“I did not realize how much I could do with what we already have.”
A Nigerian health worker’s revelation captures what may be the most significant breakthrough in global health implementation during the current funding crisis. While organizations worldwide slash programs and lay off staff, a small Swiss non-profit, The Geneva Learning Foundation (TGLF), is demonstrating how to achieve seven times greater likelihood of improved health outcomes while cutting costs by 90 percent.
The secret lies not in new technology or additional resources, but in something deceptively simple: health workers learning from and supporting each other.
Nigeria: Two weeks to connect thousands, four weeks to change, and six weeks to outcomes
On June 26, 2025, representatives from 153 global health and humanitarian organizations gathered for a closed-door briefing seeking proven solutions to implementation challenges they knew all too well. TGLF presented evidence from the Nigeria Immunization Agenda 2030 Collaborative that sounds almost too good be true to senior leaders who have to make difficult decisions given the funding cuts: documented results at unprecedented speed and scale – and at lower cost.
Working with Gavi, Nigeria’s Primary Health Care Development Agency, and UNICEF, they facilitated connections among 4,300 health workers and more than 600 local organizations across all Nigerian states, in just two weeks. Not fleeting digital clicks, but what Executive Director Reda Sadki calls “deep, meaningful engagement, sharing of experience, problem solving together.”
The challenge was reaching zero-dose children in fragile areas affected by armed conflict. The timeline was impossible by traditional standards. The results transformed many skeptics into advocates – including those who initially said it sounded too good to be true.
A civil society organization (CSO) volunteer reported that government staff initially dismissed the initiative: “They heard about this, thought it was just another CSO initiative. Two weeks in, they came back asking how to join.”
Funding crisis: How does sharing experience lead to better outcomes?
What happened next addresses the most critical question about peer learning approaches: do health workers learning from each other actually improve health outcomes?
TGLF’s comparative research demonstrated that groups using structured peer learning are seven times more likely to achieve measurable health improvements versus conventional approaches.
In Nigeria, health workers learned the “five whys” root cause analysis from each other. Many said no one had ever asked them: “What do you think we should do?” or “Why do you think that is?” The transformation was both rapid and measurable.
For example, at the program start, only 25 percent knew their basic health indicators for local areas. “I collect these numbers and pass them on, but I never realized I could use them in my work,” participants reported.
Four weeks in, they had produced 409 root cause analyses. Many realized that their existing activities were missing these root causes. After six weeks, health workers began credibly reporting attribution of new activities that led to finding and vaccinating zero-dose children.
Given limited budget, TGLF had to halt development. But here is the key point: more than half of participating have maintained and continued the peer support network independently, addressing sustainability concerns that plague traditional capacity-building efforts.
The snowball effect at scale
The breakthrough emerged from what Sadki describes as reaching “critical mass” where motivated participants pull others along. “This requires clearing the rubble of all the legacy of top-down command and control systems, figure out how to negotiate hierarchies, especially because government integration is systematically our goal.”
Nigeria represents one of four large-scale implementations demonstrating consistent results. In Côte d’Ivoire, 501 health workers from 96 districts mapped out 3.5 million additional vaccinations in four weeks. Global initiatives are likely to cost no more than a single country-specific program: the global Teach to Reach network has engaged 24,610 participants across more than 60 countries. The global Movement for Immunization Agenda 2030, launched in March 2022, grew from 6,186 to more than 15,000 members in less than four months.
The foundation tracks what they call a “complete measurement chain” from individual motivation through implementation actions to health outcomes. Cost efficiency stems from scale and sustainability, with back-of-envelope calculations suggesting 90 percent cost reduction compared to traditional methods.
Solving the abundance paradox
“You touched upon an important issue that I am struggling with—the abundance of guidance that my own organization produces and also guidance that comes from elsewhere,” noted a senior manager from an international humanitarian network during the briefing. “It really feels intriguing to put all that material into a course and look at what I am going to do with this. It is a precious process and really memorable and makes the policies and materials relevant.”
This captures a central challenge facing global health organizations: not lack of knowledge, but failure to translate knowledge into action. The peer learning model transforms existing policies and guidelines into peer learning experiences where practitioners study materials to determine specific actions they will take.
“Learning happens not simply by acquiring knowledge, but by actually doing something with it,” Sadki explained.
For example, a collaboration with Save the Children converted a climate change policy brief into a peer learning course accessed by more than 70,000 health workers, developed and deployed in three days with initial results expected within six weeks.
Networks that outlast the funding crisis
The foundation’s global network now includes more than 70,000 practitioners across 137 countries, with geographic focus on nations with highest climate vulnerability and disease burden. More than 50 percent are government staff. More than 80 percent work at district and community levels.
Tom Newton-Lewis, a leading health systems researcher and consultant who attended the briefing, captured what makes this approach distinctive: “I am always inspired by the work of TGLF. There are very few initiatives that work at scale that walk the talk on supporting local problem solving, and mobilize systems to strengthen themselves.”
This composition ensures that peer learning initiatives operate within rather than parallel to official health systems. More than 1,000 national policy planners connect directly with field practitioners, creating feedback loops between strategy development and implementation reality.
Networks continue functioning when external support changes. The foundation has documented continued peer connections through network analysis, confirming that established relationships maintain over time.
Three pathways forward
The foundation outlined entry points for organizations seeking proven implementation approaches. First, organizations can become program partners, providing their staff access to existing global programs while co-developing new initiatives. Available programs include measles, climate change and health, mental health, non-communicable diseases, neglected tropical diseases, immunization, and women’s leadership.
Second, using the model to connect policy and implementation at scale and lower cost. Timeline: three days to build, four to six weeks for initial results. Organizations gain direct access to field innovations while receiving evidence-based feedback on what actually works in practice.
Third, testing the model on current problems where policy exists but implementation remains inconsistent. Organizations can connect their staff to practitioners who have solved similar problems without additional funding. Timeline: six to eight weeks from start to documented results.
The foundation operates through co-funding partnerships rather than grant-making, with flexible arrangements tailored to partner capacity and project scope. What they call “economy of effort” often delivers initiatives spanning more than 50 countries for the cost of single-country projects.
Adaptability across contexts
The model has demonstrated remarkable versatility across different contexts and challenges. The foundation has successfully adapted the approach to new geographic areas like Ukraine and thematic areas like mental health and psychosocial support. Each adaptation requires understanding specific contexts, needs, and goals, but the fundamental peer learning principles remain consistent.
An Indian NGO raised a fundamental challenge: “Where we struggle with program implementation post-funding is without remuneration frontline workers. Although they want to bring change in the community, are motivated, and have enough data, cannot continue.”
Sadki’s response: “By recognizing the capabilities for analysis, for adaptation, for carrying out more effective implementation because of what they know, because they are there every day, that should contribute to a growing movement for recognition that CHWs in particular should be paid for the work that they do.”
The path forward
The Nigerian health worker’s realization—discovering untapped potential in existing resources—represents more than individual transformation. It demonstrates how peer learning unlocks collective intelligence already present within communities and health systems.
In two weeks, health workers connected with each other across Nigeria’s most challenging regions, facilitated by the foundation’s proven methodology. By the sixth week, they had begun reporting credible, measurable health improvements. The model works because it values local knowledge, creates peer support systems, and integrates with government structures rather than bypassing them.
With funding cuts forcing difficult choices across global health, this model offers documented evidence that better health outcomes can cost less, sustainable networks continue without external support, and local solutions scale globally. For organizations seeking proven implementation approaches during resource constraints, the question is not whether they can afford to try peer learning, but whether they can afford not to.
Image: The Geneva Learning Foundation Collection © 2025
