ArticleBMJ open2024
Success in vaccination programming through community health workers: a qualitative analysis of interviews and focus group discussions from Nepal, Senegal and Zambia.
Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Interventions involving community health workers and their effect on cervical cancer screening uptake in sub-Saharan Africa: a systematic review.BMC public health · 2026Pooled it
- Community-based intervention to reach the last mile of childhood vaccination coverage in Burera district, Rwanda: a mixed method study.BMC public health · 2026Article
- Expanding Kidney Care: How Nonphysician Health Workers Can Address the Global CKD Crisis.Kidney international reports · 2026Review
- Multilevel Analysis of Zero-Dose Children in Sub-Saharan Africa: A Three Delays Model Study.Vaccines · 2025Article
- Article
- Understanding vaccine recommendation behaviours among healthcare workers in Senegal: A cross-sectional analysis.Tropical medicine & international health : TM & IH · 2025Article
- Risk factors associated with zero-dose and under-immunized children, and the number of vaccination doses received by children in Ethiopia: a negative binomial regression analysis.BMC public health · 2025Article
- Strengthening vaccine uptake: a qualitative assessment of community health worker educational resource needs and community perspectives on vaccination in Western Kenya.Frontiers in public health · 2025Article
- Article
- Protecting our future: call for respiratory syncytial virus vaccine trial in infants.Annals of medicine and surgery (2012) · 2024Article
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Authors and funding
13 authors at 5 institutions in 5 countries.
Funding
Abstract
objectivesCommunity health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts.
designWe employed a multiple case study design using qualitative research methods.
settingWe conducted research in Nepal, Senegal and Zambia.
participantsWe conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts.
resultsImplementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work.
conclusionImprovements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries-including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming.
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