Tag: Gavi

  • Pour retrouver les enfants congolais non vaccinés, il est question des fumoirs à poisson et du dialogue inter-religieux

    Pour retrouver les enfants congolais non vaccinés, il est question des fumoirs à poisson et du dialogue inter-religieux

    Au deuxième jour de leurs travaux en direct, les professionnels de la santé congolais sont passés de la découverte à l’exploration des causes profondes qui laissent des centaines de milliers d’enfants exposés aux maladies évitables par la vaccination. Ils découvrent que les racines du problème sont souvent là où personne ne les attend: dans l’économie de la pêche, le dialogue avec les églises ou la gestion des camps de déplacés.

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

    Les analyses, plus fines, révèlent des leviers d’action insoupçonnés, démontrant la puissance d’une méthode qui transforme les soignants en stratèges.

    « La séance d’hier, c’était une séance de découverte, mais aujourd’hui, c’était une séance d’exploration. Explorer, c’est aller en profondeur. Il faut sonder ».

    Ces mots de Fidèle Tshibanda Mulangu, un participant congolais, résument la bascule qui s’est opérée ce mercredi 8 octobre.

    Après une première journée consacrée au partage des défis, la dynamique a changé.

    L’objectif n’était plus seulement d’identifier les problèmes, mais de les disséquer avec une précision accrue.

    Dans le cadre de l’initiative menée par La Fondation Apprendre Genève et ses partenaires — le ministère de la Santé de la RDC, l’UNICEF et Gavi — les participants ont été invités à appliquer une deuxième fois la méthode d’analyse des causes profondes.

    L’effet a été immédiat.

    « La séance d’hier m’a permis de comprendre que ce que je pensais être une cause profonde n’était qu’une cause intermédiaire », a ainsi partagé Hermione Raissa Tientcheu Ngounou, illustrant la sophistication croissante des analyses.

    Le dialogue rompu entre la foi et la santé publique

    Au cœur du Kasaï, un groupe de travail a de nouveau abordé la question des églises de réveil hostiles à la vaccination.

    Mais cette fois, l’analyse a dépassé le constat d’un obstacle religieux. « Les fidèles, lorsqu’ils tombent malades, ne vont pas dans les structures sanitaires, mais ils préfèrent rester dans des centres de prière », a expliqué le rapporteur du groupe, décrivant une rupture de confiance avec le système de santé formel.

    En poussant la réflexion, les participants ont conclu que le vrai problème était « l’absence d’un cadre de concertation formel entre le système de santé et les confessions religieuses ».

    La cause profonde n’était donc pas la foi, mais une faillite institutionnelle.

    Une prise de conscience qui a immédiatement fait émerger des solutions.

    « Dans le contexte des églises de réveil, les leaders de ces églises doivent être nos alliés », a insisté un participant, Mwamialumba Fidel.

    Vacciner dans le chaos de la guerre

    Dans le Nord-Kivu, une autre discussion a porté sur la vaccination des populations déplacées.

    Confrontés à une cause première comme la guerre, hors de leur portée, les soignants ont fait preuve d’un pragmatisme remarquable.

    L’analyse ne s’est pas enlisée dans un sentiment d’impuissance.

    Le groupe a rapidement identifié une faille concrète dans le système.

    « Pour les déplacés, le grand problème est que les enfants arrivent sans carnet de vaccination, et on ne sait pas comment les intégrer dans le PEV de routine », a partagé Clémence Mitongo.

    La cause racine n’était donc plus le conflit, mais « le manque de stratégie spécifique pour la prise en charge de ces enfants » une fois en sécurité.

    Le groupe a ainsi transformé un problème insoluble en un défi organisationnel sur lequel il est possible d’agir.

    Au-delà des frontières, une leçon d’économie locale

    La richesse des échanges a été amplifiée par la participation de professionnels d’autres pays.

    Un des cas les plus édifiants est venu de Madagascar, où 93 enfants d’un village de pêcheurs n’étaient pas vaccinés.

    « Les femmes sont obligées d’accompagner les hommes pour la vente du poisson. Et quand elles reviennent, nos équipes sont déjà parties », a expliqué le rapporteur du groupe.

    La cause profonde, révélée par l’analyse, n’avait rien de sanitaire.

    C’était l’absence d’un fumoir pour conserver le poisson, qui forçait les femmes à s’absenter.

    L’impact de cet exemple a été puissant.

    « Ce cas du Madagascar est très édifiant et illustre parfaitement la pertinence de l’analyse approfondie », a commenté Alphonse Kitoga.

    Une pédagogie de l’action

    Ces cas pratiques illustrent la maturation rapide des participants.

    La méthode des « cinq pourquoi », introduite la veille, est devenue un outil maîtrisé, un réflexe analytique.

    « C’est une nouvelle approche pour nous », a affirmé Baudouin Mbase Bonganga. « Le fait de travailler en groupe, de partager les expériences, ça nous a vraiment enrichis ».

    L’exercice ne vise pas à transmettre un savoir, mais à cultiver une compétence: la capacité de chaque professionnel à devenir un fin diagnosticien des problèmes de sa communauté et un architecte de solutions adaptées.

    De l’analyse à l’action

    Cette journée d’exploration intensive n’est qu’une étape.

    Les participants ont jusqu’au vendredi 10 octobre pour soumettre la première version de leur projet de terrain, où ils appliqueront ces analyses à leurs propres communautés.

    L’initiative démontre qu’en s’appropriant les bons outils, les acteurs de terrain peuvent rapidement monter en puissance.

    Comme l’a brillamment résumé Papa Gorgui Samba Ndiaye: « Cette méthode permet de contextualiser réellement les problèmes, et ce qui est bien, c’est qu’on sort des solutions toutes faites… Ça nous amène à innover ».

    Le mouvement est en marche, et il est porté par ceux qui, chaque jour, sont en première ligne.

    Image: Peer learning exercise, as seen from The Geneva Learning Foundation’s livestreaming studio.

  • 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

  • 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”.

  • Recommendations to support knowledge translation of evidence to identify and reach zero-dose children

    Recommendations to support knowledge translation of evidence to identify and reach zero-dose children

    This article is excerpted from the Gavi Zero-Dose Learning Hub publication “Knowledge Translation for Zero-Dose Immunization Research”.

    In its role as the Learning Innovation Unit (LIU) lead, The Geneva Learning Foundation (TGLF) conceptualized a baseline strategy for knowledge translation (KT).

    TGLF developed the following recommendations to support the Country Learning Hubs’ (CLH) KT work. 

    The recommendations are intended to improve the use of evidence generated by research, ensuring it effectively informs practices, policies, and interventions targeting vaccine equity.

    Each recommendation is accompanied by a rationale and example.

    Together, these recommendations aim to build a robust and efficient approach to KT that maximizes the impact of research findings on identifying and reaching ZD and UI children, ultimately contributing to improved immunization equity. This toolkit provides researchers with a list of steps for planning for KT with guiding

    Table 1. KT Recommendations from TGLF

    RecommendationExample
    Perform a rapid capacity audit for KT to inform strategies. Diagnose organizational capacity for KT and builds on available infrastructure and expertise, while tailoring strategies to address limitations.Rapid capacity audit questions include: (1) what percent of resources are committed to KT?, (2) what competencies are needed for KT?, and (3) what networks are needed for KT?
    Integrate KT planning from the research inception. Get buy-in from stakeholders, and capitalize on emerging insights. This will also allow sufficient time for capacity strengthening, prevent lags between results and translation, and create efficiencies.Establish KT goals at the beginning of the project, and consider the KT goals while designing evaluation frameworks and stakeholder engagement plans.
    Engage intended stakeholders/audiences throughout the evidence generation process. Drive relevance, applicability, and shared ownership of emerging findings.Include sub-national practitioners on advisory committees, and engage stakeholders and communities in developing research questions.
    Implement co-creation and participatory processes. Foster a culture that values active listening; encourages engagement with diverse viewpoints; and supports questioning, feedback, and experimentation. This approach underpins the development of a shared vision for collective progress and innovation.Involve a diverse group of stakeholders. Explore rapid feedback mechanisms. Establish platforms or forums for peer-to-peer exchange, where individuals can share their success stories and challenges.
    Tailor methods and communications materials to the audience(s). Contribute to the effectiveness and impact of KT efforts.Identify audience(s) and their preferred mode(s) of communication and needs (i.e., busy policymakers may prefer short, non-technical policy briefs).
    Leverage informal networks and create continuous learning opportunities to translate evidence. Tap into peer learning and try new ideas; facilitate cost-effective diffusion that enables adaptation.Identify influencers. Support sharing through professional networks and learning collaboratives.
    Capture user feedback systematically on value and use. Demonstrate the value and use of the translated knowledge.Distribute short usage surveys when research outputs are accessed (post-webinar/event surveys, follow-up email/surveys after sharing resources).
    Monitor changes in policies and practices beyond dissemination metrics.Facilitate evidence uptake and measurable improvements from application.Establish key indicators on changes adopted across networks based on research findings.
    Share experiences. Encourage learning from real-world examples of how evidence-based practices have been adapted and implemented. This can inform efforts to tailor interventions to unique settings, fostering innovation and problem-solving.Develop and disseminate case studies that highlight the pathway from learning to action, facilitating peer-to-peer learning and accelerating the adoption of effective practices.

    See also: Gavi Zero-Dose Learning Hub’s innovative model for inter-country peer learning and knowledge translation

    Image: The Geneva Learning Foundation Collection © 2024

  • Gavi  Zero-Dose Learning Hub’s innovative model for inter-country peer learning and knowledge translation

    Gavi Zero-Dose Learning Hub’s innovative model for inter-country peer learning and knowledge translation

    This article about inter-country peer learning and knowledge translation is excerpted from the Gavi Zero-Dose Learning Hub publication “Knowledge Translation for Zero-Dose Immunization Research”.

    The Geneva Learning Foundation (TGLF) hosted the first ZDLH Inter-Country Peer Learning Exchange session (ZDLH-X), in May 2023 with a focus on Bangladesh and Mali.

    The second online peer learning exchange, ZDLH-X2, in September 2023 focused on Nigeria and Uganda.

    The ZDLH-X events were the centerpiece of a learning programme that includes three general steps.

    • First, registrants completed a questionnaire, provided by TGLF, on local ZD challenges, practices, and priorities.
    • Second, there was a series of online events to share and curate zero-dose practices.
    • Finally, there were follow-up knowledge translation events online for reflection on learning, and participants completed post-event questionnaires.

    Through this process, TGLF identified stories to be featured in a January 2024 ZDLH webinar event. The stories reveal how practitioners in Bangladesh, Mali, Nigeria, and Uganda are developing local solutions to increase equity in immunization.

    The peer learning events provide a framework for addressing the complex problem-solving required to address the zero-dose challenge.

    The ZDLH-X approach uses multidisciplinary participation, narrative-based mental model building, peer inspiration, reflective sessions, and collaborative activities to address multidimensional challenges like reaching zero-dose children.

    Watch the complete Gavi Zero-Dose Learning Hub Webinar: Equity in Action: Local Strategies for Reaching Zero-Dose Children and Communities. Here is an excerpt, focused on the ZDLH-X inter-country learning model and its relevance for knowledge translation.

    Table 5. ZDLH-X Peer Exchange as a Knowledge Translation Model

    Driver for complex problem-solvingHow ZDLH-X provides a model
    Learning from each otherThe events connected over 3,000 practitioners working on ZD issues globally, enabling inter-country peer exchange of insights from across contexts. This diversity of knowledge and perspectives mirrors the need identified by research to assimilate inputs from different domains when solving complex problems.
    Utilizing mental models (reflective thinking)Through presentations, participants shared local strategies for reaching communities with ZD children. These stories and visuals helped others envision new ways to make a difference, showcasing the power of learning from peers to expand the problem-solving toolkit.
    Enabling metacognition (thinking about thinking)Q&A sessions encouraged participants to think critically about their current methods and attitudes. These reflective conversations are crucial for understanding and improving thought processes, a key element in tackling complex issues.
    Managing affective factors (motivation)Peer testimonials provided motivation through relatable stories of overcoming barriers, such as vaccine hesitancy or gender-related barriers. Psychology research links such motivation and emotional regulation to complex problem-solving success.
    Supporting collaborationThe event facilitated group discussions, allowing for a collective examination of challenges specific to different communities. Research shows that collaborative efforts lead to better outcomes in solving complex problems, thanks to a shared understanding among team members.

    Prior TGLF research on immunization learning culture revealed continuous learning as the weakest dimension, characterized by few opportunities, low risk tolerance, limited incentives, and a focus on tasks over capacity strengthening.

    By incorporating evidence-based strategies to strengthen continuous learning, the ZDLH-X inter-country peer learning events were designed to provide the missing elements through blended peer, social, remote, and networked learning.

    Value Creation Framework

    A value creation framework measured the ZDLH-X events’ impact across five areas: professional change, social connections, practice improvement, influence, and mindset shifts.

    Value creation questions provide a method to assess value of inter-country peer learning through both quantitative and qualitative responses.

    These evidence-based inquiries, made optional to encourage participation, can provide deeper understanding of how resources or events facilitate knowledge application, ensuring more accurate evaluation of the effectiveness of KT activities.

    Respondents rated agreement with statements in each area.

    Results were benchmarked against a 10,000-participant cohort.

    Across all five areas assessed, ZDLH-X participants reported substantially higher value creation versus the benchmark, demonstrating the effectiveness of the peer learning approach.

    Sample value creation questions
    Participation changed me as a professional (change in skills, attitudes, identity, self-confidence, feelings, etc.).
    Participation helped my professional practice (get new ideas, insights, materials, procedures, etc.)
    Participation made me see my world differently (change in perspective, new understandings of the situation, redefine success, etc.)

    Relating Learning to Performance

    Previous large-scale TGLF research (n=6,185) demonstrated significant predictive relationships between strengthening immunization learning culture and enhancing knowledge and mission performance.

    These causal links contextualize ZDLH-X outcomes within a broader performance framework.

    When asked about applying learnings, 99 percent of ZDLH-X respondents expressed intent to use new ZD strategies.

    Post-event knowledge translation feedback included examples of adaptations based on ideas gained, illustrating tangible practice changes.

    This evidence indicates that structured, blended peer learning can reliably extract practical insights on local ZD solutions from frontline staff and spur knowledge translation.

    Quantitatively and qualitatively, the methodology generated value for participants while enabling continuous learning.

    Coupled with prior research demonstrating a strong correlation between learning culture and performance, it is reasonable to hypothesize that such methods may positively influence coverage outcomes.

    Additional research should replicate these findings across contexts and connect observed practice changes to immunization results.

    The ZDLH-X model leverages peer exchange to sustainably strengthen continuous learning and identify how to better reach ZD children through inter-country peer learning.

    Initial findings suggest this approach could complement traditional learning agendas to build immunization system resilience.

    Wider application and validation is warranted based on the events’ promising outcomes.

    Practitioners gained the knowledge of relevant solutions while advancing the learning culture needed to continuously adapt and perform in our complex world.

    ZDLH-X Recommendations to Support Engagement Conducive to Effective Knowledge Translation

    Table 6. ZDLH-X Recommendations to Support Engagement Conducive to Effective Knowledge Translation

    Virtual Peer Exchange Model RecommendationsImplementation Guidance and Questions
    Help ZD practitioners relate their own experiences to what is shared.Ask: “When you listen to your colleague, how different is this from the ZD challenge you face? Tell us about this challenge.”
    Explain the role of global and national-level experts as a guide on the side rather than sage on the stage.Remind them to listen attentively to each person sharing their experience: “Examine this experience in light of your global expertise. Identify questions for follow-up to clarify the story. Share short, specific feedback first, and then generalize to bring in the big picture. Be concise and get to the point. The longer you speak, the less we will learn from ZD practitioners.”
    Emphasize that participant experience is valued and recognized as legitimate.Share that there will be no slide presentations. Instead, participants are invited to share stories and respond to stories shared. National/ global staff are invited to listen, learn, and contribute as a guide on the side.
    Provide explicit guidance to help participants structure their thinking to act as scaffolding for knowledge translation.Tell participants, “Prepare to listen and share your feedback. As you listen to fellow ZD practitioners, reflect on your own experience. What experience do you want to share and why? How do you think this experience will be helpful to colleagues working on ZD? Be concise.”
    Share rules of engagement to ensure all participants are included and feel recognized.Reminder: if a person from one country or region has spoken, the next person should be from a different country or region. When possible, if a man has spoken, the next person should be a woman. Tell participants, “We will be very strict about timing. Remember that you can also share your thoughts by writing in the comments. Respect diversity and differences, and one another as peers.”
    Acknowledge connectivity challenge in a frontline event to encourage participation.Remember that practitioners from remote areas may have connectivity issues, despite interest and motivation. Consider organizing “viewing parties” where staff gather to watch and listen from a location with reliable internet.
    Share supportive messaging to help build engagement that increases motivation to translate knowledge into practice.Tell participants, “We are here to listen and learn from you. Trust your experience. Focus on what you know because you are there every day. Do not forget to introduce yourself: who you are and where you work. Be concise. You will be asked questions by the facilitation team, by guides on the side, and by attendees. It is okay if you do not have all the answers. Listen to the experiences of your peers, as you will be asked questions about them.”
    Emphasize the value proposition of the opportunity to translate knowledge into practice.Tell participants, “Learn from the experiences of other immunization professionals on how they have successfully identified and reached ZD and UI communities; gain understanding about the specific tools and interventions that were effective in other contexts and be able to adapt them to your context. Share your own experience, including success stories, lessons learned and challenges; reflect on your own ZD practices and identify areas for improvement.”
    Share criteria to help  participants share  relevant experience.Advise participants, “Be as precise and concrete as possible. Describe what you did and why, step by step. How do you know it worked? What did you do that is new or different? What facilitated and complicated this intervention? How does what you did connect to broader health system components (e.g., HRH, data/monitoring, planning, financing, supply chain/logistics)? For challenges that are relevant to others: In what specific ways does your intervention impact a ZD problem? What other challenges relate to this one (e.g., gender, conflict, urban/rural, demand, finance)? What about your intervention do you think is common or relevant to others— in your country or in another country?”
    Provide guiding questions to help practitioners share their ZD experience.Ask: “What is the ZD situation where you work? How do you know? What are you doing about it, why, and how? How is it different from what you did before? How has it turned out so far? How do you know what you are doing is successful?”
    Consider the determinants of KT for individuals.When trying to translate knowledge into practice: Give me enough time to work on knowledge translation. Ensure progress is monitored by my supervisor. Make available someone to coach or mentor me. Facilitate access to fellow practitioners for guidance and support. Encourage co-workers to support. Make job aids available for guidance. Periodically remind of need for change in practice.
    Share relevant content with platforms, with an invitation to disseminate and report back on KT.Follow up with each platform to analyze KT effectiveness and lessons learned.

    Learn moreAccess the ZDLH-X recordings, synthesis reports, a list of frequently asked questions,  and conceptual framework.

    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
    202038303.614.684.814.685.104.83
    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

  • 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