From Polio to COVID-19: Factors Sustaining Community Influencer Motivation in the CORE Group Partners Project’s Social Mobilization Initiatives for Vaccination in India

Abstract Introduction Engaging Community Influencers (CIs) was a key strategy for polio eradication in India, also contributing to routine vaccination and COVID-19 vaccination. CIs were high status individuals selected for their pre-existing reach into vaccine-hesitant communities. This paper describes the factors that kept the CIs engaged over time. The findings add to our understanding of what drives CHW motivation. Methods We performed a thematic analysis of 65 in-depth interviews conducted across six study districts of Uttar Pradesh, involving 36 CIs, 18 CGPP field staff, nine project managers and two representatives from other stakeholders. Findings The most important motivational factors that emerged from the research were improved social status, altruism, and effective working relationships. The inputs required to foster these were information support; providing respect and visibility; and fostering robust working relationships between program staff, CIs, CHWs, and government functionaries. Conclusions CIs’ engagement in the program maintained and bolstered their pre-existing status. Deploying and sustaining this cadre requires a strategic approach to maintaining motivation over time. Providing respect and visibility and maintaining effective working relationships is key to sustaining the CIs’ motivation. Key Messages The Community Influencer approach, initially introduced for polio eradication, has evolved over time into a vital strategy for increasing routine immunization and COVID-19 vaccination coverage. Community Influencers are high status individuals, selected by program (CGPP) staff for their pre-existing status in vaccine-hesitant communities. This study looks at how the motivation and engagement for this cadre was sustained over a 20-year period. Several key factors sustained the Community Influencers’ engagement over time, including a pre-existing commitment to their community, the program successes, visibility and respect; the working relationships with program staff and government functionaries; and, finally, the Influencers’ status within the community. Considering that many health systems struggle with a demotivated workforce, these findings provide practical guidance for fostering health worker engagement.