A Systematic Review of the Roles of Community Health Practitioners in Reducing Child Mortality Through Vaccination in Nigeria
Chapter One
Objective of the study
The objective of this study is to systematically review existing literature to examine the roles played by Community Health Practitioners (CHPs) in reducing child mortality through vaccination in Nigeria.
The specific objectives are to:
- Identify and analyze the key roles of Community Health Practitioners in the delivery of vaccination services aimed at reducing child mortality in Nigeria.
- Examine the effectiveness of interventions led or supported by Community Health Practitioners in improving vaccination coverage among children under five.
- Assess the challenges and barriers faced by Community Health Practitioners in the implementation of immunization programs in different parts of Nigeria.
- Evaluate the impact of CHP-driven immunization efforts on child health outcomes, particularly in rural and underserved communities.
CHAPTER TWO
REVIEW OF RELATED LITERATIURE
Community Health Practitioners (CHPs)
Community Health Practitioners (CHPs) are frontline healthcare workers trained to provide essential health services at the grassroots level, particularly in rural, underserved, and hard-to-reach communities. In many low- and middle-income countries, including Nigeria, CHPs play a vital role in delivering primary healthcare services, promoting disease prevention, conducting health education, and facilitating community-based interventions such as vaccination, antenatal care, and health promotion (WHO, 2021; Perry et al., 2023). In Nigeria, CHPs typically include Community Health Officers (CHOs), Community Health Extension Workers (CHEWs), and Junior CHEWs (JCHEWs). These cadres form the backbone of Nigeria’s Primary Health Care (PHC) system and are largely responsible for implementing community-level health programs under the supervision of the National Primary Health Care Development Agency (NPHCDA) (NPHCDA, 2021). They are deployed in Primary Health Care Centres (PHCs), health posts, and mobile clinics to bridge the gap between formal health systems and local populations.
According to the Community Health Practitioners Registration Board of Nigeria (CHPRBN), CHPs are trained professionals certified to perform preventive, promotive, and basic curative healthcare services. Their training typically spans two to four years, depending on the cadre, and includes both classroom instruction and field-based practical experience (CHPRBN, 2020). Their responsibilities often include child immunization, antenatal care, growth monitoring, home visits, community mobilization, and surveillance of diseases (Ajayi & Akinyemi, 2023).
The importance of CHPs in vaccination efforts is well-documented. They are often the first point of contact for health services in rural areas, where physician density is extremely low. Through their proximity and familiarity with community members, CHPs foster trust and facilitate the delivery of vaccines, especially during routine immunization campaigns and Supplementary Immunization Activities (SIAs). They also help identify defaulters, track immunization coverage, and dispel vaccine-related myths and misinformation (Ibrahim et al., 2023; Yakubu et al., 2023).
Despite their critical role, CHPs face several challenges. Studies have reported issues such as insufficient training, inadequate logistics and supplies, irregular remuneration, and limited opportunities for career advancement, all of which affect morale and performance (Olumide et al., 2023; Adedokun et al., 2022). Furthermore, the scope of their work often extends beyond immunization to include multiple health tasks, which can lead to work overload and reduced service quality (Oluwadare, 2021). The global health community recognizes CHPs as essential contributors to achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG-3), which aims to ensure healthy lives and promote well-being for all ages. The World Health Organization (WHO, 2018) describes CHWs (a broader category which includes CHPs) as a “key component of a responsive and resilient health system,” especially in resource-constrained settings.
CHAPTER THREE
METHODOLOGY
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This chapter outlines the systematic approach employed in reviewing the roles of Community Health Practitioners (CHPs) in reducing child mortality through vaccination in Nigeria. The chapter describes the research design, search strategy, inclusion and exclusion criteria, data extraction, and method of analysis.
Research Design
A systematic review design was adopted for this study. This design was appropriate as it provided a structured method to identify, appraise, and synthesize available research findings on the roles and effectiveness of CHPs in childhood immunization across Nigeria. The review strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
CHAPTER FOUR
DATA ANALYSIS AND DISCUSSION
This chapter presents the results of the systematic review and discusses them in relation to the research questions.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary
This systematic review was conducted to evaluate the roles of Community Health Practitioners (CHPs) in reducing child mortality through vaccination efforts in Nigeria. Specifically, the study sought to explore the specific roles played by CHPs in delivering childhood vaccinations and to assess the effectiveness of their interventions across different regions of Nigeria.
The background of the study highlighted the persistently high rates of under-five mortality in Nigeria, a large portion of which are vaccine-preventable. While government policies have prioritized immunization as a key public health intervention, the actual implementation largely depends on CHPs who serve as the first point of healthcare contact in many rural and underserved communities.
A systematic review approach was adopted to assess a broad range of published and grey literature. The review revealed that CHPs play several critical roles including community mobilization, health education, administration of vaccines, follow-up of defaulters, and maintaining immunization records. These functions are essential for improving vaccination coverage and, by extension, reducing child mortality.
Findings also revealed that CHPs have significantly contributed to increasing routine immunization (RI) uptake and awareness, particularly in underserved communities. However, their efforts are constrained by challenges such as poor infrastructure, limited training, vaccine stock-outs, and sociocultural resistance to immunization.
Conclusion
Based on the reviewed evidence, it is evident that Community Health Practitioners are pivotal in Nigeria’s immunization landscape. Their proximity to local communities and understanding of indigenous norms positions them as essential agents in the promotion of child health through vaccination. Their involvement has demonstrably improved immunization coverage rates and reduced vaccine-preventable child deaths, especially in rural regions.
Despite these successes, systemic challenges persist, including limited logistical support, inadequate supervision, insufficient motivation, and cultural barriers that impede effective immunization delivery. To optimize the impact of CHPs on child mortality reduction, these issues must be addressed through targeted interventions and policy reforms.
Recommendations
There is a need for continuous training and re-training of CHPs on updated vaccination protocols, cold chain management, and community engagement strategies to improve service delivery.
Government and stakeholders should provide adequate infrastructure, logistics, and vaccine supplies to support CHPs, especially in remote areas.
Strengthening community involvement and addressing cultural myths about vaccines can enhance the trust and effectiveness of CHPs in rural areas.
Establishing robust data collection and evaluation systems to assess the performance of CHPs and track immunization outcomes can help in improving accountability and impact.
Providing adequate remuneration, recognition, and career development opportunities for CHPs will boost their morale and commitment to immunization programs.
REFERENCES
- Federal Ministry of Health (FMoH) Nigeria. (2021). National Strategy on Infant and Young Child Feeding in Nigeria 2020–2025. Abuja: FMoH.
- Ogbonna, C. A., Aniebue, P. N., & Eze, J. N. (2022). Evaluation of baby-friendly practices in Nigerian hospitals: Barriers and progress. Annals of Global Health, 88(1), 101.
- Oni, T., Aluko, J. O., & Lawal, M. (2023). Maternity protection and workplace breastfeeding support in Nigeria: Policy gaps and recommendations. Health Policy and Planning, 38(4), 528–536.
- Onyeneho, N. G., & Igbokwe, O. I. (2023). Utilization of maternal health services under Nigeria’s National Health Insurance Scheme: Implications for breastfeeding support. International Journal of Health Services, 53(1), 35–49.
- UNICEF. (2022). State of the World’s Children Report. Retrieved from https://www.unicef.org
