Assessing the capacity to implement the international health regulations to control COVID-19 at points of entry in Eswatini.

Introduction: Significant challenges to implementing international health regulations (IHR) at points of entry (PoEs) have been highlighted by the coronavirus disease 2019 (COVID-19) pandemic. Better assessment of the capacities of the PoEs may promote focused interventions. This study aimed to assess the capacities and practices at PoEs.

Methodology: A self-filled questionnaire based on the World Health Organization (WHO) Joint External Evaluation Tool was distributed to frontline workers at four major PoEs. A total of 368 questionnaires were distributed and 308 were completed. Online interviews were conducted with key informants (n = 16). The capacity of PoE was scored by referencing the WHO checklist for core capacity requirement, and categorized into limited, partial, or full capacity. Pearson's Chi square test was used to compare differences among PoEs. Qualitative data was thematically analyzed.

Results: The majority of the 308 participants in the survey were from Ngwenya (59.4%). Approximately 68% were government employees, and 81% had more than 2 years of experience. Participants reported shortage of resources, such as medical facility (30.5%), staff (37.7%), gloves (47.7%), masks (48.4%), and isolation room; and inconsistencies in practices such as record keeping, reporting cases, and quarantine measures. The overall capacity for IHR implementation was limited, with the airport PoE showing partial capacity and the three ground PoEs having limited capacity.

Conclusions: The capacity to implement the IHR at Eswatini PoEs was limited. The results suggest the need to allocate resources to PoEs and to enhance training on practices regarding case handling, reporting, and record keeping.