背景:全球慢性卫生工作者短缺和常规免疫接种率停滞不前需要新的策略来增加疫苗接种覆盖率和公平性。经过训练,他们当地社区的信任成员,社区卫生工作者(CHW)在扩大免疫工作队伍和增加覆盖不足社区的疫苗接种覆盖率方面处于有利地位.马拉维是少数几个依靠CHW的国家之一-在马拉维称为健康监测助理(HSA)-管理常规免疫接种,因此提供了一个独特的例子,说明如何做到这一点。
方法:我们试图通过对HSA的访谈来描述功能性CHW主导的常规免疫计划的操作和程序特征,HSA主管,卫生部官员,以及马拉维的社区成员。本案例研究描述了HSA如何以及在哪里提供疫苗接种,他们的疫苗接种相关责任,培训和监督过程,疫苗安全考虑,以及社区级别的疫苗供应链。访谈参与者一贯将HSA描述为高功能疫苗接种干部,熟练并致力于增加儿童的疫苗获取。他们还指出,需要加强对HSA的专业支持的某些方面,特别是与培训有关,监督,和供应链流程。受访者同意其他国家应考虑效仿马拉维的榜样,并使用CHWs管理疫苗,只要他们能得到充分的训练和支持。
结论:这个来自马拉维的账户提供了一个由CHW主导的疫苗接种计划如何运作的例子。利用CHWs作为疫苗接种者是一种有希望但仍未被探索的任务转移方法,显示出帮助各国最大限度地利用其卫生人力的潜力,增加疫苗接种覆盖率,覆盖更多的零剂量儿童。然而,需要更多的研究来证明利用CHW作为疫苗接种者对患者安全的影响,免疫覆盖率/疫苗公平性,与使用其他干部进行常规免疫相比,成本效益更高。
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.
We sought to 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.
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.