Overcoming Immunisation Workforce Challenges Due to COVID-19

Author: Elizabeth Ohadi

The Linked Immunisation Action Network hosted a podcast with health workforce experts to discuss the global health workforce challenges that have arisen as a result of the COVID-19 pandemic. We wanted to hear how countries across the world have been addressing these challenges.

Key Messages
  • To prevent, diagnose, and treat COVID-19 while meeting the demands of routine immunisation activities, many countries sought to add more frontline health workers to their workforce.
  • The challenge all countries faced was to reorient existing health workers while not worsening working conditions by increasing workload, working hours, and the risks to the well-being of health workers.
  • Countries that had quality health workforce data readily available were able to mobilize and adapt more quickly to the needs of the pandemic.
  • Solutions adopted by some countries to strengthen the mental health support provided to health workers include the creation of mental support phone lines, media campaigns to reduce the stigma associated with seeking and accessing support services, and institutional programmes to support mental health and manage stress.
  • The COVID-19 pandemic has highlighted the need to urgently address the health workforce challenges that previously existed – to invest in new skills development, to increase the availability of health workers, decrease inequities in the distribution of the health workforce, and improve how they deliver health services.

As we approach the third year of the COVID-19 pandemic and countries within the Linked Network strive to maintain, restore, or even increase routine immunisation coverage rates, a critical challenge is the shortage of health workers available to support routine immunisation activities. This shortage is primarily attributed to the diversion of both clinical and programmatic health workers to support COVID-19 mitigation and vaccination activities. Health workers are also becoming infected with COVID-19, resulting in illness or the need to isolate, or they need to care for sick family members. Many health workers are feeling burned out as they are working longer hours and taking on additional responsibilities and risk, with incidences of burnout sometimes leading to a decrease in motivation. The pandemic has also led to increased mental health struggles among health workers. For all these reasons and more, the health workforce has been incredibly strained, compromising the delivery of essential health services like routine immunisation. Below are some examples highlighted in the podcast of how countries have responded to meet the needs of the moment.

Securing surge capacity. To prevent, diagnose, and treat COVID-19 while meeting the demands of routine immunisation activities, many countries sought to add more frontline health workers to their workforce. These new health workers included current students and recent graduates of medical programmes, retirees, foreign clinicians, military and other security personnel, and volunteers. Their recruitment and deployment were facilitated by the fast-tracked adoption of new or updated policies. It required countries to rapidly train these new health workers, finding a safe and effective balance between online and in-person trainings, and frequent dissemination of new information and training on updated protocols in the context of a rapidly changing COVID-19 situation.

These efforts were not without their challenges. For example, countries needed to quickly hire and deploy additional health workers during peaks in COVID-19 incidence and then to maintain and absorb these health workers within the health system during the dips. Some countries opted to contract additional health workers for a short period, typically 3 months, but this left health workers weighing the short-term benefits against the risk of contracting and spreading the virus to their families, without the long-term benefits of job and income stability.

Reorienting the existing health workforce. An alternative or additional avenue was the redistribution of existing health workers or their responsibilities. Health workers were temporarily deployed to another region or facility based on need, or as was the case for many routine immunisation workers, they were diverted from their regular responsibilities to support the COVID-19 vaccination programme. In some instances, their responsibilities were simply expanded or modified to support COVID-19 activities. While in some countries these changes were accompanied by additional pay, in many countries they were not. The challenge all countries faced was to reorient existing health workers while not worsening working conditions by increasing workload, working hours, and the risks to the well-being of health workers.

Workforce planning.  Health workforce planning is a crucial element of emergency response, and there was a notable difference in countries that had quality health workforce data readily available – they were able to mobilize and adapt more quickly to the needs of the pandemic.  As an example, prior to the pandemic, Indonesia had invested in building its health workforce database, including routine mapping of health worker availability. The Ministry of Health leveraged this information and was able to identify needs and anticipated capacity gaps to support redistributions and reorganization of the health workforce.

Decreasing burnout.  To decrease burnout during the COVID-19 pandemic, countries have responded with a variety of solutions, such as increasing compensation, providing life and disability insurance, and implementing policies mandating appropriate work and rest and vacation hours. In some countries, the recognition of COVID-19 as an occupational disease guaranteed that health workers would continue to receive their regular pay when quarantined. It was not always possible for countries to sustain the additional compensation and benefits over the course of the pandemic, and when remuneration incentives ended, countries reported a negative effect on health worker motivation. Also negatively impacting motivation were delays in receipt of the additional compensation that was promised. In the Latin America region, many countries implemented mandatory maximum working hours per day and week, mandatory vacation, as well as rotation policies to help health workers maintain a balance between their work and personal lives. However, the resulting spike in COVID-19 cases as the Omicron variant spread made it very difficult to maintain these regulations and policies.

Critical to reducing burnout among the immunisation workforce is understanding the challenges they face and identifying the resources they need to effectively do their jobs.  Supportive supervision is key to health workforce management; however, it was extremely limited during the pandemic. Identifying the means for restarting or increasing the frequency of supportive supervision visits is a possible solution for ensuring health workers feel connected and supported.

Supporting mental health. Health systems are resilient only so much as the health workforce is resilient. And a resilient workforce is a healthy workforce. The pandemic has shown countries around the world the necessity of ensuring both the physical and emotional well-being of health workers. Mental health issues among health workers certainly existed prior to the pandemic and were often under supported, but COVID-19 magnified these issues due to high stress, long shifts, and the excessive workloads it brought on. Solutions adopted by some countries to strengthen the mental health support provided to health workers include the creation of mental support phone lines, media campaigns to reduce the stigma associated with seeking and accessing support services, and institutional programmes to support mental health and manage stress.

And some countries looked to technology. In Malawi, an artificial intelligence virtual mental health care assistance bot was used to support health workers. Accessible through an app, this innovation provides low cost, private support to health workers by helping them to broadly understand the most common mental health conditions, identify immediate steps to help them cope such as controlled breathing techniques, and recommend when additional support is needed.

Building back better. The COVID-19 pandemic has highlighted the need to urgently address the health workforce challenges that previously existed – to invest in new skills development, to increase the availability of health workers, to decrease inequities in the distribution of the health workforce, and to improve how they deliver health services. We need to develop strategies to rapidly train health workers when necessary, and we need to strengthen the availability and use of health workforce data. Finally, we must continue to capture the experiences and evidence on this topic that will continue to emerge throughout this pandemic and share the lessons we’ve collectively learned.

Do you have a story or example of supporting health workers during the COVID-19 pandemic? We invite you to post it in the comments, below!

We would like to acknowledge the contributions of our health workforce experts and podcast guests: Luis Bernal, former Director of Human Resources for Health, Ministry of Health and Social Protection, Colombia and Professor of the School of Medicine and Health Sciences at Rosario University, Colombia, Juana Paola Bustamante Izquierdo, Economist, Health Labour Market Unit, World Health Organization, and Rachel Deussom, Director, Global Health Practice, Chemonics and former Technical Director, HRH2030, Chemonics.

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