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  • Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme

    Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme

    Insights report about Nigeria’s Immunization Agenda 2030 Collaborative surfaces surprising solutions for both demand- and supply-side immunization challenges

    When 4,434 practitioners from all 36 states asked why children in their communities remained unvaccinated, the problems they thought they understood often had entirely different root causes.

    “I ended up being surprised at the answer I got,” said one health worker.

    Half of the health workers who participated in Nigeria’s largest-ever peer learning exercise in July 2024 discovered that their initial assumptions about local immunization challenges were wrong. The six-week programme generated 409 detailed analyses of local immunization challenges, with each reviewed by peers across the country.

    One year after The Geneva Learning Foundation launched the first Immunization Agenda 2030 Collaborative, in partnership with UNICEF and Gavi, under the auspices of the Nigeria Primary Health Care Development Agency (NPHCDA), a comprehensive insights report documents findings that illuminate persistent gaps between health system planning and community realities.

    How to access the Nigeria Immunization Collaborative’s first insights report:

    Chat with the report

    Health workers report being asked for insights for first time

    A recurring theme emerged from participant feedback that surprised programme organizers. “Many said no one has ever asked us what we think should happen or why do you think that is,” said TGLF’s Charlotte Mbuh, during the February 2025 presentation of the findings to NPHCDA and the country’s immunization partners.

    This potential for linking community experience with formal planning processes became evident when systematic analysis revealed that participants consistently identified practical solutions—many of which they could implement with existing resources.

    “Through my participation in the immunization Collaborative, I learned the critical value of root cause analysis,” reported one participant from Apo Resettlement Primary Health Centre in Abuja. “I applied this approach to uncover that insufficient manpower was the primary issue limiting vaccine coverage”—not the community resistance initially assumed.

    Dr. Akinpelu Adetola, a government public health specialist in Lagos State, exemplified this pattern. Her investigation of declining vaccination rates revealed poor scheduling that created both overcrowded and quiet clinic days. “A register and scheduling system were introduced to address this issue,” she shared with colleagues from across the country.

    Implementation gaps – not knowledge gaps – in the Nigeria Immunization Collaborative

    The Collaborative’s most significant finding challenges a common assumption in global health programming. Participants consistently proposed solutions that were “already well-known, suggesting that progress is limited by implementation issues rather than a lack of solutions,” according to the evaluation report.

    This pattern appeared across diverse contexts and challenge types. When health workers applied root cause analysis to local problems, they frequently identified straightforward interventions that had been overlooked by previous efforts focused on changing community attitudes or providing additional training.

    The evaluation found that 42% of participating health workers identified zero-dose challenges as their top local priority—aligning with national strategy priorities while providing granular intelligence about how these challenges manifest in specific communities.

    Nigeria Immunization Agenda 2030 Collaborative: Reconnecting data collection with local problem-solving

    A striking finding illuminated a fundamental disconnect in Nigeria’s health information systems: only 25% of participants knew their local coverage rates for key vaccines, despite many being responsible for collecting and reporting these figures at the local levels.

    “Many said, well, I collect these numbers, pass them on, but I didn’t know I could actually use them. They could actually help me in my work,” Mbuh explained, describing how participants began analyzing data they were already gathering within the first four weeks of the programme.

    While participants initially focused on demand-side issues—why communities do not seek vaccination services—systematic investigation often revealed supply-side problems underlying apparent “hesitancy.”

    Six primary supply-side challenges consistently undermine immunization delivery: poor data quality hampering service planning; vaccine stockouts due to inadequate inventory management; non-functional cold chain equipment; missed opportunities for catch-up vaccination; service quality issues that deter families; and systematic exclusion of hard-to-reach populations.

    Scale, speed, and sustainability across a complex federal system

    Launched by The Geneva Learning Foundation on 22 July 2024 in partnership with NPHCDA with support from UNICEF and Gavi, the Nigeria Immunization Agenda 2030 Collaborative connected health workers and other immunization stakeholders from more than 300 local government areas – with most based in northern States – within two weeks. Over 600 government facilities, private sector providers, and civil society organizations then signed on as organizational partners. Participants included 65% from local government and facility levels—both the community health workers who directly deliver immunization services and the LGA managers who support them.

    The initiative achieved this scale while operating at faster speed and significantly lower cost than conventional technical assistance and capacity-building approaches.

    The programme supported participants in using a simple, practical “five-whys” root cause analysis methodology, with each analysis reviewed by three peers across Nigeria’s diverse contexts. This peer review process provided depth to complement scale: it improved analytical quality regardless of participants’ initial skill levels.

    “The peer review was another mind-blowing innovation where intellect from other parts of Nigeria viewed your work and made constructive input,” noted one reviewer. “It made me realize I can be a team player.”

    Rapid implementation documented within weeks

    Within six weeks, health workers began reporting connections between new activities based on their root cause analyses and improved health outcomes.

    “During the Collaborative, we discussed successful case studies from other regions. Inspired by these stories, I have strengthened partnerships with local health authorities and other stakeholders to deepen immunization coverage, especially among under-fives. This collaboration has resulted in a significant increase in childhood vaccination rates in my community,” reported one participant from Ebonyi State.

    Unlike conventional training programs that end with certificates, evidence emerged that participants were applying insights within their ongoing work responsibilities and sustaining collaboration independently.

    Evidence of sustained networks and application one year later

    In fact, evidence one year on points to surprising sustainability, as the network continues to function without any external support.

    Four months after the programme concluded, TGLF organized a Teach to Reach session with 24,610 health workers participating, featuring Collaborative participants sharing early outcomes from the Nigeria initiative. This session revealed participants maintaining connections and applying methodologies in new contexts.

    “When we applied the root cause analysis, the five ‘whys’, this opened our eyes to see that it was not all about community members alone,” reported Uyebi Enosandra, a disability specialist working in Delta State. “We have challenges with the primary health workers, not knowing how to incorporate children with disability in the immunization programme.”

    Her account exemplified the pattern documented across participant testimonials: systematic analysis revealed different root causes than initially assumed, leading to more targeted solutions.

    Gregory, a retired professional who participated in outbreak response work in Borno State, described encountering Collaborative participants in the field: “I was pleased to hear that they participated in the Collaborative. And whatever step I wanted to take, they were almost ahead of me to say, sir, we have learned this and we are going to apply it.”

    “In my everyday activities at work I use this ‘5 whys’ to get to the root cause of any complaint and in my own little space make an impact on the patient,” one participant reported in follow-up feedback.

    The methodology’s application extended beyond immunization contexts. Participants reported using the analytical framework for disability inclusion, malaria programming, and broader health system challenges, suggesting the transferable value of structured problem-solving approaches.

    The December 2024 Teach to Reach session revealed ongoing demand for the methodology. Despite significant connectivity challenges affecting West Africa during the session, participants expressed eagerness to share the approach with colleagues. “Presently I’m even encouraging my colleagues to join,” one participant noted. “They’ve been asking me, how do I join, when will this come and all that.”

    The most significant sustainability indicator, according to Mbuh, appeared in widespread participant feedback: “I did not realize how much I could do with what we already have.” This response gained particular relevance as Nigeria and other countries navigate current funding constraints affecting global health programming.

    Potential to strengthen existing systems

    For NPHCDA and international partners, the Collaborative provided intelligence typically unavailable through conventional assessments. The analysis of root cause analyses offers detailed insights into how challenges manifest across Nigeria’s diverse geographic and cultural contexts.

    The approach demonstrated potential to complement existing training, supervision, and technical assistance systems by harnessing health workers’ practical experience and problem-solving capacity. The model addresses real-world challenges participants can immediately influence while building professional networks alongside technical competencies.

    “This pilot programme has demonstrated demand for peer learning, and the feasibility of running a national peer learning programme that brings together the strengths of a national immunization programme, a global partner and an educational organization,” the evaluation concludes.

    For Nigeria’s work toward Zero-Dose Immunization Recovery Plan goals through 2028, the Collaborative provides an innovative approach for translating national strategies into local action while building health worker capacity for continuous adaptation and problem-solving.

    The programme has evolved into what participants describe as a self-sustaining platform that continues operating independent of formal support, suggesting potential for integration with existing health system structures and processes in a true “sector-wide” approach.

    Reference

    Jones, I., Sadki, R., Sequeira, J., & Mbuh, C. (2025). Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme (1.0). The Geneva Learning Foundation (TGLF). https://doi.org/10.5281/zenodo.14167168

    Image: Cover the report “Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme”.

  • The funding crisis solution hiding in plain sight

    The funding crisis solution hiding in plain sight

    “I did not realize how much I could do with what we already have.”

    A Nigerian health worker’s revelation captures what may be the most significant breakthrough in global health implementation during the current funding crisis. While organizations worldwide slash programs and lay off staff, a small Swiss non-profit, The Geneva Learning Foundation (TGLF), is demonstrating how to achieve seven times greater likelihood of improved health outcomes while cutting costs by 90 percent.

    The secret lies not in new technology or additional resources, but in something deceptively simple: health workers learning from and supporting each other.

    Nigeria: Two weeks to connect thousands, four weeks to change, and six weeks to outcomes

    On June 26, 2025, representatives from 153 global health and humanitarian organizations gathered for a closed-door briefing seeking proven solutions to implementation challenges they knew all too well. TGLF presented evidence from the Nigeria Immunization Agenda 2030 Collaborative that sounds almost too good be true to senior leaders who have to make difficult decisions given the funding cuts: documented results at unprecedented speed and scale – and at lower cost.

    Working with Gavi, Nigeria’s Primary Health Care Development Agency, and UNICEF, they facilitated connections among 4,300 health workers and more than 600 local organizations across all Nigerian states, in just two weeks. Not fleeting digital clicks, but what Executive Director Reda Sadki calls “deep, meaningful engagement, sharing of experience, problem solving together.”

    The challenge was reaching zero-dose children in fragile areas affected by armed conflict. The timeline was impossible by traditional standards. The results transformed many skeptics into advocates – including those who initially said it sounded too good to be true.

    A civil society organization (CSO) volunteer reported that government staff initially dismissed the initiative: “They heard about this, thought it was just another CSO initiative. Two weeks in, they came back asking how to join.”

    Funding crisis: How does sharing experience lead to better outcomes?

    What happened next addresses the most critical question about peer learning approaches: do health workers learning from each other actually improve health outcomes?

    TGLF’s comparative research demonstrated that groups using structured peer learning are seven times more likely to achieve measurable health improvements versus conventional approaches.

    In Nigeria, health workers learned the “five whys” root cause analysis from each other. Many said no one had ever asked them: “What do you think we should do?” or “Why do you think that is?” The transformation was both rapid and measurable.

    For example, at the program start, only 25 percent knew their basic health indicators for local areas. “I collect these numbers and pass them on, but I never realized I could use them in my work,” participants reported.

    Four weeks in, they had produced 409 root cause analyses. Many realized that their existing activities were missing these root causes. After six weeks, health workers began credibly reporting attribution of new activities that led to finding and vaccinating zero-dose children.

    Given limited budget, TGLF had to halt development. But here is the key point: more than half of participating have maintained and continued the peer support network independently, addressing sustainability concerns that plague traditional capacity-building efforts.

    The snowball effect at scale

    The breakthrough emerged from what Sadki describes as reaching “critical mass” where motivated participants pull others along. “This requires clearing the rubble of all the legacy of top-down command and control systems, figure out how to negotiate hierarchies, especially because government integration is systematically our goal.”

    Nigeria represents one of four large-scale implementations demonstrating consistent results. In Côte d’Ivoire, 501 health workers from 96 districts mapped out 3.5 million additional vaccinations in four weeks. Global initiatives are likely to cost no more than a single country-specific program: the global Teach to Reach network has engaged 24,610 participants across more than 60 countries. The global Movement for Immunization Agenda 2030, launched in March 2022, grew from 6,186 to more than 15,000 members in less than four months.

    The foundation tracks what they call a “complete measurement chain” from individual motivation through implementation actions to health outcomes. Cost efficiency stems from scale and sustainability, with back-of-envelope calculations suggesting 90 percent cost reduction compared to traditional methods.

    Solving the abundance paradox

    “You touched upon an important issue that I am struggling with—the abundance of guidance that my own organization produces and also guidance that comes from elsewhere,” noted a senior manager from an international humanitarian network during the briefing. “It really feels intriguing to put all that material into a course and look at what I am going to do with this. It is a precious process and really memorable and makes the policies and materials relevant.”

    This captures a central challenge facing global health organizations: not lack of knowledge, but failure to translate knowledge into action. The peer learning model transforms existing policies and guidelines into peer learning experiences where practitioners study materials to determine specific actions they will take.

    “Learning happens not simply by acquiring knowledge, but by actually doing something with it,” Sadki explained.

    For example, a collaboration with Save the Children converted a climate change policy brief into a peer learning course accessed by more than 70,000 health workers, developed and deployed in three days with initial results expected within six weeks.

    Networks that outlast the funding crisis

    The foundation’s global network now includes more than 70,000 practitioners across 137 countries, with geographic focus on nations with highest climate vulnerability and disease burden. More than 50 percent are government staff. More than 80 percent work at district and community levels.

    Tom Newton-Lewis, a leading health systems researcher and consultant who attended the briefing, captured what makes this approach distinctive: “I am always inspired by the work of TGLF. There are very few initiatives that work at scale that walk the talk on supporting local problem solving, and mobilize systems to strengthen themselves.”

    This composition ensures that peer learning initiatives operate within rather than parallel to official health systems. More than 1,000 national policy planners connect directly with field practitioners, creating feedback loops between strategy development and implementation reality.

    Networks continue functioning when external support changes. The foundation has documented continued peer connections through network analysis, confirming that established relationships maintain over time.

    Three pathways forward

    The foundation outlined entry points for organizations seeking proven implementation approaches. First, organizations can become program partners, providing their staff access to existing global programs while co-developing new initiatives. Available programs include measles, climate change and health, mental health, non-communicable diseases, neglected tropical diseases, immunization, and women’s leadership.

    Second, using the model to connect policy and implementation at scale and lower cost. Timeline: three days to build, four to six weeks for initial results. Organizations gain direct access to field innovations while receiving evidence-based feedback on what actually works in practice.

    Third, testing the model on current problems where policy exists but implementation remains inconsistent. Organizations can connect their staff to practitioners who have solved similar problems without additional funding. Timeline: six to eight weeks from start to documented results.

    The foundation operates through co-funding partnerships rather than grant-making, with flexible arrangements tailored to partner capacity and project scope. What they call “economy of effort” often delivers initiatives spanning more than 50 countries for the cost of single-country projects.

    Adaptability across contexts

    The model has demonstrated remarkable versatility across different contexts and challenges. The foundation has successfully adapted the approach to new geographic areas like Ukraine and thematic areas like mental health and psychosocial support. Each adaptation requires understanding specific contexts, needs, and goals, but the fundamental peer learning principles remain consistent.

    An Indian NGO raised a fundamental challenge: “Where we struggle with program implementation post-funding is without remuneration frontline workers. Although they want to bring change in the community, are motivated, and have enough data, cannot continue.”

    Sadki’s response: “By recognizing the capabilities for analysis, for adaptation, for carrying out more effective implementation because of what they know, because they are there every day, that should contribute to a growing movement for recognition that CHWs in particular should be paid for the work that they do.”

    The path forward

    The Nigerian health worker’s realization—discovering untapped potential in existing resources—represents more than individual transformation. It demonstrates how peer learning unlocks collective intelligence already present within communities and health systems.

    In two weeks, health workers connected with each other across Nigeria’s most challenging regions, facilitated by the foundation’s proven methodology. By the sixth week, they had begun reporting credible, measurable health improvements. The model works because it values local knowledge, creates peer support systems, and integrates with government structures rather than bypassing them.

    With funding cuts forcing difficult choices across global health, this model offers documented evidence that better health outcomes can cost less, sustainable networks continue without external support, and local solutions scale globally. For organizations seeking proven implementation approaches during resource constraints, the question is not whether they can afford to try peer learning, but whether they can afford not to.

    Image: The Geneva Learning Foundation Collection © 2025

  • The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges

    The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges

    Less than three weeks after its launch, the Nigeria Immunization Collaborative – a partnership between the Geneva Learning Foundation, the National Primary Health Care Development Agency (NPHCDA), and UNICEF – has already connected over 4,000 participants from all 36 states and more than 300 Local Government Areas (LGAs).

    The Collaborative is part of the Movement for Immunization Agenda 2030 (IA2030).

    In the Collaborative’s first peer learning exercise that concluded on 6 August 2024, over 600 participants conducted root cause analyses of immunization barriers in their communities.

    Participants engaged in a two-week intensive process of analyzing immunization challenges, conducting root cause analyses, and developing actionable plans to address these issues.

    They did this without having to stop their daily work or travel, a key characteristic of The Geneva Learning Foundation’s model to support work-based learning.

    Watch the General Assembly of the Nigeria Immunization Collaborative on 6 August 2024

    What are health workers saying about the Collaborative?

    For Mariam Mustapha, a participant from Kano State, the Collaborative is “multiple individuals that perform a task”, united around a shared purpose.

    She highlighted the importance of engaging with community members, noting, “These people from the community, most of them, they don’t have enough knowledge or they are receiving misinformation about immunization and vaccines.”

    The peer learning exercise employed a structured approach, asking participants to explain their immunization challenge, conduct a “5 Whys” analysis to identify root causes, and develop actionable plans within their scope of work.

    How does the Collaborative help health workers?

    This method proved enlightening for many participants.

    John Emmanuel, a community health worker from Bauchi State, shared his experience: “I just discovered that over the years, I have been superficial in my approach. I’ve been one sided. I’ve been actually peripheral in my approach. So during the root cause analysis, I was able to identify the broader perspective of identifying the challenge and then fixing it as it affects my job here in the community.”

    The Collaborative also fostered connections between health workers across different regions of Nigeria.

    Mohammed Nasir Umar, a JSI HPV program associate in Zamfara State, noted the value of this cross-pollination of ideas: “The root cause analysis really widened my horizon on how I think around the challenges. The ‘5 Whys’ techniques approach was really, really helpful.”

    Participants identified a range of immunization challenges, including vaccine hesitancy, lack of information and awareness, sociocultural and religious factors, reaching zero-dose children, incomplete immunization, healthcare worker issues, logistical challenges, political interference, poor documentation, and community trust issues.

    But then each one started asking ‘why’, stopping only once they found a root cause that they are in a position to do something about.

    Esther Sharma, working with NPHCDA in a local government area, identified a critical issue in her facility: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here.”

    Her solution involves ensuring consistent staffing during immunization days, which should encourage more community members to seek vaccination services.

    How are new stakeholders participating in the Collaborative?

    The Collaborative also welcomed participation from organizations not traditionally involved in immunization services.

    Angela Emmanuel, a nurse and founder of the Emmanuel Cancer Foundation in Lagos, found value in the exercise for her work on HPV vaccination and cancer prevention.

    She emphasized the need for a more educational approach: “Our motive should be education. Our motive should be the awareness, not just asking them to take this vaccine.”

    Chijioke Kaduru, a public health physician who served as a Guide for the Collaborative, reflected: “While some of these challenges are similar in many settings, the local context and the nuances that shape these challenges clearly make them a good opportunity to engage, to interact, to understand them better, and to start to also see the ideas that colleagues have about how to solve those problems.”

    By connecting frontline health workers, fostering critical thinking, and encouraging the development of locally-tailored solutions, the Nigeria Immunization Collaborative represents a potentially scalable model for strengthening health systems and improving immunization coverage.

    As the exercise concludes, participants are poised to implement their action plans in their respective communities.

    How are government workers participating in the Collaborative?

    A key focus of the final session was the presentation of root cause analyses by government workers from the Federal and State Primary Health Care Development Agencies.

    These presentations provided valuable insights into the challenges faced at various levels of the health system and the innovative solutions being developed.

    Maimuna Tata, a deputy in-charge at a health facility in Bunkura local government area of Kano State, presented her analysis of why routine immunization sessions were not being conducted at her facility.

    Through her “5 Whys” analysis, she uncovered a systemic issue: “The health facility is newly built and was commissioned after the 2024 micro plan exercise and needs to undergo several processes for provision of routine immunization.”

    Tata’s proposed solution demonstrated the kind of innovative thinking the Collaborative aimed to foster: “Instead of them coming for outreach session in the settlement, I think the vaccine should be channeled to the health facility so that the health facility can conduct the sessions. And at the end of the day, we will now be submitting our reports to the health facility, that is the model health facility, pending the time the health facility will be recorded or will be updated in the server.”

    Esther Sharma, working with NPHCDA in a local government area, identified a critical staffing issue: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here. I am the routine immuunization focal person where I currently work and when I went there newly, I asked a lot of people, why don’t they come to the hospital for immunization? And they said when they come, they don’t find anybody to attend to them.”

    Her solution involves ensuring consistent staffing during immunization days, which she reported has already encouraged more community members to seek vaccination services.

    Image: The Geneva Learning Foundation Collection © 2024