How new training approaches are transforming health workers’ ability to deliver vaccines

A major barrier to providing health services is a global shortage of healthcare workers. The World Health Organization (WHO) estimates this shortage to be 17.4 million worldwide.

There is also chronic under-investment in the education of health workers, says WHO. But the rise in internet access and number of mobile phones could offer flexible, less costly alternatives to traditional training. The past decade has already seen a wave of digital health initiatives that range from encouraging compliance with treatment regimens, reminders of health prevention information or online healthcare consultations with doctors.

"Ensuring that vaccines are affordable and accessible is critical, but not enough in countries with shortages of qualified health workers."

One of Gavi’s goals is to ensure that blended learning approaches supported by digital technologies are standard practice for health workers in Gavi-supported countries by the end of 2025. Gavi and The Rockefeller Foundation launched a partnership at the end of 2019 to support frontline health workers’ education using these approaches, especially in delivering immunisations services.

“Rockefeller and Gavi share an understanding that strengthening health systems to meet future demands will require innovative ways of working, and this partnership demonstrates the catalytic role that the private sector can play in global health,” says Moz Siddiqui, Head, Private Sector Partnerships and Innovation at Gavi.

Digital training during a pandemic

The COVID-19 pandemic presented many challenges for health systems – chief among them lockdowns and mobility restrictions that sought to reduce disease transmission, but as a side-effect limited the functionality of health systems.

In response to these new restrictions, the Rockefeller-Gavi partnership launched initiatives in Somalia, Sierra Leone and the Democratic Republic of the Congo (DRC) focused on using mobile phone technologies to teach frontline workers digitally, expanding the number of vaccinators available.

More projects are being launched in Benin, Ivory Coast, India and Senegal to target over 12,000 vaccinators. The pilot projects are aimed at supporting the delivery and administration of COVID-19 vaccines as well as restoring and maintaining routine immunisation services affected by the pandemic, that can in the long term contribute to reaching more children who missed out on vaccines.

In Somalia, the project partnered with Dimagi and Medic Mobile, the two largest developers of apps designed specifically for community health workers - over 700,000 health workers around the world currently use these apps.

The project supported the Ministry of Health to introduce and roll-out COVID-19 vaccine,  including vaccination registration, eligibility-checking, status tracking, and follow-up​. Data from 200,000 vaccinated people have  been registered in an initial phase. This is the first time in the history of Somalia’s health system that such data has been recorded electronically and available in real-time, helping the country reach people who otherwise might have missed out on COVID-19 vaccines.

In Sierra Leone, meanwhile, TechChange and the COVID-19 Digital Classroom Consortium (the CORE Group and Last Mile Health) worked together on a toolkit for governments, organisations, and users to adapt global training modules for COVID-19 and other content to country contexts.

The toolkit was designed to tap into how learners would like to adapt and share content, such as using content offline or translating it into local languages. The kit also addresses barriers to use, such as the need for simplification but also adaptation to additional health priorities like disease outbreaks.

In DRC, Viamo is supporting the Ministry of Health and the National Public Health Institute in the rapid roll-out of the COVID-19 vaccine through Interactive Voice Response training for 5,000 health workers, the first project of this kind and unique in the DRC.

The training focuses on vaccine delivery, possible secondary effects, infection control and prevention at the injection side, among other things. It is being delivered in five languages (French, Lingala, Tshiluba, Kikongo and Swahili) to enable thousands of health workers to be trained at once. Modules are delivered by Interactive Voice Response (IVR) and SMS to mobile phones,

With support from Stanford University, data is being collected on the reactions of learners as well as changes in health workers’ knowledge, attitudes and practices. The analysis will focus in particular on the participants’ ability to identify misinformation and myths circulating within their communities, as this understanding is critical for tailoring specific communication and vaccine demand strategies.        

Understanding what works to scale-up solutions

The findings are in for Somalia and Sierra Leone so far, showing them to be successful overall. In Somalia, for example, health workers found digital COVID-19 vaccine registration easier than paper-based systems, and it also allowed them to be able to physically distance from people about to be vaccinated. The government is also exploring options to use it for routine immunisation, which traditionally suffers from a low-quality paper-based data system.

In Sierra Leone, the results show that 97% of people reported increased knowledge and skills and there was a course completion rate of 65% (in 1603 participants). Health workers reported that they enjoyed learning at their own pace, being able to return to the course material, and having supportive online forums or WhatsApp groups. Users also reported that limited bandwidth restricted their ability to use the tool.

Now, these pilot projects are being evaluated to identify lessons to guide other countries and support the adoption of digital technologies.

“Ensuring that vaccines are affordable and accessible is critical, but not enough in countries with shortages of qualified health workers. This is why we believe it is important to invest in innovative methods of training to ensure that health services are delivered to missed communities and unreached children,” says Katja Schemionek,Senior Manager, Health Systems and Immunisation Strengthening, Gavi.