Health on Wheels was launched in April 2022, targeting municipalities where vaccine coverage was below 30 percent.[4] To prepare for implementation, PAHO collaborated with the MOH to develop evidence-based guidelines and protocols and provided financial support to procure vehicles, equipment, and personnel. Before the Health on Wheels brigades' arrival to selected communities, PAHO-funded and trained project managers conducted dialogues with local leaders on the importance of vaccine acceptability and access, using PAHO's communication guidelines, and clarified the project’s objectives.

^{A health educator discusses the different services offered through Health on Wheels brigades with community members in Senahú, Alta Verapaz, September 2022.}
Photo credit: WHO/PAHO Guatemala.

Healthcare teams then engaged in extensive community management and promotion to foster demand. The teams, with q’eqchi-speaking community facilitators, dedicated time to understand the community's apprehensions towards COVID-19 vaccines, which stemmed from pervasive misinformation, and then organized educational kiosks and broadcasting service information via loudspeakers. 

In one of the 15 municipalities known for its vaccine resistance, Municipality 12, aggression towards healthcare workers and vaccine destruction had previously led to the cessation of local COVID-19 vaccination efforts.[5] Nonetheless, after a productive series of meetings where project leaders agreed to community leaders’ requests to accompany health promotion activities and honour individual vaccination choices, the initiative gained permission to enter previously vaccine-rejecting communities. 

Backed by local leaders In Municipality 12, in August and September 2022 HoW adeptly provided COVID-19 vaccinations to willing residents aged over six through health posts. Community resistance shifted to acceptance, there were no negative consequences, and the impact of the program was immediately evident.[6] From August to October 2022, 19 teams successfully engaged with 190 communities in Alta Verapaz, tailoring their approach to local traditions and languages.[7] In addition to the 2.2-fold rise in COVID-19 vaccination in intervention, versus non-intervention communities, 15 816 general health consultations were conducted, 17 234 routine vaccines were administered to children aged 0 to 5 years, and 47 HPV vaccines were provided to adolescents. 1228 pregnant women received care, 2721 children under two years were dewormed, 3752 children under five years received nutritional supplements, and 5574 children underwent growth monitoring which led to the identification and management of 21 cases of acute malnutrition.[8] 

HoW's strategy showcases the importance of culturally sensitive and integrated health service delivery in overcoming barriers to vaccine access and healthcare in remote areas. In Alta Verapaz, involving local leaders was key to reducing vaccine hesitancy, and the provision of various primary care services was integral to the strategy's success. General consultations were particularly effective in identifying and increasing acceptance of COVID-19 vaccination in eligible individuals. The project's sustainability was bolstered by forming health brigades in partnership with the MoH. Supported financially by the United States Government, PAHO/WHO will provide vehicles to replicate HoW's strategy throughout Guatemala. Concurrently, United Nations Children’s Fund (UNICEF) and the UN World Food Programme (WFP) are launching similar programs in different geographical areas to further extend the reach and effectiveness of this integrated healthcare model.