Enhancing malaria vaccine, RTS,S/AS01 rollout for under-5 children in the South West Region of Cameroon: roles, challenges, and strategies of healthcare workers and managers (a qualitative study)

Abstract

Introduction: malaria remains a major cause of morbidity and mortality among children under five in Cameroon. The recent introduction of the malaria vaccine, RTS,S/AS01 marks significant progress in malaria control. However, its success depends on the effective roles of healthcare workers and managers in implementation. This study explored their perceptions, roles, and challenges during the pilot rollout in the South West Region (SWR) of Cameroon. Methods: a qualitative exploratory design was used, involving focus group discussions and key informant interviews with healthcare workers and managers engaged in the malaria vaccine rollout program in the SWR of Cameroon. Data were thematically analyzed to identify key roles, barriers, and strategies for enhancing uptake and sustainability. Results: healthcare workers exhibited positive attitudes, moderate-to-high knowledge, and strong willingness to promote the malaria vaccine. Yet, knowledge gaps particularly on side effects and effectiveness along with vaccine shortages, limited community sensitization, and parental hesitancy impeded full implementation. Managers reported strong vaccine availability but poor accessibility due to difficult terrain, logistical challenges, and inadequate funding. Leadership through supervision, training, and data-driven monitoring was critical to sustaining coverage, though policy rigidity and infrastructural deficits limited scalability. Conclusion: strengthening the capacity, motivation, and autonomy of healthcare workers and managers is essential to sustain malaria vaccine implementation. Enhanced training, community engagement, flexible policies, and logistical support will promote equitable access and long-term program success. These findings provide context-specific insights/strategies to guide the national scale-up of the malaria vaccine across Cameroon.