Department of Environmental Health, Emory University, Atlanta, Georgia, USA.
Centre for Molecular Dynamics, Kathmandu, Nepal.
BMJ Open. 2024 Apr 3;14(4):e079358. doi: 10.1136/bmjopen-2023-079358.
Community 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.
We employed a multiple case study design using qualitative research methods.
We conducted research in Nepal, Senegal and Zambia.
We 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.
Implementation 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.
Improvements 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.
社区卫生工作者是低收入和中等收入国家基层卫生服务的重要力量，包括为儿童早期免疫规划提供服务。了解在免疫覆盖率取得成功的国家中，社区卫生工作者是如何参与儿童早期疫苗接种的，将为跨背景提供基于证据的政策指导提供支持。
我们采用了使用定性研究方法的多案例研究设计。
我们在尼泊尔、塞内加尔和赞比亚进行了研究。
我们在 2019 年 10 月至 2021 年 4 月期间，在尼泊尔、塞内加尔和赞比亚的国家、地区、区、卫生机构和社区各级卫生系统中，与 678 名参与者进行了 207 次访谈和 71 次焦点小组讨论。我们使用主题分析来调查每个国家和跨背景支持儿童早期免疫的社区卫生工作者规划的促成因素。
疫苗接种规划的实施主要依赖于（1）社区卫生工作者的组织、（2）激励和（3）信任。组织通过扩大社区卫生工作者的队伍来履行与疫苗接种相关的角色和责任来实现。激励措施得到了内在和外在激励的支持。信任是由于社区对社区卫生工作者的尊重和对其工作的重视而表现出来的。
社区卫生工作者的组织、激励和信任促进了免疫覆盖率的提高。随着卫生工作者短缺的持续预测，特别是在低收入国家，社区卫生工作者通过使更多服务不足的人群能够获得疫苗接种服务，缩小了获得疫苗接种服务的公平差距。尽管所有三个国家的疫苗接种规划都有所改善，包括政府承诺解决人力资源短缺问题、培训和薪酬；工作量、薪酬的不一致性、培训时间和范围以及监督仍然是免疫规划的主要挑战。卫生决策者应考虑社区卫生工作者的组织、激励和信任，以改善免疫规划的实施。
