We have seen this happen way too many times in health systems; national policies are updated, new vaccines are introduced, guidelines change. But the people on the front lines, the ones who actually hold a connection with the communities, sometimes get left behind. That is exactly what is happening in Nando and Nazinon, two regions in Burkina Faso.
After the World Health Organisation lifted the global health emergency for COVID-19, Burkina Faso developed a national strategy to integrate COVID-19 vaccination into routine immunisation. New vaccines followed: the injectable Polio Vaccine, the Human Papillomavirus Vaccine (HPV) and the most recent one, the Typhoid Conjugate Vaccine, which were all added to the national immunisation schedule.
Unfortunately, the community-based health workers, the people who go door to door identifying people who need vaccines and tracking down those who have missed their appointments, were working with outdated information.
Let us think about what that means. Imagine a mother who asks her community health worker about getting her daughter vaccinated against HPV. The health worker, who has not been updated, cannot give her accurate information. Trust erodes and opportunities are missed. Children do not get vaccinated and the community health workers have no way to upgrade their skills beyond their initial training.
Through the Saving Lives and Livelihoods project, we decided to tackle this head-on. We knew that community health workers are essential to the health system in Burkina Faso and are the bridge between formal health services and communities, particularly for immunisation. But a bridge only works if both sides are connected to the same road. We built a cascade training model that strengthened the entire human resource chain.
We ran a three-day Training of Trainers at the regional level. We brought in members of the district health management team and worked alongside the Directorate of Immunisation to create a pool of trainers who understood both the technical details and how to teach them effectively.
Those newly trained district teams then conducted three day training sessions for health workers, two from each health facility across all 11 districts in the two regions. This was about ensuring there is understanding of epidemic-prone disease surveillance and comprehensive Expanded Programme on Immunisation management (EPI).
Finally. community-based health workers at each facility underwent two-day training sessions on the updated vaccine schedule, targeted populations, community mobilisation, and effective tracing of defaulters.
We established a pool of 48 trained district-level trainers across the two regions. We trained 1,660 health workers at the facilities and strengthened the immunisation competencies of 2,397 community health workers. In total, 3,128 individuals now have the skills needed to ensure high-quality vaccination services in these areas.
The real story, however, is what happened next. One community health worker told us, “Understanding the importance of vaccination and target groups allowed us to significantly boost demand.” Knowledge created confidence, and confidence created action. Between February and September 2025, we saw tangible results. Nearly 46,895 girls were vaccinated against HPV. Over 405 individuals were vaccinated against COVID-19. 102,968 women received Td2+ vaccination for neonatal tetanus prevention.
In conclusion, we learnt that training community based health workers enabled the project to achieve two major objectives related to capacity building and increased immunisation coverage. Using the cascade training model ensured a lasting asset even after the project’s completion. Trust is at the heart of immunisation. Community health workers build trust through consistent, reliable interactions. They are neighbours, friends, family members.
They speak the same language and understand local concerns. When they speak about vaccination, people listen.
But the real story is what happened next. One community health worker told us something that stuck with me: “Understanding the importance of vaccination and target groups allowed us to significantly boost vaccine demand.”
That’s the thing about knowledge – it creates confidence, and confidence creates action.
Between February and September 2025, we saw tangible results. Nearly 47,000 girls were vaccinated against HPV. Over 400 individuals were vaccinated against COVID-19. More than 102,000 pregnant women received Td2+ vaccinations to prevent neonatal tetanus.
Community mobilisation strengthened. Vaccine demand increased. Coverage went up in both regions.
Author
- Issouf Bamba, Project Manager, Amref Health Africa, Burkina Faso
- Boubacar Diallo, M&E Officer, Amref West Africa
- Edited by David Mitine, Communications Officer, Global Health Security Unit, Amref Health Africa