to 35-month age bracket had done the same<\/p>\n
\u201cThere\u2019s a critical missing gap: the \u2018invisible\u2019 children living in remote rural areas cut off from critical immunisations and emergency healthcare because medics can\u2019t cross punishing hills, menacing rivers, rocky ravines and [because of a] lack of reliable cellular phone networks to reach them or establish base,\u201d says Sister Beulah Nokwande, an immunisation nurse at Hlatikhulu Government Hospital<\/a>, the referral hospital in Shiselweni. Nokwande works closely with RHMs like Mbatha, exchanging insights on progress and challenges in remote communities.<\/p>\n In 2025, to support the work of RHMs, the Eswatini Health Ministry and nonprofit partners launched the Community-Based Health Information System (CBHIS), a digital health data initiative that put efficient devices into the hands of workers like Mbatha<\/p>\n \u201cI would say it\u2019s not a new system per se,\u201d says Patrick Shabangu<\/a>, Technical Director at the Institute for Health Measurement (IHM) Southern Africa, a regional healthcare programming nonprofit that helped the Eswatini Ministry to Health to launch the CBHIS strategy. Instead, Shabangu says, it\u2019s a system that\u2019s been evolving since 2012. That year, IHM began working<\/a> with the Ministry to develop a hybrid strategy that pulled data from paper ledgers into desktop computers.<\/p>\n \u201cHowever, the need from the government to make it portable resulted in the RHMs and their handheld devices now. And then [the Ministry] requested for funds from the World Bank,\u201d he says. That funding kicked in in 2023, with IHM taking a leading role in implementation<\/p>\n Both new and old RHMs were onboarded into the mobile digital health strategy, Shabangu explains, and kinds of data, including vaccination status, began to flow into a central health database known as the Client Management Information System<\/p>\n Centralisation of real-time information made it possible to cut response times down. \u201cClients could be quickly referred to hospital facilities to see a doctor once it was determined that their babies had skipped or delayed critical vaccines \u2013 or defaulted on ARVs [anti-retrovirals, for HIV treatment], life-saving meds,\u201d he says<\/p>\n The CBHIS application\u2019s greatest attraction is its versatility, says Mbatha, referring to the devices\u2019 ability to function offline<\/p>\n In the remote encampments of Shiselweni, mobile cellular phone signals are weak, accessible only from some elevated hilltops. The devices transform into on-site mobile data centres of sorts, she says<\/p>\n \u201cI don\u2019t need a 2G, 3G or 4G signal to do my work. I can input a newborn\u2019s vaccines data onto the device, collate family structure, log in biodata about last clinic visits and symptoms \u2013 all without a cellular signal,\u201d she says<\/p>\n Afterwards, RHMs like her walk to a summit of a local hill to grab patchy signal from a cell phone tower far away. When even a weak 2G signal is detected, the data on the handheld devices is synced to Eswatini\u2019s national digital medical records database<\/p>\n The RHM\u2019s handheld devices clear big headaches for poor rural mothers who live in the remotest regions of Shiselweni. One of them isMalwande Duma, 37, a mumof twin two-year-old boys. Duma is one of many women here who have relocated their children to regional towns and back, following their husbands\u2019 search for work<\/p>\n \u201cIn thepast, immunisationdata formy kidswould remainhidden inthe villageson paperand inkrecords. Cityclinic nurseswould beconfused, wantingto knowwhich vaccinesspecifically mykids got. They wouldre-dosome vaccines, \u2018overdoing\u2019 itor totallymissing others,\u201d she says<\/p>\n Today, mums like her are happy. The vaccination IDs of their rural children are easily displayed on the computer of any Eswatini computer in a public clinic registry because the RHMs uploaded rural kids\u2019 data onto the country\u2019s e-Impilo medical database<\/p>\n The digital medical IDs created by the handheld devices interfacing with the country\u2019s central health database does more than simply ensuring that kids don\u2019t miss critical vaccines, says Khanyakwezwe Mabuza, the PrincipalSecretary in the Ministry of Health<\/p>\n \u201cThe whole digitisationcreatesalegalstatusforkids\u2019health \u2013 footprintsinthenationalhealthpathwaysothatnokidsareleftbehind,betheyinthecityorfar-offvillages,\u201d Mabuza says<\/p>\n The CBHIS programme helps to optimise planning \u2013 the government doesn\u2019t have to allocate re simply log in and fetch the real-time stats to calculate exactly how many kids in a certain district need supplementary nutrition at public school. \u201cNow that\u2019s empowering,\u201d Mabuza says<\/p>\n Back in Shiselweni, Mbatha carefully slots her device into a waterproof pouch and gazes down at the villages she will pass through on her way back down<\/p>\n \u201cTop?\u201d she asks, rhetorically. \u201cThat\u2019s where we are already as a country. The critical task ahead is to make sure we collect, refine our healthcare data as a country, and continue to have sovereignty over it,\u201d she says<\/p>\n","protected":false},"excerpt":{"rendered":" Stories from the community Zero-dose childrenRoutine immunisationInnovation Rural health monitors wield digital handheld devices to help close Eswatini\u2019s immunisation gap<\/p>\n","protected":false},"author":1,"featured_media":4297,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[43,40,41,39,42],"class_list":["post-4294","post","type-post","status-publish","format-standard","has-post-thumbnail","category-parenting","tag-digital","tag-health","tag-monitors","tag-rural","tag-wield"],"_links":{"self":[{"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/posts\/4294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lumeamara.online\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4294"}],"version-history":[{"count":1,"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/posts\/4294\/revisions"}],"predecessor-version":[{"id":4296,"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/posts\/4294\/revisions\/4296"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/lumeamara.online\/index.php?rest_route=\/wp\/v2\/media\/4297"}],"wp:attachment":[{"href":"https:\/\/lumeamara.online\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4294"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lumeamara.online\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4294"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lumeamara.online\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Better tools mean more room for manoeuvre\u00a0<\/h3>\n
![\"Rural](\"https:\/\/lumeamara.online\/wp-content\/uploads\/2026\/07\/Rural_health_monitor_training_on_digital_device_use_h2.jpg\")
Online or offline<\/h3>\n
Relief for mothers<\/h3>\n