Task-Shifting Immunization Activities to Community Health Workers: A Mixed-Method Cross-Sectional Study in Sahel Region, Burkina Faso

Abstract

Introduction: Faced with the frequent disruptions to the health care system and provision of immunization services caused by terrorist attacks that began in 2015, the Sahel region in Burkina Faso initiated resilience strategies, including the task-shifting of immunization activities to community health workers (CHWs). This strategy was designed to involve more CHWs in the vaccination delivery process and ultimately to improve the performance of the health care system.

Strategy development and implementation: The task-shifting strategy began as a pilot in Djibo health district in 2019 and then extended to all 4 districts of the Sahel region. CHWs included both personnel recruited through the Ministry of Health and Public Hygiene processes at the national level and other community members who support the operation of health facilities. They were trained on standardized immunization modules and provided with vaccines by functional health facilities teams. Implementation initiated with the administration of oral antigens by CHWs. Subsequently, their service delivery was expanded to include injectable vaccines in the context of the worsening terrorist attacks and the urgent need to protect the health of local populations affected by the security and humanitarian crisis.

Strategy evaluation: The intervention was evaluated through an internal programmatic review conducted as a descriptive cross-sectional study implemented from August 1 to October 28, 2022, in the Sahel region, including a survey in Dori health district. CHWs involved in implementing the strategy were considered for interviews. Performance indicators for all antigens have shown an upward trend since the strategy's inception in 2019.

Conclusion: The task-shifting of immunization activities to CHWs has been implemented successfully in a region seriously affected by terrorism-related insecurity. It holds the promise of maintaining or even improving performance if institutionalized and scaled up while improving the monitoring of adverse events following immunization by the CHWs.

FIGURE 1

Key Development Dates During the Pilot Phase of Task-Shifting Immunization Activities to Community Health Workers, Sahel Region, Burkina Faso

FIGURE 2

Evolution of Vaccination Coverage of the Sahel Health Region, Burkina Faso, 2017–2021 Abbreviations: measles rubella 1, first dose of measles rubella vaccine; measles rubella 2, second dose of measles rubella vaccine; MenA, meningococcal type A vaccine; penta 1, first dose of pentavalent vaccine; penta 3, third dose of pentavalent.

FIGURE 3

Evolution of BCG, OPV1, and OPV3 Vaccination Coverage From 2017 to 2021 in the Sahel Region of Burkina Faso Abbreviations: BCG, bacille Calmette-Guérin vaccine; OPV1, first dose of oral polio vaccine; OPV3, third dose of oral polio vaccine.