The Impact of Frontline Community Health Workers on Vaccine Hesitancy in Rural Bihar

Despite advances in vaccine access and availability, vaccine hesitancy remains a significant barrier to vaccine coverage, particularly in low-income and socially excluded communities globally. The rural population in Bihar, India, is dealing with several public health challenges, such as inadequate access to health services, geographic isolation, social and religious disparities, and misinformation about vaccines. A lack of a robust and cohesive health-care system further exacerbates these challenges. Community Health Workers (CHWs) such as Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs) and Anganwadi Workers (AWWs) are an important link between rural communities and the formal health care system, as well as a source of trust in immunization services in such settings. This review will assess the effectiveness of the intervention Community Health Workers (CHWs) can bring to address vaccine hesitancy in rural Bihar, and consider how these barriers can be addressed and overcome. Long-term studies reveal that targeted community-based engagement efforts by frontline female health workers have resulted in substantial changes in vaccination coverage in certain communities, rising from nearly 12% to 84% over a span of 10 years (UNICEF, 2024). Despite these achievements, CHWs have faced several difficulties, including insufficient training, workloads along with lack of support in Adverse Events Following Immunization (AEFI). It highlights social, cultural and institutional factors influencing vaccine uptake, identifies communication strategies used by CHWs to build trust within communities and examines some recent innovations such as local microplanning and visual counseling tools. It also suggests recommendations for action that will improve grassroots health delivery and the performance of citizens in immunization in rural area.