Immunisation Essentials: Competencies for Frontline Health Workers

Immunisation is a critical public health programme and is likely the largest contributor to reducing infant and child mortality in the last two decades. Gavi, the vaccine alliance estimates that in several Gavi-supported countries, every US$ 1 investment in vaccination results in a US$ 54 economic return, as a result of people living longer and healthier lives. Immunization programmes globally have seen a number of successes like the eradication of polio, chicken pox, smallpox, diphtheria, pertussis and other diseases in several countries. Some countries like Sri Lanka have achieved an immunization coverage of 99% for all childhood vaccines. There are, however, many countries in Sub-Saharan Africa and Southeast Asia, where a large number of children remain unvaccinated every year.

In 2020, I observed the operations of the world’s largest immunization programme, the Universal Immunization Programme of India, in one of its largest states, Madhya Pradesh where 1.9 million children are vaccinated every year through a staggering 1 million immunization sessions. Working with UNICEF, I travelled across several districts and villages for data collection. It was crucial for me to engage with health workers at various levels (state, district and village) to understand the activities involved in the immunization programme and to obtain evidence supporting the available research. One of the key findings during this journey was understanding the vital contributions of frontline health workers in making immunization a successful programme. It is, therefore, very important to recognise their role in immunization in India, apart from their involvement in several other programmes such as family planning, maternal health, NCDs, to name a few.

Throughout the journey in Madhya Pradesh, a question which kept coming up wasDo the health workers have these competencies to meet their work functions?

Over the years, immunization practices have evolved rapidly, with the introduction of new vaccines, new methods of administration, changes in syringe technology, sustainable disposal of medical waste, guidelines on adverse events, and several others. Under the leadership of organisations such as WHO, UNICEF, Gavi and others, immunization practices have been streamlined globally. Health workers now require specific knowledge and skills to meet their immunization targets. The World Health Organisation in 2017-18 developed a detailed competency framework for immunization programmes, where they described all the competencies required for an immunization programme to succeed at various levels: national, provincial, district and community. Categorised according to seven attributes, the health workers at the community level require several competencies to meet their work functions. These attributes cover the entire breadth of an immunization program from advocacy & communications, disease surveillance, monitoring & evaluation to planning, vaccine safety, logistics and performance management.

Source: Standard Competencies Framework for the Immunization Workforce, version 2.1, December 20, 2018, WHO, accessible at <https://www.who.int/immunization/programmes_systems/workforce/Standard_Immunization_Competencies_Framework_DRAFT.pdf?ua=1>

For frontline health workers, programme managers and other personnel working in immunization, acquiring these competencies has become even more critical because of the COVID-19 pandemic and involvement in large scale vaccination campaigns. Moreover, as we see new technologies in immunization, there will be additional competencies for health workers to gain to keep up with the ever-changing pace of immunization service delivery. It is possible that with changing needs, immunization programme managers and leaders realise the important role of frontline health workers and invest systematically to develop human capital at the community level.

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Sanjay Saha

Sanjay Saha


  1. Le déficit des ressources humaines qualifiées et compétentes dans le système de santé dans les pays en voie de développement demeure une réalité . L’engagement communautaire doit être une préoccupation des leaders communautaires les agents locaux et les autres professionnelles de la santé .

  2. Herd immunity
    When someone is vaccinated, they are very likely to be protected against the targeted disease. But not everyone can be vaccinated. People with underlying health conditions that weaken their immune systems (such as cancer or HIV) or who have severe allergies to some vaccine components may not be able to get vaccinated with certain vaccines. These people can still be protected if they live in and amongst others who are vaccinated. When a lot of people in a community are vaccinated the pathogen has a hard time circulating because most of the people it encounters are immune. So the more that others are vaccinated, the less likely people who are unable to be protected by vaccines are at risk of even being exposed to the harmful pathogens. This is called herd immunity.

    This is especially important for those people who not only can’t be vaccinated but may be more susceptible to the diseases we vaccinate against. No single vaccine provides 100% protection, and herd immunity does not provide full protection to those who cannot safely be vaccinated. But with herd immunity, these people will have substantial protection, thanks to those around them being vaccinated.


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