A Conceptual Model for Integrating Community Health Workers into National Immunization Programs to Boost Vaccine Uptake

Increasing vaccine uptake remains a persistent public health challenge in many low- and middle-income countries, as well as in marginalized populations within high-income settings. Community Health Workers (CHWs) serve as trusted intermediaries between health systems and communities, posiPtioning them as critical actors for strengthening immunization delivery. This paper proposes a comprehensive conceptual model for integrating CHWs into national immunization programs to improve vaccine acceptance, coverage, and continuity of follow-up. The model identifies five core domains community engagement and trust building, service-delivery support, surveillance and data reporting, coordination within health system structures, and capacity building with incentive systems. Within these domains, CHWs play key roles in educating caregivers, addressing vaccine hesitancy, identifying unvaccinated or defaulting children, supporting outreach activities, and reporting real-time community-level data to immunization managers. The model emphasizes the need for strong governance, standardized supervision structures, and scalable training frameworks to ensure CHW effectiveness and sustainability. It further highlights the importance of digital tools such as mobile data-reporting platforms and electronic defaulter-tracking systems for improving communication and reducing missed opportunities for immunization. Additionally, integrating CHWs into microplanning processes enhances resource allocation, outreach scheduling, and equity-oriented targeting of hard-to-reach communities. The proposed model supports participatory community mechanisms that strengthen accountability, responsiveness, and culturally appropriate communication strategies.

By formalizing the role of CHWs within immunization frameworks, national programs can achieve higher vaccination uptake, reduced dropout rates, improved data quality, and stronger linkages between community structures and primary health care facilities. Ultimately, this conceptual model offers a scalable blueprint for countries seeking to optimize community-based immunization strategies and ensure more resilient, equitable, and people-centered vaccine delivery systems.