Developing a Tool Kit to Build Vaccine Confidence and Ensure Equitable COVID-19 Vaccination Implementation Strategies in Low- and Middle-Income Countries (LMICs)

Background and Aims

This project aims to take a holistic approach to address vaccine confidence by promoting equitable vaccine delivery in LMICs. Guided by an implementation science approach and equity-focused framework, we will identify key principles and develop guidance for vaccine delivery in LMICs, thus working towards improved public confidence and greater equity in COVID-19 vaccination. 

We will explore contextual and process-oriented factors impacting the COVID-19 vaccination programs in the Philippines, as well as barriers and enablers to achieving equitable vaccine delivery. Based on these findings and with local researchers, we will develop and pilot a tool kit to guide key stakeholders in implementing equitable COVID-19 vaccination programs in the Philippines. Next, we will involve our partners from the Philippines, the World Health Organization (WHO) Western Pacific Region, and WHO Headquarter to develop a generic tool kit and adaptation plan for equitable vaccine delivery in other settings, leveraging the adaptation and customization procedure proposed by the WHO. Components of the tool kit will include strategies for:

  1. Identifying at-risk groups’ barriers and facilitators to vaccination program
  2. Community engagement
  3. Mobilizing healthcare workers and partners to reach these communities
  4. Addressing vaccine hesitancy and confidence in at-risk groups 

Our team consists of researchers from Canada and the Philippines with expertise in infectious diseases, vaccination programs, and implementation science. 


  • Application for ethics approval was submitted to the ethics review board of University of Toronto. 
  • Initial preparation for starting Phase I of the project is ongoing.  

Updated January 25th, 2022.

Pakistan NCD-COVID-19 Trial

Background and Aims

We aim to address the healthcare delivery and policy gaps at the primary health care level in designing and implementing integrated COVID-NCD care to patients with diabetes or hypertension in Pakistan. We will implement a package of Covid-19 care integrated with existing NCD care, mainly for hypertension and diabetes, at the primary care level in Rural Health Centres (RHCs) of Punjab, Pakistan. We will conduct a parallel two-arm, cluster randomized controlled trial of the enhanced NCD-COVID-19 integrated care package in rural Punjab, Pakistan with a total of 1500 patients. The study will take 18 months. 

In the intervention RHCs, we will implement, in addition to the usual care in the WDF project, an NCD-COVID integrated care package comprised of:  

  1. Integrated NCD-COVID guidelines to support RHC staff to make health delivery safer
  2. A telemedicine platform with a smart phone app and online IT
  3. An Extension for Community Healthcare Outcomes (ECHO) based online platform for remote staff training, mentoring, and performance monitoring

All interventions will be delivered with a culturally gender-sensitive and inclusive approach.  We will evaluate the effectiveness of the study based on both NCD and COVID care indicators through patient surveys and data collected from RHC registrations. We will also conduct a mixed-methods outcomes evaluation, process evaluation and cost-effectiveness evaluation to understand how the project is implemented, what are the health system and other contextual factors that impact project implementation, and what are the unexpected consequences. This will help to facilitate future scale-up in Pakistan and LMICs.  


  • Application for ethics approval was submitted to the ethics review board of University of Toronto.
  • Initial preparation for starting Phase I of the project is ongoing.

Updated January 25th, 2022.

Developing Integrated Guidelines for Health Care Workers in Hospital and Primary Healthcare Facilities in Response to COVID-19 Pandemic in Low- and Middle-Income Countries (LMICs)

Background and Aims

Our study aims to develop an integrated plan for HWCs in low-and middle-income countries (LMICs) to respond to the COVID-19 pandemic. Using lessons learned from the COVID-19 outbreak firstly identified in Wuhan, China, we are collaborating with HCWs and non-governmental organizations (NGOs) in the Philippines and Sri Lanka to develop contextually specific guidelines and training modules for frontline HCWs responding to the COVID-19 pandemic.

With local researchers in the Philippines, we will first develop and pilot test guidelines and training videos. Next, in Sri Lanka, we will work with local researchers to adapt these materials to the local context. Through guidelines and training videos, our work aims to familiarize frontline HCWs with updated information so as to support them in operationalizing a contextually appropriate and robust COVID-19 response plan. Specific guidelines components include personal protection equipment (PPE) and infection prevention and control requirements, recommendations to improve hospital workflow, reduce nosocomial infections, and fear and stigma reduction among patients with suspected cases of COVID-19.

Our team consists of leading researchers from Canada, the Philippines, and Sri Lanka with previous infectious disease research and program implementation experience – this will enable us to quickly mobilize resources to create contextually appropriate and comprehensive guidelines and training materials to support frontline HCWs. This work is funded by the International Development Research Centre (IDRC).


  • Guidelines updated for hospital, primary care facilities and communities in the Philippines and adapted for Sri Lanka. Trainings, interviews and surveys conducted in the Philippines and Sri Lanka.
  • Data collection, analysis and evaluation work conducted in the Philippines and Sri Lanka.

Updated on January 18th, 2022.


Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles

National primary care responses to COVID-19: a rapid review of the literature

Updated on August 31st, 2021.

Developing a Preparedness Plan for Rapid Integrated Response to the COVID-19 Outbreak in China Involving Hospital and Primary Healthcare Providers

Background and Aims

Early in the COVID-19 outbreak in China, Guangdong province reported the second highest incidences of confirmed COVID-19. At that time in China a major challenge to the COVID-19 response was transmission from individuals who were asymptomatic or had subclinical symptoms. Additionally, nosocomial transmission from symptomatic but unconfirmed COVID-19 patients to others posed a major public health challenge as symptoms may be difficult to be distinguished from the common seasonal flu, and available test kits (RT-PCR) used to confirm COVID-19 cases were in short supply.

In response to these circumstances, this study aims to create a revised preparedness guideline for hospital and community health care workers to effectively manage the COVID-19 outbreak.

This is being conducted in two communities in Guangdong in both urban and rural settings. We developed a concise guideline and job aids to provide contextually relevant information on patient triage, treatment, infection control, communication, as well as guidance on health promotion and psychological interventions. This guidance was based on Chinese national clinical guidelines and WHO technical guidance for COVID-19 case investigation, clinical care and community management for health workers in hospitals, primary care facilities and communities. This work is funded by the Bill & Melinda Gates Foundation.


  • Guidelines developed for hospital and communities, and WeChat applet developed
  • Baseline survey and interviews conducted
  • Education videos developed and training conducted
  • Research paper and policy brief drafted

Updated on March 11th, 2022.

Research Team Members

Xiaolin Wei

Zhaoguo Wei

Chao Zhuo

Sponsors and Funding Agencies

Bill & Melinda Gates Foundation

Project Contact

Zhitong Zhang


Deskguides for Healthcare Workers in the Philippines and Sri Lanka (updated Aug 31, 2021)

These desk guides were created with the intent to be easily read and understood, and to disseminate guidelines on COVID-19 response which are effective and relevant in their local geographical contexts. To those whom it may concern the greatest, we encourage you to provide suggestions on how to improve them in order to better meet these goals.

Training Video for Healthcare Workers:

Philippines: ICM Healthcare Worker Video Training Series

Sri Lanka: PCR & RAT Training, Donning & Doffing Training

Click here to leave feedback.

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