Sometimes There is an Obvious Solution

Problem: not enough doctors and nurses; millions of people to vaccinate. Solution: let Community Health Workers do it.

Only 16% of Africa’s population has received two doses of COVID vaccine as of end-April 2022. Ministries of health and global health organizations should be pulling out all the stops to identify roadblocks and remove them as comprehensively as possible.

One massive roadblock is so familiar that its consequences for COVID vaccination are almost overlooked.  I’m speaking of the global shortage of several millions of doctors, nurses and other healthcare workers, which is expected to hit 15 million by 2030.[1]

But there’s a strong potential solution, which is not getting as much attention as it deserves – the availability of millions of Community Health Workers around the world. Many are located in rural areas. With the right training, they could take on vaccination.

This solution could help to significantly speed up the rate and penetration of vaccination campaigns.

So it is great to see that Liberia, prompted by the pressures of delivering COVID vaccine at great scale, is now allowing its CHWs to administer vaccines. The NGO Last Mile Health has been closely supporting that move

Liberia thus joins a short list of countries where CHWs can officially vaccinate (they vaccinate “unofficially” in some nations). Malawi stands out as a great example of a country where the CHWs (there called Health Surveillance Assistants) have been successfully vaccinating for decades.

Shouldn’t this policy of vaccination by CHWs become widespread?

VillageReach (www.villagereach.org), a medical services support organization active in LMICs, knows a lot about the realities of what works and what doesn’t at the community level. In a recent blog (Opinion: Amid labor shortage, let community health workers give vaccines | Devex), VR’s Rebecca Alban argued:

“If countries were to shift how vaccinations are provided and leverage CHWs as vaccinators, they could significantly expand the immunization capacity of the strained global health care workforce… Governments, global health funders, and policymakers should rethink CHWs’ current role as mere promoters of immunization services and consider them viable providers of immunization services.”

I agree.

Community Healthcare Workers in LMICs are usually women, and are typically recruited from the communities they serve. They operate in a gray area between the formal healthcare system and the community – usually not paid a salary (although they should be in my view), but linked to the local primary healthcare system to varying degrees. They provide health education, support pregnant and new mothers, and often act as the first port of call for people in their communities.

CHW’s are already involved in vaccination in many ways short of giving injections. They mobilize parents to take their children for vaccination. They address parents’ questions about immunization, just as they address patients’ questions about many other health issues.

Beyond addressing the immediate need to deliver COVID vaccines, I see two main reasons to think that more widespread vaccination by Community Health Workers is worth serious consideration.

First, it seems very reasonable to think that at least some parents would prefer their child to be vaccinated by a Community Health Worker than by an unknown health worker. Vaccine confidence is not a minor issue, and we know that parents’ confidence is closely associated with who gives the vaccine.

Second, by providing additional capacity to deliver vaccines, CHW’s could free up more highly-trained health colleagues to do other things.

Change within healthcare systems requires overcoming a lot of inertia. Could the pandemic, and the need to deliver COVID vaccines, provide the urgent push needed to overcome this? Will other countries at least explore revamping their delivery models?

If so, there is potential for dividends well beyond COVID, if Community Health Workers can reach even a small fraction of the 10 million children worldwide who are currently receiving no doses of childhood vaccine at all.

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[1] “Global Health Workforce Labor Market Projections for 2030”

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