Stories

Tag: The Big Catch Up

  • 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.