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Report

Barangay Health Workers (BHWs) as RESBAKUNA Champions

Understanding BHW context, challenges and opportunities for COVID-19 vaccine demand generation

IDinsighters, barangay captain, and barangay health workers outside the community health center, doing the PinasLakas (DOH COVID-19 vaccination drive) campaign pose in Luta Del Norte, Philippines ©IDinsight/Jilson Tiu

Final Report – BHWs as RESBAKUNA Champions - 6 MB

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Executive Summary

This report serves as a guide to the DOH Task Group for COVID-19 Vaccine Demand Generation and Communications (TG DGC) or RESBAKUNA team in understanding the context, challenges and opportunities in tapping BHWs as COVID-19 vaccine promoters to adults in rural communities.

Overview

DOH’s RESBAKUNA team and IDinsight are working in a multi-phase learning partnership to increase COVID-19 vaccine demand and uptake for target populations in the Philippines. In Phase I of the partnership, IDinsight conducted a remote qualitative study to understand the vaccine demand of the adult, rural indigent population or priority group A5. IDinsight found that Barangay Health Workers (BHWs) are strong influencers among this population when it comes to health-related topics, including the COVID-19 vaccines. However, BHWs face different challenges to being effective in COVID-19 vaccine demand generation. For this reason, IDinsight and DOH focused Phase 2 of the partnership to identify how best to capacitate and equip BHWs in COVID-19 vaccine information dissemination and promotion.

Methodology

IDinsight followed a Human-Centered Design (HCD) approach in conducting this qualitative assessment. Following the HCD approach, we began with obtaining an in-depth understanding of the tasks and activities BHW perform in their daily routine and the people they interact with. Through this process of discovery, we learned about the challenges BHWs face in generating demand for COVID-19 vaccines, as well as potential entry points for a solution. Upon identifying a tractable problem, we ideated and narrowed in on a set of potential solutions and sought direct feedback from BHWs. The tools we used from this process of problem discovery and definition to solutions generation and feedback included shadowing, direct observation, interviews, and focus group discussions (FGDs) with BHWs. In addition, we also consulted with other internal and external DOH stakeholders working directly with BHWs.

Findings

We found that BHWs have untapped potential to promote COVID-19 vaccines. Through the many COVID and non-COVID activities they are responsible for; they have multiple points of interaction with community members. Additionally, although active vaccine promotion is not their responsibility, community members often proactively reach out to BHW with questions about the vaccine. BHW are currently unable to reach their full potential for vaccine promotion because of structural and information challenges they face. In this report, we focus on the information challenges that DOH HPB and the RESBAKUNA team can address through communication-related solutions.

The two information challenges were:

  • Limited access to updated, comprehensive and correct COVID-19 vaccine information
  • Lack of confidence in providing information about and promoting the COVID- 19 vaccines

To address these challenges, we presented BHWs and stakeholders with several existing and potential information solutions. These included an upgraded KIRA chatbot and Facebook group for digital solutions, and physical reference materials for BHWs, scripts and talking points for target groups, and physical IEC materials for distribution to the community for offline materials. When asked to try and/or comment on these solutions, BHWs had a diverse set of suggestions. Our process revealed that the best information solutions highly depend on the local context, particularly on the level of COVID-19 vaccine demand and mobile internet connectivity.

Recommendations

IDinsight recommends that DOH create a strategy to empower BHWs more to become RESBAKUNA champions given their unique position in the community and the opportunities to easily integrate COVID-19 vaccine demand generation efforts into their activities without adding to their workload. To help support BHWs, we recommend that DOH adopt a targeted Below the Line (BTL) communication strategy in rural areas based on two factors:

  1. COVID-19 vaccine demand in relation to supply, and
  2. Mobile and internet connectivity of households (as summarized in Figure 1 below).

DOH can also consider the following specific recommendations for each of the solutions based on feedback from BHWs and stakeholders:

  1. Target introduction of the KIRA chatbot in areas with good mobile internet connectivity. Improve the KIRA chatbot’s user experience, text recognition, answer bank, and features.
  2. Establish a private Facebook group and onboard CHD HEPOs and/or BHW coordinators to serve as rotating moderators.
  3. Expand access to printed materials in areas with poorer connectivity and lower vaccine demand.
  4. Develop scripts for target groups incorporating motivational interviewing principles and disseminate in digital or printed format, depending on connectivity.

Read the full report here