Journal article
[pre-print] Leveraging community health workers as vaccinators: a case study exploring the role of Malawi’s Health Surveillance Assistants in delivering routine immunization services
Background: Global chronic health worker shortages and stagnating routine immunization rates require
new strategies to increase vaccination coverage and equity. As trained, trusted members of their local
communities, community health workers (CHWs)are in a prime position to expand the immunization
workforce and increase vaccination coverage in under-reached communities. Malawi is one of only a few
countries that relies on CHWs - called Health Surveillance Assistants (HSAs) in Malawi - to administer
routine immunizations, and as such offers a unique example of how this can be done.
In this research, we describe the operational and programmatic characteristics of a
functional CHW-led routine immunization program by conducting interviews with HSAs, HSA supervisors,
ministry of health officials, and community members in Malawi. This case study describes how and
where HSAs provide vaccinations, their vaccination-related responsibilities, training and supervision
processes, vaccine safety considerations, and the community-level vaccine supply chain. Interview
participants consistently described HSAs as a high-functioning vaccination cadre, skilled and dedicated
to increasing vaccine access for children. They also noted a need to strengthen some aspects of
professional support for HSAs, particularly related to training, supervision, and supply chain processes.
Interviewees agreed that other countries should consider following Malawi’s example and use CHWs to
administer vaccines, provided they can be sufficiently trained and supported.
Conclusions: This account from Malawi provides an example of how a CHW-led vaccination program
operates. Leveraging CHWs as vaccinators is a promising yet under-explored task-shifting approach that
shows potential to help countries maximize their health workforce, increase vaccination coverage and
reach more zero-dose children. However more research is needed to produce evidence on the impact of
leveraging CHWs as vaccinators on patient safety, immunization coverage/vaccine equity, and cost-effectiveness
as compared to use of other cadres for routine immunization.
Languages
- English
Publication year
2023
Journal
BMC Human Resources for Health
Type
Journal article
Categories
- Service delivery
Countries
- Malawi
Organisations
- VillageReach
WHO Regions
- African Region
Topic references
CHW_TECHNICAL
Title | Author | Year | Type | Language |
---|---|---|---|---|
[pre-print] Leveraging community health workers as vaccinators: a case study exploring the role of Malawi’s Health Surveillance Assistants in delivering routine immunization services | Emily Gibson, Jenny Payne, Rebecca Alban, Tafwirapo Chihana | 2023 | Journal article | English |
Community Health Workers as Vaccinators: A Rapid Review of the Global Landscape, 2000–2021 | Emily Gibson, Luc Mahougbé Kouwanou, Mariam Zameer, Rebecca Alban | 2023 | Journal article | English |
Community health workers who vaccinate: Improving equity in immunization | Emily Gibson, Luc Mahougbé Kouwanou, Mariam Zameer, Rebecca Alban | 2022 | Report | English |
Leveraging community health workers to vaccinate in Malawi: A unique health workforce approach to increase routine immunization coverage | Emily Gibson, Jenny Payne, Rebecca Alban, Tafwirapo Chihana | 2023 | Report | English |