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

The authors describe a successful strategy of task-shifting child immunization activities to CHWs in insecure areas of Burkina Faso to improve vaccine coverage. Key Findings As part of Burkina Faso's national health system resilience plan, a task-shifting strategy was piloted in 1 district using community health workers (CHWs) to provide child immunization services to hard-to-reach populations in areas affected by terrorist attacks. Vaccine coverage improved for all antigens administered. Essential factors of the strategy's success included capacity-building of CHWs, adequate planning to ensure a vaccine supply, communication activities to increase community awareness and demand, and routine data collection and monitoring. After the experience in the Sahel region, the strategy was scaled up in the whole Sahel region and integrated into national guidelines. Key Implications National immunization guidelines should be adapted and used by governments and implementing partners to strengthen the credibility of a task-shifting strategy. Task-shifting strategies must take into account the CHWs' training, supervision, and remuneration, as well as additional financial costs that CHWs incur in performing their duties. We call on health system managers to build strong community health systems so countries or regions are better prepared to withstand crises and shocks. 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.