Guatemala's Tailored, Rural Vaccination Plan Strengthens COVID-19 Vaccine Coverage
On September 15, 2021, the Guatemalan Ministry of Health (MSPAS) approved a Strategy to Strengthen the COVID-19 Vaccination Plan in Rural Areas to supplement the country’s larger national vaccination plan. The strategy will improve vaccination coverage in hard-to-reach communities by establishing a framework to improve planning management of resources, and efficiency, as well as create more vaccination centers in underserved areas. Implementation of the strategy has the potential to benefit 11 million Guatemalans and has already increased vaccination rates by 13 percentage points, on average, in the remote areas where it has been put into practice.
Diagnosing Rural Challenges
This summer, Guatemala faced its fourth wave of COVID-19 infections. With new variants ripping through the country—resulting in a national positivity rate of 45 percent in August—Guatemala’s health sector was racing to vaccinate as many people as possible. The need to scale up COVID-19 vaccination was particularly pronounced in the country’s rural areas, where in July only 6.5 percent of the population had received one or more doses.
To understand the challenges of vaccinating rural communities, technical teams from MSPAS, the U.S. Agency for International Development (USAID), Health and Education Policy Plus (HEP+), and other health sector partners traveled to areas with the lowest vaccination rates. The teams started in Ixcán, Quiché, one of the most isolated municipalities in the country. Its remote geography made Guatemala’s previous strategy of phased vaccination by age group inefficient, with health workers having to make several difficult trips to vaccinate small numbers of people. Other barriers to vaccination included a lack of personnel at vaccination posts, distance of vaccination centers from communities in need, and misinformation about COVID-19 and the vaccine itself. Similar challenges were found in the equally isolated communities of Ixil, Alta Verapaz, Chiquimula, and San Marcos.
The Power of Dialogue
The team’s findings highlighted the need for a more tailored vaccination strategy for rural communities. To create specific guidelines, MSPAS and USAID convened a multidisciplinary commission that heard from representatives of various health area directorates and vaccination posts on the specific challenges faced in their low-vaccination area.
In the communities themselves, HEP+ and MSPAS held meetings with health area authorities, community and religious leaders, members of civil society organizations, mayors, and local media to promote vaccination, identify ideal locations for vaccination centers, and challenge myths and misinformation that lead to vaccine rejection by rural communities. Establishing these relationships with local, influential actors later proved essential in improving rural vaccination rates. Local leaders designed awareness campaigns to educate people about COVID-19 and demystify the vaccine. Representatives from community development councils volunteered to receive the first dose of the vaccine in their communities and share their experiences with the public.
These efforts gave rise to the Strategy to Strengthen the COVID-19 Vaccination Plan in Rural Areas, developed and approved by MSPAS with HEP+ support. To put the new strategy in action, MSPAS authorized vaccines for anyone 18 years of age and over living in remote communities. It also authorized the establishment of strategically located vaccination centers in Ixcán, Alta Verapaz, Chiquimula, and Totonicapán. HEP+ analyzed each health area directorate budget, recommending the reallocation of resources according to local needs, which freed up resources to hire additional vaccination center staff.
Implementation of Guatemala’s new, rural vaccination strategy has paid off. In just one month, the areas where the plan has been put in place have seen, on average, an increase of 13 percentage points in vaccination rates. As of October 13, 2021, the percentage of people who had received at least one dose of the COVID-19 vaccine increased from 17 to 25.8 percent in Ixcán, from 6.4 to 26.2 percent in Ixil, from 7.95 to 20.4 percent in Alta Verapaz, and from 22.2 to 34.2 percent in Chiquimula.