The Role of Community Health Workers in Improving Immunization Uptake Among Children

1.1 Introduction

Community health workers (CHWs) are lay members of communities who are trained to provide basic health and medical care to their fellow community members. They serve as a bridge between the formal health system and the community, promoting access to essential health services, particularly in underserved areas (Lehmann & Sanders, 2007). According to the World Health Organization, CHWs are individuals chosen by the community and accountable to it, who receive training tailored to the health needs of their community and work in close proximity to the people they serve (WHO, 2018). Immunization is recognized as one of the most effective and cost-efficient public health strategies for reducing childhood morbidity and mortality associated with vaccine-preventable diseases (Adebayo et al., 2020). In Nigeria, the immunization coverage rate has been fluctuating, with many states falling below the national target. The persistence of preventable diseases such as measles, polio, and diphtheria highlights the urgent need for innovative and community-centered approaches to increase immunization uptake (Ogunyemi & Lawal, 2021).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitation of the study and Definition of terms.

1.2 Background of the Study

Community health workers (CHWs) have long been recognized as vital actors in strengthening primary healthcare systems, especially in low- and middle-income countries. According to Lehmann and Sanders (2007), CHWs are community-based individuals who provide culturally appropriate health services and act as a critical link between communities and formal health systems. The World Health Organization (2018) reported that the use of CHWs has been instrumental in promoting health equity and expanding access to essential services, particularly in remote and underserved areas where professional healthcare workers are scarce.

Perry et al. (2014) stated that during the global push to eradicate polio, CHWs became instrumental in reaching remote and underserved populations, thereby reducing transmission in high-risk regions, including parts of Nigeria. Ogunyemi and Lawal (2021) contended that beyond polio eradication, CHWs have continued to play a key role in sustaining immunization campaigns for other vaccine-preventable diseases by fostering trust within communities and reducing cultural resistance to vaccines. Historical evidence also shows that the challenges faced by CHWs are not new.

Immunization is widely regarded as one of the most effective public health interventions. Adebayo et al. (2020) asserted that childhood immunization reduces mortality and morbidity from vaccine-preventable diseases such as measles, polio, and diphtheria, and remains central to achieving Sustainable Development Goal 3, which focuses on ensuring healthy lives and promoting well-being for all ages. However, Nigeria has continued to struggle with low immunization coverage, especially in rural and hard-to-reach communities. Eze et al. (2019) contended that factors such as poor maternal awareness, cultural misconceptions, religious beliefs, and logistical challenges contribute to poor uptake of vaccines among children under five years.

Community health workers play a significant role in overcoming these barriers. Ogunyemi and Lawal (2021) affirmed that CHWs, through home visits, health education, and community engagement, increase vaccine acceptance and help identify children who miss scheduled doses. Similarly, Oladepo et al. (2018) stated that Community Health Workers often gain the trust of community members, enabling them to effectively counter misinformation and mobilize caregivers to participate in immunization programs. On the other hand, their contributions are sometimes undermined by challenges such as inadequate training, lack of incentives, weak supervision, and insufficient government support, which limit their ability to fully maximize their potential in improving immunization outcomes.

The persistence of vaccine-preventable diseases in Nigeria demonstrates the importance of strengthening community-based health systems. Evidence from other countries indicates that empowering CHWs leads to increased immunization coverage and reduced child mortality rates. For instance, Perry et al. (2014) reported that countries with strong Community Health Worker programs have made significant strides in reducing child deaths from preventable diseases. This study is set against the backdrop of examining the role of community health workers in improving immunization uptake among children.

1.3 Statement of Problems

Investigation revealed that childhood immunization is one of the most cost-effective strategies for preventing morbidity and mortality caused by vaccine-preventable diseases. However, the utilization of available immunization services is often far below the expected coverage rates recommended by the World Health Organization (Adebayo et al., 2020). In many rural and underserved communities, children remain at risk of preventable diseases due to these systemic gaps.

Furthermore, studies have shown that where community health workers are properly trained, supported, and integrated into the healthcare delivery system, immunization uptake significantly improves. Their close relationship with community members positions them as trusted agents of change, capable of dispelling myths and fostering acceptance of immunization programs (Ogunyemi & Lawal, 2021). Yet, the sustainability of this role is undermined by challenges such as lack of government support, poor remuneration, and limited career progression for community health workers, which affect their commitment and overall performance. It is against this backdrop that this study seeks to examine the role of community health workers in improving immunization uptake among children.

1.4 Aim and Objectives of the Study

The aim of this study is to investigate the effectiveness of community health workers in enhancing immunization uptake among children.

The specific objectives of this study include:

1. To assess the contributions of community health workers in promoting immunization uptake among children.
2. To examine the challenges faced by community health workers in delivering immunization services.
3. To evaluate the strategies used by community health workers to address barriers to immunization.
4. To determine the level of community trust and acceptance of immunization programs facilitated by community health workers.

1.5 Research Questions

Based on the stated objectives, the study will address the following research questions:

• What are the contributions of community health workers in promoting immunization uptake among children?
• What are the challenges faced by community health workers in delivering immunization services?
• What strategies do community health workers use to address barriers to immunization?
• To what extent do communities trust and accept immunization programs facilitated by community health workers?

1.6 Research Hypotheses

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: Community health workers do not significantly contribute to improved immunization uptake among children
• H1: Community health workers significantly contribute to improved immunization uptake among children

Hypothesis Two

• H0: The strategies employed by community health workers do not significantly reduce barriers to immunization uptake
• H1: The strategies employed by community health workers significantly reduce barriers to immunization uptake

1.7 Significance of the Study

It is believed that at the completion of the study, the findings will guide policymakers on strengthening CHW programs, motivate health practitioners to adopt community-based strategies, inform program managers on effective immunization interventions, and contribute to reducing vaccine-preventable diseases among children.

Furthermore, the research study will also benefit health practitioners and program managers as it will accentuate practical ways in which community health workers will improve vaccine coverage, reduce defaulting rates, and increase community trust in immunization campaigns.

Lastly, the study will serve as a useful reference for future research on public health, immunization, and community-based interventions. It will enrich existing literature by providing evidence on the importance of community health workers in achieving national and global immunization goals.

1.8 Scope of the Study

This study will focus on the role of community health workers in improving immunization uptake among children in Kaduna State, Nigeria, where immunization coverage has remained inconsistent despite several health campaigns.

1.9 Limitations of the Study

A study of this nature is bound to experience certain problems as such the constraints imposed on the research include:

1. Time Constraints: A study of this nature needs relatively long time during which information for accurate or at least near accurate inference could be drawn. The period of the study was short, time posed as constraints to the research.
2. Financial Constraints: The research would have extended the survey to other area at the empirical level, but limitation as included cost of transportation to the source of material and the cost of time setting of the already completed work.
3. Lack of Cooperation: Many of the respondents are usually aggressive on issue that border cooperation among the respondents border.
4. Response Bias: The study will involve surveys and interviews with cooperative managers and members. Response bias may occur if respondents provide socially desirable answers or if there is reluctance to disclose negative financial information due to privacy concerns or fear of repercussions.

1.10 Definition of Terms

Community Health Workers (CHWs):

Individuals selected from the community, trained to provide basic healthcare services and act as a link between the community and formal health facilities. According to Lehmann and Sanders (2007), CHWs play a vital role in extending health services to underserved areas.

Immunization:

A preventive health measure involving the administration of vaccines to protect individuals, particularly children, against infectious diseases. WHO (2018) defined immunization as a proven tool for controlling and eliminating life-threatening diseases.

Immunization Uptake:

The extent to which children in a community receive the recommended vaccines within the specified schedule. Adebayo et al. (2020) described immunization uptake as a key indicator of effective vaccine delivery programs.

Vaccine-Preventable Diseases:

Diseases such as polio, measles, diphtheria, and tetanus that can be prevented through timely immunization. Perry et al. (2014) reported that global efforts in vaccination have drastically reduced deaths from these diseases.