Background Deployment of large-scale surveillance in low-income settings can be challenging. Meanwhile, the inclusion of pharmacists, health centres, over-the-counter medicine sellers (OTC), and herbal clinic practitioners as referral agents for health programs has the potential to improve access to healthcare services, increase enrolment in surveillance programs, and improve patient outcomes. We report here the participation of these important players in a large-scale vaccine deployment: Typhoid Vaccine in Ghana (TyVEGHA) programme in a rural setting in Ghana.

Methods We published elsewhere the concept of the severe typhoid fever programme (SETAPlus). In brief, we trained pharmacists, OTC agents, and herbal medicine sellers within the catchment area of the TyVEGHA study to support referral of eligible participants to Agogo Presbyterian Hospital-Trial Site. Facilitated (through incentives and community-sensitization) Participatory Training (FPT) was conducted to support the partnership and understanding of referral processes for eligible participants. The owners/caretakers were trained in the use of digital thermometers, bench aids and logs for referral and enrolment. Refresher training was conducted every six-months to ensure sustained knowledge/skills. We assigned study members to supervise their activities and facilitate referral process. Finally, we conducted monitoring activities twice-a-week to certify compliance with good clinical practice and adherence to protocol.

Results Prior to the use of FPT in July-2022, the number of providers identified was 36. This number increased to 48 as of April 2023 (within a period of nine month), with 137 participants being referred for enrolment, blood draw, and subsequent follow-up. However, only 79% of the total facilities identified are currently referring participants due to challenges including inconsistent operation of OTCs, unrealistic incentive expectations and proxy drug purchases.

Conclusion FPT using health agents and community sensitization increased referral for participation in the TyVEGHA study. The study highlights the potential advantages of including these as referral points for health programs.