Dear HIFA and CHIFA colleagues,
Citation and abstract of a new paper in Global Health: Science and Practice, and a comment from me below.
CITATION: Community Health Workers as Vaccinators: A Rapid Review of the Global Landscape, 2000–2021
Emily Gibson, Mariam Zameer, Rebecca Alban and Luc Mahougbé Kouwanou
Global Health: Science and Practice February 2023, https://doi.org/10.9745/GHSP-D-22-00307
ABSTRACT
Introduction: Community health workers (CHWs) could expand immunization access in under-reached communities by administering vaccines. This rapid review identifies countries where CHWs administered vaccines and synthesizes health systems factors that may contribute to or detract from the feasibility of CHWs administering vaccines.
Methods: We conducted a rapid review of peer-reviewed literature from 3 databases and gray literature identified through web searches and by CHW subject matter experts. We treated extracted data on conditions related to vaccine administration by CHWs as qualitative data and conducted deductive content analysis.
Results: We retained 32 documents from 497 initial records and identified 23 CHW cadres that vaccinated in 20 countries, ranging from long-established national programs delivering routine immunizations to pilot projects delivering 1 specific vaccine. CHWs who vaccinate face the following challenges: (1) inadequate supply chain training, (2) inadequate cold chain equipment, (3) transportation for supplies and to communities, (4) heavy existing workload, (5) inadequate or irregular remuneration, (6) inadequate or irregular supervision.
Conclusion: To improve immunization coverage in underimmunized and zero-dose communities, countries where CHWs vaccinate should provide CHWs with adequate remuneration, supervision, supply chain support and management, and formal integration within the health system. CHWs administered vaccines in 20 of the 75 countries with documented CHW programs, suggesting the majority of an estimated 3.3 million CHWs globally do not yet administer vaccines. In light of health care workforce shortages and immunization equity gaps, further exacerbated by the COVID pandemic, policymakers should consider task-shifting vaccine administration to CHWs to bolster immunization access for under-reached communities. Additional systematic documentation is needed to further explore best practices to support CHWs as vaccinators, especially related to supply chain, policy, safety, and efficacy.
COMMENT: With appropriate support CHWs certainly can help meet unmet needs for vaccination. I would be interested to hear the approach being taken in different countries. Perhaps the logical approach is to assess the current situation, particularly with regard to low vaccine coverage, and to describe the current human resources deployment and how this could be strengthened, including the potential of training CHWs. Does anyone have experience of training CHWs as vaccinators?
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
