146 Chapter 6 3.3.5 Staff rotation as a best practice Limited staffing and skillset are challenges at most health facilities. This was obvious at the peak of the pandemic when several healthcare workers were infected and had to isolate. The respondents stated they had a process where staff were intermittently moved to provide services at other units to avoid delay or suspension of services. “To ensure continual service provision we do staff rotation, if a TB nurse is not available, one is always assigned to the TB department” R4 “Yes, we have enough clinical staff. We normally rotate so that whenever there is a gap someone can cover it up” R9 Discussion Based on the views of healthcare workers, we describe some of the impacts of the COVID-19 pandemic on TB service delivery and access in Eswatini; and describe some approaches by healthcare workers to ensure the continuity of TB services. At the height of the pandemic, COVID-19 took priority over other conditions, worsening health system challenges which were already in a precarious state. Different measures adopted to limit the spread of COVID19 infection hindered patients from accessing care as some services were suspended or limited. This affected the number of patients accessing care and the quality of services provided by healthcare workers. Healthcare workers were equally affected by the pandemic, resulting in reduced number of staff for patient care. Despite these challenges, healthcare workers adopted different methods to ensure patients continued receiving care. These included providing care for patients within their communities or at home; providing additional support to patients such as counselling, transport, food packages, and health education; making different services available at one service point and adopting staff rotation to ensure a healthcare worker is always available to attend to patients. 4.1 Comparison with other studies Available evidence at the onset of the pandemic indicated that COVID-19 would adversely affect TB services delivery resulting in reduced access by different population groups with poor outcomes.15–17 This was corroborated by the WHO Global Tuberculosis Report 2021 on COVID and TB which showed that different TB targets were missed between 2019 and 2020 when the pandemic commenced compared to the years 2017 to 2019. For instance, there was an 18% reduction in global TB case notification with a lower mean TB case notification in most TB high-burden countries notably in Gabon (80%), the Philippines (37%) and Lesotho (35%).7 There were also reductions in people commencing MDR/RRTB
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