Stories

Tag: immunization

  • En République démocratique du Congo, la traque des enfants « zéro dose » passe par l’intelligence collective des acteurs de la santé

    En République démocratique du Congo, la traque des enfants « zéro dose » passe par l’intelligence collective des acteurs de la santé

    KINSHASA et LUMUMBASHI, le 7 octobre 2025 (La Fondation Apprendre Genève) – « Ces jeunes filles qui ont des grossesses indésirables, quand elles mettent au monde, elles ont tendance à laisser les enfants livrés à eux-mêmes », explique Marguerite Bosita, coordonnatrice d’une organisation non gouvernementale à Kinshasa.

    « Ce manque d’informations sur les questions liées à la vaccination se pose encore plus, car ces enfants grandissent exposés à des difficultés de santé ».

    Sa voix, émanant d’une mission de terrain dans la province du Kongo Central, s’est jointe à des centaines d’autres ce 7 octobre 2025.

    Il s’agissait de la deuxième journée d’un exercice d’apprentissage par les pairs de 16 jours visant à identifier et à atteindre les enfants dits « zéro dose » en République démocratique du Congo (RDC).

    Ce sont ces centaines de milliers de nourrissons qui n’ont reçu aucun vaccin pour les protéger de nombreuses maladies.

    Pour les 1 617 professionnels de la santé inscrits à cet exercice, il ne s’agissait pas d’un webinaire de formation classique, mais d’une étape importante d’un mouvement bien plus large.

    Organisé par La Fondation Apprendre Genève, cet exercice est une pierre angulaire du Mouvement congolais pour la vaccination à l’horizon 2030 (IA2030).

    Il bénéficie du soutien du ministère de la Santé de la RDC à travers son Programme élargi de vaccination (PEV), de l’UNICEF et de Gavi, l’Alliance du Vaccin.

    L’initiative renverse le modèle traditionnel de l’aide internationale.

    Au lieu de s’appuyer sur des experts extérieurs, elle part d’un postulat aussi simple qu’il est conséquent.

    La meilleure expertise pour résoudre les défis de première ligne se trouve chez les travailleurs de la santé eux-mêmes.

    La composition de cette cohorte témoigne de la profondeur de l’initiative.

    Plus de la moitié des participants proviennent des niveaux périphériques et infranationaux du système de santé, là où la vaccination a lieu.

    Un professionnel sur cinq travaille au niveau central, assurant un lien essentiel entre les politiques nationales et les réalités du terrain.

    Le profil des participants est tout aussi varié.

    Un tiers sont des médecins, 30 % des agents de santé publique, suivis par les agents de santé communautaire (13 %) et les infirmiers (9 %).

    Fait marquant, près de la moitié d’entre eux travaillent directement pour le ministère de la Santé à travers le Programme élargi de vaccination (le «PEV»).

    Cette forte proportion de personnel gouvernemental, complétée par une représentation significative de la société civile et du secteur privé, ancre fermement l’initiative dans une appropriation nationale.

    Le regard du terrain

    « Les défis sont tellement grandioses », a déclaré Franck Kabongo, consultant en santé publique à Lubumbashi, dans la province du Haut-Katanga.

    En effet, les défis décrits par les participants sont immenses.

    Il a souligné deux obstacles majeurs.

    D’une part, la difficulté d’atteindre les enfants dans les communautés reculées.

    Car les problèmes logistiques représentent un « casse-tête» pour de nombreux acteurs de santé impliqué dans la vaccination.

    Pour Mme Bosita à Kinshasa, le problème est profondément social.

    Son organisation soutient les enfants vulnérables, y compris les orphelins et ceux qui vivent dans la rue, dont beaucoup sont nés de jeunes mères sans suivi médical.

    « Il n’y a pas assez de sensibilisation sur le terrain par rapport à cette notion », a-t-elle déploré, expliquant sa volonté d’intégrer la vaccination dans le travail de son association.

    Ces témoignages, partagés dès les premières minutes, ont brossé un tableau saisissant d’un corps de métier dévoué.

    Ils luttent contre un enchevêtrement complexe de barrières logistiques, sociales et informationnelles qui laissent les enfants les plus vulnérables sans protection.

    À la recherche des causes profondes

    Le cœur de l’exercice n’est pas seulement de partager les problèmes, mais de les disséquer.

    Grâce à une analyse de groupe structurée, les participants s’exercent à la technique des « cinq pourquoi ».

    Cette méthode vise à dépasser les symptômes pour trouver la véritable cause fondamentale d’un problème.

    Lors d’une session plénière, Charles Bawande, animateur communautaire dans la zone de santé de Kalamu à Kinshasa, a présenté un dilemme courant.

    Une forte concentration d’enfants zéro dose parmi les communautés de rue, très mobiles et souvent peu scolarisées.

    Au départ, le problème semblait être un simple manque d’information.

    Mais au fur et à mesure que le groupe a creusé, une réalité plus complexe est apparue.

    Pourquoi les enfants sont-ils manqués?

    Parce que les travailleurs de santé communautaires, les relais communautaires, ne disposent pas des informations nécessaires.

    Pourquoi n’ont-ils pas ces informations?

    Parce qu’ils n’assistent souvent pas aux séances d’information essentielles.

    Pourquoi n’y assistent-ils pas?

    Parce qu’ils sont occupés par d’autres activités.

    « Ils doivent vivre, ils doivent manger… ils sont locataires, ils doivent payer le loyer », a expliqué M. Bawande.

    La dernière question a révélé le cœur du problème.

    Pourquoi sont-ils occupés par d’autres choses?

    Parce que leur travail de relais communautaire est entièrement bénévole.

    Alors qu’on attend d’eux qu’ils agissent comme des volontaires, beaucoup sont des parents et des chefs de famille qui doivent donner la priorité à leur gagne-pain.

    Un problème qui semblait être un simple déficit d’information s’est révélé être ancré dans la précarité économique du système de santé bénévole.

    Une mosaïque de défis partagés

    Lorsque les participants se sont répartis en près de 80 petits groupes, leurs discussions ont révélé un large éventail d’obstacles, chacun profondément lié au contexte local.

    Les rapports des groupes ont dressé une carte riche et détaillée des freins à la vaccination à travers le vaste pays.

    Près de Goma, dans le Nord-Kivu, le groupe de Clémence Mitongo a identifié l’insécurité due à la guerre comme une barrière principale qui a déplacé les populations et perturbé les services de santé.

    Dans la province du Kasaï, le groupe de Yondo Kabonga a mis en lumière l’impact des rumeurs, de la désinformation et des barrières géographiques comme les ravins et les rivières.

    Ailleurs, d’autres groupes ont fait état de la résistance issue de convictions religieuses, certaines églises enseignant à leurs fidèles que la foi seule suffit à protéger leurs enfants.

    Un autre groupe a discuté du cas des réfugiés revenus d’Angola, où l’ignorance des parents concernant le calendrier vaccinal constitue un obstacle majeur.

    Ce diagnostic collectif a démontré la puissance du modèle d’apprentissage par les pairs.

    Aucun expert ne pourrait à lui seul posséder une compréhension aussi fine et étendue des défis à l’échelle nationale.

    Une nouvelle façon d’apprendre

    Cet exercice est fondamentalement différent des programmes de formation traditionnels.

    Il s’agit d’un parcours pratique où les participants deviennent des créateurs de connaissances et leaders des actions qui en découlent.

    Au cours du programme, chaque participant développera son propre projet de terrain, qu’il partagera avec son équipe, son centre de santé ou son district.

    Il s’agit d’un plan concret pour s’attaquer à un défi « zéro dose » dans sa propre communauté.

    Après avoir soumis une version préliminaire d’ici le vendredi 10 octobre, ils entreront dans une phase d’évaluation par les pairs.

    Chaque participant recevra les retours de trois collègues et, en retour, en fournira à trois autres, contribuant ainsi à renforcer le travail de chacun par l’intelligence collective.

    Tracer une voie à suivre

    L’étape suivante pour ces milliers de professionnels de la santé est de consolider leurs discussions de groupe et de poursuivre le travail sur leurs projets individuels avant l’échéance de vendredi.

    Le parcours se poursuivra avec des phases consacrées à l’évaluation par les pairs, à la révision des projets et, enfin, à une assemblée générale de clôture pour partager les plans améliorés.

    Cet exercice intensif est plus qu’un simple événement.

    Il est un catalyseur pour le Mouvement congolais pour la vaccination à l’horizon 2030.

    L’objectif est de traduire la stratégie mondiale du Programme pour la vaccination à l’horizon 2030 en actions tangibles, menées localement, qui produisent un impact réel.

    La solution, comme le suggère ce mouvement, ne se trouve pas dans des lignes directrices venues de Genève, mais dans la sagesse, la créativité et l’engagement combinés de milliers de praticiens congolais, travaillant ensemble à travers tout le pays.

    Illustration: The Geneva Learning Foundation Collection © 2025

  • A global health framework for Artificial Intelligence as co-worker to support networked learning and local action

    A global health framework for Artificial Intelligence as co-worker to support networked learning and local action

    The theme of International Education Day 2025, “AI and education: Preserving human agency in a world of automation,” invites critical examination of how artificial intelligence might enhance rather than replace human capabilities in learning and leadership. Global health education offers a compelling context for exploring this question, as mounting challenges from climate change to persistent inequities demand new approaches to building collective capability.

    The promise of connected communities

    Recent experiences like the Teach to Reach initiative demonstrate the potential of structured peer learning networks. The platform has connected over 60,000 health workers, primarily government workers from districts and facilities across 82 countries, including those serving in conflict zones, remote rural areas, and urban settlements. For example, their exchanges about climate change impacts on community health point the way toward more distributed forms of knowledge creation in global health. 

    Analysis of these networks suggests possibilities for integrating artificial intelligence not merely as tools but as active partners in learning and action. However, realizing this potential requires careful attention to how AI capabilities might enhance rather than disrupt the human connections that drive current success.

    Artificial Intelligence (AI) partnership could provide crucial support for tackling mounting challenges. More importantly, they could help pioneer new approaches to learning and action that genuinely serve community needs while advancing our understanding of how human and machine intelligence might work together in service of global health.

    Understanding Artificial Intelligence (AI) as partner, not tool

    The distinction between AI tools and AI partners merits careful examination. Early AI applications in global health primarily automate existing processes – analyzing data, delivering content, or providing recommendations. While valuable, this tool-based approach maintains clear separation between human and machine capabilities.

    AI partnership suggests a different relationship, where artificial intelligence participates actively in learning networks alongside human practitioners. This could mean AI systems that:

    • Engage in dialogue with health workers about local observations
    • Help validate emerging insights through pattern analysis
    • Support adaptation of solutions across contexts
    • Facilitate connections between practitioners facing similar challenges

    The key difference lies in moving from algorithmic recommendations to collaborative intelligence that combines human wisdom with machine capabilities.

    A framework for AI partnership in global health

    Analysis of current peer learning networks suggests several dimensions where AI partnership could enhance collective capabilities:

    • Knowledge creation: Current peer learning networks enable health workers to share observations and experiences across borders. AI partners could enrich this process by engaging in dialogue about patterns and connections, while preserving the central role of human judgment in validating insights.
    • Learning process: Teach to Reach demonstrates how structured peer learning accelerates knowledge sharing and adaptation. AI could participate in these networks by contributing additional perspectives, supporting rapid synthesis of experiences, and helping identify promising practices.
    • Local leadership: Health workers develop and implement solutions based on deep understanding of community needs. AI partnership could enhance decision-making by exploring options, modeling potential outcomes, and validating approaches while maintaining human agency.
    • Network formation: Digital platforms currently enable lateral connections between health workers across regions. AI could actively facilitate network development by identifying valuable connections and supporting knowledge flow across boundaries.
    • Implementation support: Peer review and structured feedback drive current learning-to-action cycles. AI partners could engage in ongoing dialogue about implementation challenges while preserving the essential role of human judgment in local contexts.
    • Evidence generation: Networks document experiences and outcomes through structured processes. AI collaboration could help develop and test hypotheses about effective practices while maintaining focus on locally-relevant evidence.

    Applications across three global health challenges

    This framework suggests new possibilities for addressing persistent challenges.

    1. Immunization systems

    Current global immunization goals face significant obstacles in reaching zero-dose children and strengthening routine services. AI partnership could enhance efforts by:

    • Supporting microplanning by mediating dialogue about local barriers
    • Facilitating rapid learning about successful engagement strategies
    • Enabling coordinated action across health system levels
    • Modeling potential impacts of different intervention approaches

    2. Neglected Tropical Diseases (NTDs)

    The fight against NTDs suffers from critical information gaps and weak coordination at local levels. Many communities, including health workers, lack basic knowledge about these diseases. AI partnership could help address these gaps through:

    • Facilitating knowledge flow between affected communities
    • Supporting coordination of control efforts
    • Enabling rapid validation of successful approaches
    • Strengthening surveillance and response networks

    3. Climate change and health

    Health workers’ observations of climate impacts on community health provide crucial early warning of emerging threats. AI partnership could enhance response capability by:

    • Engaging in dialogue about changing disease patterns
    • Supporting rapid sharing of adaptation strategies
    • Facilitating coordinated action across regions
    • Modeling potential impacts of interventions

    Pandemic preparedness beyond early warning

    The experience of digital health networks during recent disease outbreaks reveals both the power of distributed response capabilities and the potential for enhancement through AI partnership. When COVID-19 emerged, networks of health workers demonstrated remarkable ability to rapidly share insights and adapt practices. For example, the Geneva Learning Foundation’s COVID-19 Peer Hub connected over 6,000 frontline health professionals who collectively generated and implemented recovery strategies at rates seven times faster than isolated efforts.

    This networked response capability suggests new possibilities for pandemic preparedness that combines human and machine intelligence. Heightened preparedness could emerge from the interaction between health workers, communities, and AI partners engaged in continuous learning and adaptation.

    Current pandemic preparedness emphasizes early detection through formal surveillance. However, health workers in local communities often observe concerning patterns before these register in official systems.

    AI partnership could enhance this distributed sensing capability while maintaining its grounding in local realities. Rather than simply analyzing reports, AI systems could engage in ongoing dialogue with health workers about their observations, helping to:

    • Explore possible patterns and connections
    • Test hypotheses about emerging threats
    • Model potential trajectories
    • Identify similar experiences across regions

    The key lies in combining human judgment about local significance with AI capabilities for pattern recognition across larger scales.

    The focus remains on accelerating locally-led learning rather than imposing standardized solutions.

    Perhaps most importantly, AI partnership could enhance the collective intelligence that emerges when practitioners work together to implement solutions. Current networks enable health workers to share implementation experiences and adapt strategies to local contexts. Adding AI capabilities could support this through:

    • Ongoing dialogue about implementation challenges
    • Analysis of patterns in successful adaptation
    • Support for rapid testing of modifications
    • Facilitation of cross-context learning

    Success requires maintaining human agency in implementation while leveraging machine capabilities to strengthen collective problem-solving.

    This networked vision of pandemic preparedness, enhanced through AI partnership, represents a fundamental shift from current approaches. Rather than attempting to predict and control outbreaks through centralized systems, it suggests building distributed capabilities for continuous learning and adaptation. The experience of existing health worker networks provides a foundation for this transformation, while artificial intelligence offers new possibilities for strengthening collective response capabilities.

    Investment for innovation

    Realizing this vision requires strategic investment in:

    • Network development: Supporting growth of peer learning platforms that accelerate local action while maintaining focus on human connection.
    • AI partnership innovation: Developing systems designed to participate in learning networks while preserving human agency.
    • Implementation research: Studying how AI partnership affects collective capabilities and health outcomes.
    • Capacity strengthening: Building health worker capabilities to effectively collaborate with AI while maintaining critical judgment.

    Looking forward

    The transformation of global health learning requires moving beyond both conventional practices of technical assistance and simple automation. Experience with peer learning networks demonstrates what becomes possible when health workers connect to share knowledge and drive change.

    Adding artificial intelligence as partners in these networks – rather than replacements for human connection – could enhance collective capabilities to protect community health. However, success requires careful attention to maintaining human agency while leveraging technology to strengthen rather than supplant local leadership.

    7 key principles for AI partnership

    1. Maintain human agency in decision-making
    2. Support rather than replace local leadership
    3. Enhance collective intelligence
    4. Enable rapid learning and adaptation
    5. Preserve context sensitivity
    6. Facilitate knowledge flow across boundaries
    7. Build sustainable learning systems

    Listen to an AI-generated podcast about this article

    🤖 This podcast was generated by AI, discussing Reda Sadki’s 24 January 2025 article “A global health framework for Artificial Intelligence as co-worker to support networked learning and local action”. While the conversation is AI-generated, the framework and examples discussed are based on the published article.

    Framework: AI partnership for learning and local action in global health

    DimensionCurrent StateAI as ToolsAI as PartnersPotential Impact
    Knowledge creationHealth workers share observations and experiences through peer networksAI analyzes patterns in shared dataAI engages in dialogue with health workers, asking questions, suggesting connections, validating insightsNew forms of collective intelligence combining human and machine capabilities
    Learning processStructured peer learning through digital platforms and networksAI delivers content and analyzes performanceAI participates in peer learning networks, contributes insights, supports adaptationAccelerated learning through human-AI collaboration
    Local leadershipHealth workers develop and implement solutions for community challengesAI provides recommendations based on data analysisAI works alongside local leaders to explore options, model scenarios, validate approachesEnhanced decision-making combining local wisdom with AI capabilities
    Network formationLateral connections between health workers across regionsAI matches similar profiles or challengesAI actively facilitates network development, identifies valuable connectionsMore effective knowledge networks leveraging both human and machine intelligence
    Implementation supportPeer review and structured feedback on action plansAI checks plans against best practicesAI engages in iterative dialogue about implementation challenges and solutionsImproved implementation through combined human-AI problem-solving
    Evidence generationDocumentation of experiences and outcomes through structured processesAI analyzes implementation dataAI collaborates with health workers to develop and test hypotheses about what worksNew approaches to generating practice-based evidence

    Image: The Geneva Learning Foundation Collection © 2024

  • Peer learning in immunization programmes

    Peer learning in immunization programmes

    The path to strengthening immunization systems requires innovative technical assistance approaches to learning and capacity building. A recent correspondence in The Lancet proposes peer learning in immunization programmes as a crucial mechanism for achieving the goals of the Immunization Agenda 2030 (IA2030), arguing for “an intentional, well coordinated, fit-for-purpose, data-driven, and government-led immunisation peer-learning plan of action.” This proposal merits careful examination, particularly as immunization programmes face complex challenges in reaching 2030 goals.

    Learn more: 50 years of the Expanded Programme on Immunization (EPI)

    Beyond traditional knowledge exchange

    The Lancet commentary identifies several key rationales for peer learning in immunization.

    • First, “immunisation policy makers operate in dynamic sociopolitical and economic contexts that often compel quick decision making.” In such environments, peer knowledge becomes crucial “when research evidence is scarce.”
    • Second, the authors recognize that “contextual factors in immunisation systems are constantly interacting to exhibit emergent behaviour and self-organisation,” necessitating constant adaptation of technical approaches.

    These insights point toward an important truth: traditional approaches to knowledge sharing – whether through technical guidelines, formal training, or policy exchange – remain necessary but increasingly insufficient for today’s challenges.

    The question becomes not just how to share what we know, but how to systematically generate new knowledge about what works in different contexts.

    Complementary approaches to peer learning in immunization programmes

    While government counterparts learning from each other offers valuable benefits for policy coordination and strategic alignment, implementation challenges are situated – and solved – at the local levels. This call for complementary peer learning approaches. Three stand out as particularly critical:

    • First, the persistent gap between national planning and local implementation suggests the need for systematic learning about how policies and strategies are turned into effective, community-led and -owned action on the ground.
    • Second, as programmes work to sustain coverage gains beyond campaign-based interventions, they need reliable mechanisms for identifying and spreading effective practices for routine immunization.
    • Third, the continuous influx of new staff into EPI teams creates an ongoing need for rapid capacity building that goes beyond technical training to include development of professional networks and practical implementation skills.

    From reporting challenges to creating implementation knowledge

    A crucial distinction emerges between simply documenting implementation challenges and systematically creating new knowledge about effective implementation. This difference parallels the distinction in epidemiology between case reporting and analytical epidemiology.

    When health workers report challenges, they might note that coverage is low in remote areas due to transport limitations, staff shortages, and cold chain issues. This provides valuable surveillance data but does not necessarily generate actionable knowledge. In contrast, systematic analysis of successful remote area coverage can reveal specific transport solutions that work, staff deployment patterns that succeed, and cold chain adaptations that enable reach.

    This shift from reporting to knowledge creation requires careful structure and support. Just as analytical epidemiology employs specific methods to move from observation to insight, systematic peer learning needs frameworks and processes that enable pattern recognition, cross-context learning, and theory building about what works.

    Enabling systematic learning at scale

    Recent experience demonstrates the feasibility of systematic peer learning at scale. For example, Gavi-supported country-led initiatives facilitated by The Geneva Learning Foundation (TGLF) in Côte d’Ivoire and Nigeria, health workers from districts and facilities shared specific strategies through structured processes, they collectively generate new knowledge about effective implementation. Launched in 2022 with support from Wellcome, the Movement for Immunization Agenda 2030 (IA2030) has demonstrated that such ground-level learning, when properly captured and analyzed, provides crucial insights for national planning.

    Consider the introduction of new vaccines. When thousands of practitioners share specific experiences about what enables successful introduction, patterns emerge that might be missed in smaller exchanges or formal evaluations. These patterns help reveal not just what works, but how solutions adapt and evolve across contexts.

    Learn more: Movement for Immunization Agenda 2030 (IA2030): National EPI leaders from 31 countries share experience of HPV vaccination

    Supporting new EPI staff through networked learning

    The challenge of rapidly building capacity when new staff join EPI teams highlights the potential value of structured peer learning. Training approaches like Mid-Level Management (MLM) Training provide essential technical foundations, and have been able to reach more professionals by moving online. However, new staff also need to rapidly build professional networks and learn from peers facing similar challenges.

    A cohort-based approach combining technical training with structured peer learning can accelerate both capability development and network formation. This helps new staff analyze local challenges, identify priorities, and access peer support for implementation. Cross-country learning opportunities are particularly valuable for young professionals, enabling them to build relationships beyond hierarchical constraints.

    From vaccination campaigns to sustainable primary health care systems that integrate routine immunization

    For immunization programmes work to sustain coverage gains beyond campaign-based interventions, peer learning networks are needed to support the transition to stronger routine immunization systems. By connecting practitioners across health system levels, these networks help identify and spread effective practices for reaching families through regular services.

    This network-based approach complements formal exchange mechanisms by creating multiple pathways for knowledge flow:

    • Ground-level innovations inform national strategy through systematic capture and analysis
    • Peer feedback helps practitioners adapt solutions to local contexts
    • Implementation experiences create evidence about what works and why
    • Cross-level dialogue strengthens connections between policy and practice

    Peer learning embedded into government-owned health systems

    This peer learning approach does not replace traditional technical assistance, capacity building, or policy exchange. Rather, it transforms them by creating new connections between levels and actors in health systems. While formal exchanges remain crucial for policy coordination, structured peer learning adds vital capabilities:

    1. Granular understanding of implementation challenges while maintaining systematic rigor in knowledge capture;
    2. Documentation of practical innovations while creating frameworks for adaptation across contexts; and
    3. Evidence-based feedback loops between policy and practice.

    Success requires careful attention to structure. Through carefully designed processes, practitioners engage in cycles of sharing, feedback, connection, and action. This structure is not bureaucratic control but scaffolding that supports genuine knowledge creation and application.

    Looking forward

    The World Health Organization’s Executive Board has highlighted widening inequities between and within countries as a critical challenge for immunization programmes. In the African region particularly, where many countries are introducing new vaccines while working to strengthen basic immunization services, innovative approaches are needed.

    New evidence from recent large-scale peer learning initiatives suggests that structured approaches can help bridge the gap between strategy and implementation while strengthening both. Success requires investment in learning processes and support structures – but the potential rewards, in terms of accelerated progress and improved outcomes, make this investment worthwhile.

    This offers a concrete path toward what WHO calls for: “grounding action in local realities.” By systematically connecting learning across health system levels while maintaining rigorous standards for evidence and implementation support, we can create learning systems that effectively link regional strategy with local innovation and action.

    The future of immunization capacity building lies not in choosing between formal exchanges and practitioner networks, but in thoughtfully combining them to create comprehensive learning systems. These systems can drive rapid improvement while strengthening health systems as a whole – an essential goal as we work toward ambitious immunization targets for 2030 and beyond.

    Reference

    • Adamu AA, Ndwandwe D, Jalo RI, Ndoutabe M, Wiysonge CS. Peer learning in immunisation programmes. The Lancet [Internet]. 2024 Jul; 404(10450):334–5. Available from: https://doi.org/10.1016/S0140-6736(24)01340-0
    • Jones, I., Sadki, R., Brooks, A., Gasse, F., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Movement Year 1 report. Consultative engagement through a digitally enabled peer learning platform (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7119648

    Image: The Geneva Learning Foundation Collection © 2024

  • What is norms-shifting in immunization and global health?

    What is norms-shifting in immunization and global health?

    The concept of “norms shifting perspective”, in the field of immunization and global health focuses on strategies that aim to alter norms and attitudes towards vaccination to promote uptake and acceptance.

    This perspective acknowledges the influence that social norms have on individuals decisions regarding vaccination. Aims to utilize this insight to enhance acceptance through well crafted policies, messaging and interventions. The goal is to make vaccination the expected and socially endorsed choice across communities

    Here are a few aspects of this perspective.

    Recognizing the influence of social norms on vaccination behavior:

    • People’s vaccination decisions are significantly influenced by their perceptions of what others in their community think and do regarding vaccines.
    • Misperceptions about how many others accept vaccines can lead to lower uptake.

    Using accurate information about norms to increase acceptance:

    • Providing factual information about high levels of vaccine acceptance in a community can increase individuals’ intentions to vaccinate.
    • This works by correcting underestimations of vaccine acceptance and leveraging social conformity.

    Shaping norms through public policy:

    • Government policies and messaging around vaccines can shape social norms and expectations.
    • Mandates, passports, and other policies signal what is considered normal or expected behavior.

    Designing targeted interventions:

    • Campaigns that feature relatable community members getting vaccinated can help establish vaccination as a social norm.
    • Messaging that emphasizes the social benefits and widespread acceptance of vaccines can be effective.

    Considering unintended consequences:

    • Heavy-handed approaches like strict mandates may backfire by creating resistance and polarization.
    • Care must be taken to avoid stigmatizing unvaccinated individuals.

    Adapting to local contexts:

    • Effective norm-shifting interventions need to be tailored to specific communities and cultures.
    • What works to shift norms in one setting may not work in another.

    Taking a long-term view:

    • Changing deeply held social norms around health behaviors takes time and sustained effort.
    • The goal is to create lasting shifts in how vaccination is perceived and valued in communities.

    Where to learn more about norms-shifting in immunization?

    Bardosh, K., De Figueiredo, A., Gur-Arie, R., Jamrozik, E., Doidge, J., Lemmens, T., Keshavjee, S., Graham, J.E., Baral, S., 2022. The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good. BMJ Glob Health 7, e008684. https://doi.org/10.1136/bmjgh-2022-008684

    Fayaz-Farkhad, B., Jung, H., Calabrese, C., Albarracin, D., 2023. State policies increase vaccination by shaping social norms. Sci Rep 13, 21227. https://doi.org/10.1038/s41598-023-48604-5

    Moehring, A., Collis, A., Garimella, K., Rahimian, M.A., Aral, S., Eckles, D., 2023. Providing normative information increases intentions to accept a COVID-19 vaccine. Nat Commun 14, 126. https://doi.org/10.1038/s41467-022-35052-4

    Reñosa, M.D.C., Landicho, J., Wachinger, J., Dalglish, S.L., Bärnighausen, K., Bärnighausen, T., McMahon, S.A., 2021. Nudging toward vaccination: a systematic review. BMJ Glob Health 6, e006237. https://doi.org/10.1136/bmjgh-2021-006237

    Vriens, E., Tummolini, L., Andrighetto, G., 2023. Vaccine-hesitant people misperceive the social norm of vaccination. PNAS Nexus 2, pgad132. https://doi.org/10.1093/pnasnexus/pgad132

    Image: The Geneva Learning Foundation Collection © 2024

  • Integrating community-based monitoring (CBM) into a comprehensive learning-to-action model

    Integrating community-based monitoring (CBM) into a comprehensive learning-to-action model

    According to Gavi, “community-based monitoring” or “CBM” is a process where service users collect data on various aspects of health service provision to monitor program implementation, identify gaps, and collaboratively develop solutions with providers.

    • Community-based monitoring (CBM) has emerged as a promising strategy for enhancing immunization program performance and equity.
    • CBM interventions have been implemented across different settings and populations, including remote rural areas, urban poor, fragile/conflict-affected regions, and marginalized groups such as indigenous populations and people living with HIV.

    By engaging service users, CBM aims to foster greater accountability and responsiveness to local needs.

    • However, realizing CBM’s potential in practice has proven challenging.
    • Without a coherent approach, CBM risks becoming just another disconnected tool.

    The Geneva Learning Foundation’s innovative learning-to-action model offers a compelling framework within which CBM could be applied to immunization challenges.

    The model’s comprehensive design creates an enabling environment for effectively integrating diverse monitoring data sources – and this could include community perspectives.

    Health workers as trusted community advisers… and members of the community

    A distinctive feature of TGLF’s model is its emphasis on health workers’ role as trusted advisors to the communities they serve.

    The model recognizes that local health staff are not merely service providers, but often deeply embedded community members with intimate knowledge of local realities.

    For example, in TGLF’s immunization learning initiatives, participating health workers frequently share insights into the social, cultural, and economic factors shaping vaccine hesitancy and uptake in their communities.

    • They discuss the everyday barriers families face, from misinformation to transportation challenges, and strategize context-specific outreach approaches.
    • This grounding in community realities positions health workers as vital bridges for facilitating community engagement in monitoring.

    When local staff are empowered as active agents of learning and change, they can more effectively champion community participation, translating insights into tangible improvements.

    Could CBM fit into a more comprehensive system from local monitoring to action?

    TGLF’s model supports health workers in this bridging role by providing a comprehensive framework for local monitoring and action.

    Through peer learning networks and problem-solving cycles, the model equips health staff to collect, interpret, and act on unconventional monitoring data from their communities.

    For instance, in TGLF’s 2022 “Full Learning Cycle” initiative, 6,185 local health workers from 99 countries examined key immunization indicators to inform their analyses of root causes and then map out corrective actions.

    • Participants began monitoring their own local health indicators, such as vaccination coverage rates.
    • For many, this was the first time they had been prompted to use this data for problem-solving a real-world challenge they face, rather than just reporting up the next level of the health system.

    They discussed many factors critical for tailoring immunization strategies.

    This transition – from being passive data collectors to active data users – has proven transformative.

    It positions health workers not as cogs in a reporting machine, but as empowered analysts and strategists.

    By discussing real metrics with peers, participants make data actionable and contextually meaningful.

    Guided by expert-designed rubrics and facilitated discussions, health workers translated this localized monitoring data into practical improvement plans.

    For an epidemiologist, this represents a significant shift from traditional top-down monitoring paradigms.

    By valuing and actioning local knowledge, TGLF’s model demonstrates how community insights can be systematically integrated into immunization decision-making.

    However, until now, its actors have been health workers, many of them members of the communities they serve, not service users themselves.

    CBM’s focus on monitoring is important – but leaves out key issues around community participation, decision-making autonomy, and strategy.

    How could we integrate CBM into a transformative approach?

    TGLF’s experiences suggest that CBM could be embedded within comprehensive learning-to-action systems focused on locally-led change.

    TGLF’s model is more than a monitoring intervention.

    • It combines structured learning, rapid solution sharing, root cause analysis, action planning, and peer accountability to drive measurable improvements.
    • These mutually reinforcing components create an enabling environment for health workers to translate insights into impact.

    In this framing, community monitoring becomes one critical input within a continuous, collaborative process of problem-solving and adaptation.

    Several features of TGLF’s model illustrate how this integration could work in practice:

    1. Peer accountability structures, where health workers regularly convene to review progress, share challenges, and iterate solutions, create natural entry points for discussing and actioning community feedback.
    2. Rapid dissemination channels, like TGLF’s “Ideas Engine” for spreading promising practices across contexts, enable local innovations in response to community-identified gaps to be efficiently scaled.
    3. Emphasis on root cause analysis and systemic thinking equips health workers to interpret community insights within a broader ecosystem lens, connecting localized issues to upstream determinants.
    4. Cultivation of connected leadership empowers local actors to champion community priorities and navigate complex change processes.

    TGLF’s extensive digital network connects health workers across system levels and contexts, enabling them to learn from each other’s experiences with no upper limit to the number of participants.

    By contrast, CBM seems to assume that a community is limited to a physical area, which fails to recognize that problem-solving complex challenges requires expanding the range of inputs used.

    Within a networked approach that connects both community members and health workers across boundaries of geography, health system level, and roles, CBM could become an integral component of a transformative approach to health system improvement – one that recognizes communities and local health workers as capable architects of context-responsive solutions.

    Fundamentally, the TGLF model invites a shift in mindset about whose expertise counts in monitoring and driving system change.

    CBM could provide the ‘connective tissue’ for health workers to revise how they listen and learn with the communities they serve.

    For immunization programs grappling with persistent inequities, this shift from passive compliance to proactive local problem-solving is critical.

    As the COVID-19 crisis has underscored, rapidly evolving public health challenges demand localized action that harnesses the full range of community expertise.

    TGLF’s model offers a tested framework for actualizing this vision at scale.

    By investing in local health workers’ capacity to learn, adapt, and lead change in partnership with the communities they serve, the model illuminates a promising pathway for integrating CBM into immunization monitoring and beyond.

    For epidemiologists and global health practitioners, TGLF’s approach invites a reframing of how we conceptualize and operationalize community engagement in health system monitoring.

    It challenges us to move beyond tokenistic participation towards genuine co-design and co-ownership of monitoring processes with local actors.

    Realizing this vision will require significant shifts in mindsets, power dynamics, and resource flows.

    But as TGLF’s initiatives demonstrate, when we invest in the leadership of those closest to the challenges we seek to solve, transformative possibilities emerge.

    Further rigorous research comparing the impacts of different CBM integration models could help accelerate this paradigm shift, surfacing critical lessons for the immunization field and global health more broadly.

    TGLF’s model not only offers compelling lessons for reimagining monitoring and improvement in immunization programs, it also provides a pathway for integrating CBM into a system that supports actual change.

    CBM practitioners are likely to struggle with how to incorporate it into existing practices.

    By investing in frontline health workers as change agents, and surrounding them with an empowering learning ecosystem, the model offers a path to then bring in community monitoring.

    Without such leadership from health workers, it is unlikely that communities are able to participate.

    The journey to authentic community engagement in health system monitoring is undoubtedly complex.

    But if we are to deliver on the promise of equitable immunization for all, it is a journey we must undertake.

    TGLF’s model lights one promising path forward – one that positions communities and local health workers as the beating heart of a learning health system.

    While Gavi’s evidence brief affirms the promise of CBM for immunization, TGLF’s experience with its own model suggests the full potential of CBM may be realized by embedding it within more comprehensive, digitally-enabled learning systems that activate health workers as agents of change – and do so with both physical and digital communities implementing new forms of peer and community accountability that complement conventional kinds (supervision, administration, donor, etc.).

  • Why health leaders who are critical thinkers choose rote learning for others

    Why health leaders who are critical thinkers choose rote learning for others

    Many health leaders are highly analytical, adaptive learners who thrive on solving complex problems in dynamic, real-world contexts.

    Their expertise is grounded in years of field experience, where they have honed their ability to rapidly generate insights, test ideas, and innovate solutions in collaboration with diverse stakeholders.

    In January 2021, as countries were beginning to introduce new COVID-19 vaccines, Kate O’Brien, who leads WHO’s immunization efforts, connected global learning to local action:

    “For COVID-19 vaccines […] there are just too many lessons that are being learned, especially according to different vaccine platforms, different communities of prioritization that need to be vaccinated. So [everyone]  has got to be able to scale, has got to be able to deal with complexity, has got to be able to do personal, local innovation to actually overcome the challenges.”

    In an Insights Live session with the Geneva Learning Foundation in 2022, she made a compelling case that “the people who are working in the program at that most local level have to be able to adapt, to be agile, to innovate things that will work in that particular setting, with those leaders in the community, with those families.”

    However, unlike Kate O’Brien, some senior leaders in global health disconnect their own learning practices and their assumptions about how others learn best.

    When it comes to designing learning initiatives for their teams or organizations, these leaders may default to a more simplistic, behaviorist approach.

    They may equate learning with the acquisition and application of specific skills or knowledge, and thus focus on creating structured, content-driven training programs.

    The appeal of behaviorist platforms – with their promise of efficient, scalable delivery and easily measured outcomes – can be seductive in the resource-constrained, results-driven world of global health.

    Furthermore, leaders may hold assumptions that health workers – especially those at the community level – do not require higher-order critical thinking skills, that they simply need a predetermined set of knowledge and procedures.

    This view is fundamentally misguided.

    A robust body of scientific evidence on learning culture and performance demonstrates that the most effective organizations are those that foster continuous learning, critical reflection, and adaptive problem-solving at all levels.

    Health workers at the frontlines face complex, unpredictable challenges that demand situational judgment, creative thinking, and the ability to learn from experience.

    Failing to cultivate these capacities not only underestimates the potential of these health workers, but it also constrains the performance and resilience of health systems as a whole.

    The problem is that this approach fails to cultivate the very qualities that make these leaders effective learners and problem-solvers.

    Behaviorist techniques, with their emphasis on passive information absorption and narrow, pre-defined outcomes, do not foster the critical thinking, creativity, and collaborative capacity needed to tackle complex health challenges.

    They may produce short-term gains in narrow domains, but they cannot develop the adaptive expertise required for long-term impact in ever-shifting contexts.

    To help health leaders recognize this disconnect, it is useful to engage them in reflective dialogue about their own learning processes.

    By unpacking real-world examples of how they have solved thorny problems or generated novel insights, we can highlight the sophisticated cognitive strategies and collaborative dynamics at play.

    We can show how they constantly question assumptions, synthesize diverse perspectives, and iterate solutions – all skills that are essential for navigating complexity, but are poorly served by rigid, content-focused training.

    The goal is not to dismiss the need for foundational knowledge or skills, but rather to emphasize that in the face of evolving challenges, adaptive learning capacity is the real differentiator.

    It is the ability to think critically, to imagine new possibilities, to learn from failure, and to co-create with others that drives meaningful change.

    By tying this insight directly to leaders’ own experiences and values, we can inspire them to champion learning approaches that mirror the richness and dynamism of their personal growth journeys.

    Ultimately, the most impactful health organizations will be those that not only equip people with essential skills, but that also nurture the underlying cognitive and collaborative capacities needed to continually learn, adapt, and innovate.

    By recognizing and leveraging the powerful learning practices they themselves embody, health leaders can shape organizational cultures and strategies that truly empower people to navigate complexity and drive transformative change.

    This shift requires letting go of the illusion of control and predictability that behaviorism offers, and instead embracing the messiness and uncertainty of real learning.

    It means creating space for experimentation, reflection, and dialogue, and trusting in people’s inherent capacity to grow and create.

    It is a challenging transition, but one that health leaders are uniquely positioned to lead – if they can bridge the gap between how they learn and how they seek to enable others’ learning.

    Image: The Geneva Learning Foundation Collection © 2024

  • Why lack of continuous learning is the Achilles heel of immunization 

    Why lack of continuous learning is the Achilles heel of immunization 

    Continuous learning is lacking in immunization learning culture, a measure of the capacity for change..

    This lack may be an underestimated barrier to the “Big Catch-Up” and reaching zero-dose children

    This was a key finding presented at Gavi’s Zero-Dose Learning Hub (ZDLH) webinar “Equity in Action: Local Strategies for Reaching Zero-Dose Children and Communities” on 24 January 2024.

    The finding is based on analysis large-scale learning culture measurements conducted by the Geneva Learning Foundation in 2020 and 2022, with more than 10,000 immunization staff from all levels of the health system, job categories, and contexts, responding from over 90 countries.

    YearnContinuous learningDialogue & InquiryTeam learningEmbedded SystemsEmpowered PeopleSystem ConnectionStrategic Leadership
    202038303.614.68–4.814.685.104.83
    202261853.764.714.864.934.725.234.93
    TGLF global measurements (2020 and 2022) of learning culture in immunization, using the Dimensions of Learning Organization Questionnaire (DLOQ)

    What does this finding about continuous learning actually mean?

    In immunization, the following gaps in continuous learning are likely to be hindering performance.

    1. Relatively few learning opportunities for immunization staff
    2. Limitations on the ability for staff to experiment and take risks 
    3. Low tolerance for failure when trying something new
    4. A focus on completing immunization tasks rather than developing skills and future capacity
    5. Lack of encouragement for on-the-job learning 

    This gap hurts more than ever when adapting strategies to reach “zero-dose” children.

    These are children who have not been reached when immunization staff carry out what they usually do.

    The traditional learning model is one in which knowledge is codified into lengthy guidelines that are then expected to trickle down from the national team to the local levels, with local staff competencies focused on following instructions, not learning, experimenting, or preparing for the future.

    For many immunization staff, this is the reference model that has helped eradicate polio, for example, and to achieve impressive gains that have saved millions of children’s lives.

    It can therefore be difficult to understand why closing persistent equity gaps and getting life-saving vaccines to every child would now require transforming this model.

    Yet, there is growing evidence that peer learning and experience sharing between health workers does help surface creative, context-specific solutions tailored to the barriers faced by under-immunized communities. 

    Such learning can be embedded into work, unlike formal training that requires staff to stop work (reducing performance to zero) in order to learn.

    Yet the predominant culture does little to motivate or empower these workers to recognize or reward such work-based learning.

    Furthermore, without opportunities to develop skills, try new approaches, and learn from both successes and failures, staff may become demotivated and ineffective. 

    This is not an argument to invest in formal training.

    Investment in formal training has failed to measurably translate into improved immunization performance.

    Worse, the per diem economy of extrinsic incentives for formal training has, in some places, led to absurdity: some health workers may earn more by sitting in classrooms than from doing their work.

    With a weak culture of learning, the system likely misses out on practices that make a difference.

    This is the “how” that bridges the gap between best practice and what it takes to apply it in a specific context.

    The same evidence also demonstrates a consistently-strong correlation between strengthened continuous learning and performance.

    Investment in continuous learning is simple, costs surprisingly little given its scalability and effectiveness.

    Calculating the relative effectiveness of expert coaching, peer learning, and cascade training

    How does the scalability of peer learning compare to expert-led coaching ‘fellowships’?

    That means investment in continuous learning is already proven to result in improved performance.

    We call this “learning-based work”.

    References

    Watkins, K.E. and Marsick, V.J., 2023. Chapter 4. Learning informally at work: Reframing learning and development. In Rethinking Workplace Learning and Development. Edward Elgar Publishing. Excerpt: https://stories.learning.foundation/2023/11/04/how-we-reframed-learning-and-development-learning-based-complex-work/

    The Geneva Learning Foundation. From exchange to action: Summary report of Gavi Zero-Dose Learning Hub inter-country exchanges. Geneva: The Geneva Learning Foundation, 2023. https://doi.org/10.5281/zenodo.10132961

    The Geneva Learning Foundation. Motivation, Learning Culture and Immunization Programme Performance: Practitioner Perspectives (IA2030 Case Study 7) (1.0); Geneva: The Geneva Learning Foundation, 2022. https://doi.org/10.5281/zenodo.7004304

    Image: The Geneva Learning Foundation Collection © 2024

  • Movement for Immunization Agenda 2030 (IA2030): grounding action in local realities to reach the unreached

    Movement for Immunization Agenda 2030 (IA2030): grounding action in local realities to reach the unreached

    Three years after the launch of Immunization Agenda 2030 (IA2030), WHO’s 154th Executive Board meeting provided a sobering picture of how the COVID-19 pandemic reversed decades of progress in expanding global immunization coverage and controlling vaccine-preventable diseases.

    1. Over 3 million more zero-dose children in 2022 compared to 2019 and widening inequities between and within countries.
    2. Africa in particular suffered a 25% increase in children missing out on basic vaccines.
    3. Coverage disparities grew between the best- and worst-performing districts in the same countries that previously made gains.

    In response, the World Health Organization is calling for action “grounded in local realities”.

    Growing evidence supports fresh approaches that do exactly that.

    Tom Newton-Lewis is part of the community of researchers and practitioners who have observed that “health systems are complex and adaptive” and, they say, that explains why top-down control rarely succeeds.

    • The claim is that directive performance management—relying on targets, monitoring, incentives and hierarchical control—is largely ineffective at driving outcomes in low- and middle-income country health systems.
    • By contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams for improvement.

    However, top-down control and directive management appear to have been key to how immunization programmes achieved impressive results in previous decades.

    Hence, it may be challenging for the current generation of global immunization leaders to consider that enabling approaches that leverage intrinsic motivation, foster collective responsibility, and empower teams – especially for local staff – are the ones needed now.

    One example of an enabling approach is the Movement for Immunization Agenda 2030 (IA2030).

    What is the Movement for Immunization Agenda 2030 (IA2030)?

    This is a locally-led network, platform, and community of action that emerged in March 2022 in response to the Director-General’s call for a “groundswell of support” for immunization.

    In Year 1 (report), this Movement demonstrated the feasibility of establishing a large-scale peer learning platform for immunization professionals, aligned with global IA2030 goals. Specifically:

    • Over 6,000 practitioners from 99 countries joined initial activities, with 1,021 implementing peer-reviewed local action plans by June 2022.
    • These participants generated over half a million quantitative and qualitative data points shedding light on local realities.
    • Regular peer learning events known as Teach to Reach rallied tens of thousands of national and sub-national immunization staff, defying boundaries of geography, hierarchy, gender, and job roles in collaborative sessions with each other, but also with IA2030 Working Groups.

    By September 2022, over 10,000 professionals had joined the Movement, turning their commitment to achieving IA2030 into context-specific actions, sharing progress and results to encourage and support each other.

    In Year 2, further evidence emerged on participant demand and public health impacts:

    • By June 2023, the network expanded to 16,835 members across over 100 countries.
    • Some participants directly attributed coverage increases to the Movement (see Wasnam Faye’s story and other examples), with many sharing a strong sense of IA2030 ownership.

    Overall, the Movement has already demonstrated a scalable model facilitating peer exchange between thousands of motivated immunization professionals during its first two years.

    • Locally-developed solutions are proving indispensable to practitioners, to make sense of generalized guidance from the global level.
    • Movement research confirmed that “progress more likely comes from the systematic application and adaptation of existing good practice, tailored to local contexts and communities.”
    • Connecting local innovation to global knowledge could be “instrumental for resuscitating progress” towards more equitable immunization, especially when integrated into coordinated action across health system levels.
    • It could be part of a teachable moment in which global partners learn from local action, rather than prescribe it.

    The Movement has already been making sparks. It will take the fuel of global partners to propel it to accelerate progress in new ways that could meet or exceed IA2030 goals.

  • Widening inequities: Immunization Agenda 2030 remains “off-track”

    Widening inequities: Immunization Agenda 2030 remains “off-track”

    The WHO Director General’s report to the 154th session of the Executive Board on progress towards the Immunization Agenda 2030 (IA2030) goals paints a “sobering picture” of uneven global recovery since COVID-19.

    As of 2022, 3 out of 7 main impact indicators remain “off-track”, including numbers of zero-dose children, future deaths averted through vaccination, and outbreak control targets.

    Current evidence indicates substantial acceleration is essential in order to shift indicators out of the “off-track” categories over the next 7 years.

    While some indicators showed recovery from pandemic backsliding, the report makes clear these improvements are generally insufficient to achieve targets set for 2030.

    While some indicators have improved from 2021, overall performance still “lags 2019 levels” (para 5).

    Specifically, global coverage of three childhood DTP vaccine doses rose from 81% in 2021 to 84% in 2022, but remains below the 86% rate achieved in 2019 before the pandemic (para 5).

    The number of zero-dose children fell from 18.1 million in 2021 to 14.3 million in 2022. However, this number is still 11% higher compared to baseline year 2019, when there were 12.9 million zero-dose children (para 10).

    Furthermore, the report stresses that recovery has been “very uneven” (para 6), with minimal gains observed in low-income countries:

    “As a group, there was no increase in DTP3 coverage across 26 low-income countries between 2021 and 2022.” (para 6)

    Regions are also recovering unevenly, especially Africa.

    “In the African Region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019.” (para 6)

    Inequities within countries also continue expanding, with gaps widening “between the best-performing and worst-performing districts” since 2019 (para 6).

    The top priorities (para 34) include:

    1) “Catch-up and strengthening” immunization activities
    2) “Promoting equity” to reach underserved communities
    3) “Regaining control of measles” with intensified responses
    4) Advocacy for “increased investment in immunization, integrated into primary health care”
    5) “Accelerating new vaccine introduction” in alignment with WHO recommendations
    6) “Advancing vaccination in adolescence” such as HPV vaccine introduction

    The report stresses that “coordinated action” on these priorities can get countries back on track towards IA2030 targets in the wake of COVID-19 disruptions (para 27).

    What is needed, says WHO, is “grounding action in local realities” (para 32) to reach underserved areas thus far left behind.

    Given this context, this document asks: “What actions can global partners take to support countries to accelerate progress in the six priority areas highlighted?” (para 37).

    In response, WHO contends that “the operational model under IA2030 must continue shifting focus to the regional level, to facilitate coordinated and tailored support to countries.”

    It is unclear how devolution to the regional level could truly respond to highly localized barriers and enablers.

    Such a claim may best be understood with respect to the internal equilibrium between WHO’s Headquarters (HQ) and the Regional Offices, with IA2030 being initially driven by HQ.

    What other changes might be needed? And what are the barriers that might hinder global immunization partners from recognizing and supporting such changes?

    Reference: Tedros Adhanom Ghebreyesus, 2023. Progress towards global immunization goals and implementation of the Immunization Agenda 2030. Report by the Director-General, Executive Board 154th session Provisional agenda item 9. World Health Organization, Geneva, Switzerland.

    Illustration: The Geneva Learning Foundation Collection © 2024

  • Ten eyewitness reports from the frontline of climate change and health

    Ten eyewitness reports from the frontline of climate change and health

    The Geneva Learning Foundation (TGLF) has created a platform enabling health workers to describe the impacts of climate change on their local communities. Here are ten of the most striking reports.

    Published on 30 November 2023 on the Gavi #VaccinesWork blog. Written by Ian Jones for Gavi.

    In July 2023, more than 1,200 health workers from 68 countries shared their experiences of changes in climate and health at a unique Geneva Learning Foundation event designed to shed light on the realities of climate impacts on the health of the communities they serve.

    A special TGLF report – On the frontline of climate change and health: A health worker eyewitness report – includes a compendium and analysis of these 1,200 health workers’ observations and insights. Here are ten of the most striking.

    Samuel Chukwuemeka Obasi, who works for the Ministry of Health in Abuja, Nigeria, has noticed big changes to the environment.

    “Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow, so that you can easily walk through a river you required a boat to cross in years past.”

    Iruoma Chinedu Ofortube, who works at the district level in Lagos State, Nigeria, recounts two stories that illustrate the lethal impact of extreme weather.

    “A family embarked on a journey without potentially expecting any danger. Sadly, on their way, heavy rainfall started. The family was oblivious to the reality that the rain started ahead of them while they were en route to their destination. Unfortunately, they ran into a massive flood near a river. The force and the current from the flood swept their vehicle down the river, and before help could come for them, they drowned helplessly alongside other victims of the same circumstances.

    “There was also a pregnant woman in labour. Unfortunately, they couldn’t get a strong boat or canoe that could stand the high current and waves coming from the seaside. In the process of searching for a better means of taking her to the nearest health centre, she got exhausted and died.”

    Assoumane Mahamadou Issifou, who works for an NGO in Agadez, Niger, points out how food shortages are leading to malnutrition and anaemia, particularly in women and children.

    “During the five years that I served in the health service in the Agadez region, I observed significant changes, particularly in the occurrence of heavy rains, which were uncommon in the past. These heavy rains have led to flooding and the displacement of populations, often forcing them to settle wherever they can. Due to their vulnerability during these challenging times, children and women suffer greatly.

    “This situation, especially prevalent among newborns and children under five, contributes to malnutrition. The challenges persist because the Agadez region is situated in a desert area with very low rainfall.

    “However, even with minimal rain, the region faces immense difficulties. Nutritional foods are insufficient, and environmental degradation compounds the issue. As a result, the population struggles to access daily sustenance. Pregnant women and children lack foods rich in vitamins, leading to undernourishment and subsequent diseases such as malnutrition and anaemia.

    “Historically, Agadez was known for its scarcity of rain. With the recent climate change-induced increase in rainfall, few people have come to accept and understand this phenomenon. The region’s architecture is outdated, and the city has transformed into a migratory hub where diverse behaviours converge. New diseases emerge, and the indigenous population is grappling with illnesses that were previously unknown to them.”

    A woman working for the Ministry of Health in the DRC, based in Kinshasa, describes how water level changes are affecting insect proliferation and leading to changing patterns of malaria and other diseases.

    “A drought, characterised by a drop in rainfall during recent rainy seasons, has affected the City Province of Kinshasa, particularly in the Makelele District (located in the Bandalungwa commune) where I live.

    “This area is bordered by two rivers, Mâkelele 1 and 2. The scarcity of rain in the region during the past rainy seasons has led to a significant reduction in water flow within these two rivers. Consequently, rubbish and debris have accumulated along the riverbanks.

    “This situation has resulted in the proliferation of mosquitoes and other unidentified insects. This increase in insect activity has not only led to a rise in malaria cases, but has also given rise to a newly emerging form of dermatosis, the exact nature of which is yet to be determined. It is suspected that these skin lesions develop due to scratching after insect bites. Disturbingly, over 10% of the population within the municipality has been affected by this condition.”

    Dieudonne Tanasngar, who works for the Ministry of Health in Chad, explains how displacement contributes to poor sanitation practices, leading to increased spread of water-borne diseases.

    “In Lake Chad, during the rainy season, the various arms of the lake expand, causing flooding that affects the villages situated along its shores. This flooding often forces the inhabitants to relocate to higher ground.

    “However, a significant portion of the population around the lake lacks proper sanitation facilities, leading to open defecation near the water’s edge. As the water levels rise, this practice contributes to the spread of diseases, particularly when access to health care facilities becomes challenging.

    “Access to health care centres is hindered by the need to cross one or two bodies of water before reaching the nearest facility. This geographical challenge adds to the difficulties faced by the affected population. Consequently, a range of diseases can emerge and afflict the community due to these conditions.

    “The combination of poor sanitation practices, flooding, and limited access to health care facilities creates a complex situation that requires concerted efforts to improve living conditions, sanitation infrastructure, and health care access for the people living around Lake Chad.”

    Coulibaly Seydou, who works for the Ministry of Health in Boussé District, Burkina Faso, has noted how changing dietary habits, alongside declining mental wellbeing, is leading to an increased risk of non-communicable diseases such as high blood pressure and diabetes.

    “For several years, the pattern of rainfall has been becoming increasingly irregular. The duration of the rainy season is progressively getting shorter, interspersed with periods of drought. This unpredictability makes it challenging for farmers to adjust their crop choices according to the rainfall pattern, leading to growing concerns. Discussions about the upcoming rainy season can induce anxiety and worry among rural communities.

    “When it comes to the impact of climate change on mental health, we can observe a significant disturbance in the well-being of farmers. Even just a couple of days without rainfall can trigger a sense of sadness among them. Instances of minor depression have been noted among household heads who helplessly witness their crops withering due to inadequate moisture.

    “In terms of physical health, there has been an uptick in the prevalence of diseases and conditions that can be attributed to changes in dietary habits. Conditions such as hypertension, diabetes and obesity are on the rise. This can be linked to the shift towards consuming industrially processed foods that are low in nutritional value and high in chemical additives.”

    A man working for the Ministry of Health in Beni in the DRC describes the tragic case of a family driven into poverty and unable to afford health care for the children.

    “As a result of the disruption in the seasonal shifts, a modest family reliant solely on agriculture experienced the tragic death of their young son within their community.

    “The critical factors involved were as follows: their crop yield plummeted to zero due to their inability to manage the erratic changes in the seasons, and malnutrition, likely compounded by other illnesses, afflicted the family. Faced with financial constraints stemming from the complete failure of their agricultural efforts, they resorted to providing home-based care for their family.

    “Tragically, their youngest son paid the ultimate price with his life. In summary, the ever-changing climate dynamics have left us disoriented and uncertain about the future.”

    Fokzia Elijah, who works for the Ministry of Health in the Province of Batha, Chad, highlights how climate change is having multiple health and social impacts, particularly on pastoralists.

    “Batha is the first pastoral province, often experiencing prolonged droughts followed by irregular and sometimes excessive rainfall. These climatic variations lead to challenges in cattle herding, house collapses, and difficulties in sustaining pastoralism, which typically lasts only two to three months.

    “Pastoralists often migrate southward with women and children following them. Consequently, malnutrition prevails, affecting over 14% of the population, with women and children being the most vulnerable. Women who remain in the villages demonstrate resilience by engaging in limited market gardening and gathering wild oilseeds to produce sweet syrup for porridge.

    “A significant issue is the death of animals between March and June due to inadequate pasture and water. This impacts the most vulnerable, particularly women and children. Batha Province, once renowned for its diverse flora and fauna, has seen the disappearance of most animals except for birds. Hyena attacks have become frequent as they search for food in communities, often targeting domestic pets.”

    Linda Raji, who works for an NGO in the Kaida and Waru communities in Nigeria, highlights the implication of enviornmental change for young women – one of a range of gender-specific impacts of climate change.

    “Prolonged drought dries up the dirty community stream that serves both livestock and residents. This makes it difficult for community members to access water and much harder for menstrual hygiene management for teenage girls leading to an increase in infections in the unbearable heat.

    “Due to the difficulty in managing the monthly menstrual cycle due to limited access to water sanitation hygiene and period poverty, many teenage girls prefer to get pregnant to save them the worry of menstruating monthly for nine months.”

    Dr Chinedu Anthony Iwu, who works at a health facility in Orlu Local Government Area in Nigeria, describes how working with communities can build resilience to climate change impacts.

    “The changing climate has brought about an increase in the prevalence of vector-borne diseases. Mosquitoes are now breeding and transmitting diseases like malaria more intensely. The community lacked proper health care facilities and resources to effectively combat these diseases, leading to a rise in illness and mortality rates. Mothers’ means of livelihood were usually disrupted due to the time and effort spent in caring for their sick children with a significant impact on household welfare.

    “Recognising the urgent need to address these climate-related health challenges, we engaged in community-led initiatives that included comprehensive health awareness campaigns to provide education on sanitation and hygiene practices, and education of residents about preventive measures against vector-borne diseases. By engaging our community health extension workers, we were able to organise regular health check-ups in the communities, focusing on early detection and treatment of illnesses.

    “Over time, these collective efforts began to yield positive results. The mothers in the communities witnessed improvements in income as they progressively began to spend less time pursuing children’s health care challenges due to the adoption of preventive measures, thereby becoming more resilient to the changing climate.

    This experience highlights the challenges faced by rural communities in Nigeria due to climate change. It demonstrates the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate-health nexus and building resilience in the face of a changing climate.”

    Photo credit: Aerial view of a flooded urban residential area of Dera Allah yar city in Jaffarabad District, Baluchistan Province, Pakistan. Credit: Gavi/2022/Asad Zaidi