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Tag: Immunization Agenda 2030

  • Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

    Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

    The article “Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030” is, according to the authors, “the first to showcase the positive inclusion of mainstreaming gender in a WHO capacity-building program.”

    Context:

    • The paper analyzes action plans developed and peer reviewed by participants in one cohort of the 2021 World Health Organization (WHO) Scholar Level 1 certification course on Immunization Agenda 2030 (IA2030), a course developed by The Geneva Learning Foundation (TGLF) with funding from the Bill & Melinda Gates Foundation (BMGF).
    • WHO’s Scholar courses only utilize the knowledge creation component of TGLF’s learning-to-action model, whereas the full model supports implementation that leads to improved health outcomes.
    • TGLF uses an innovative peer learning-to-action model, developed through over a decade of research and practice, focused on knowledge creation through dialogue, critique, and collaboration, with rubric-based peer feedback scaffolding the learning process.
    • The course was facilitated by Charlotte Mbuh and Min Zha, two women learning leaders at The Geneva Learning Foundation (TGLF), who combine deep expertise in learning science and real-world knowledge of immunization in low- and middle-income countries (LMICs).

    Key findings:

    • The analysis included 111 action plans, a subset of the projects and insights shared, from participants across 31 countries working to improve immunization programs.
    • It found that “all action plans in the 111 sample, except three, included gender considerations” showing the course was effective in raising awareness of gender barriers.

    This is consistent with the known effectiveness of peer feedback, as the rubric followed by each learner included specific instructions to “describe how your action plan has considered and integrated gender dimensions in immunization.”

    TGLF’s peer learning model focuses on generating and applying new knowledge. This appears to be conducive to raising awareness of issues like gender barriers to immunization. By giving and receiving feedback, participants build understanding.

    Whereas only around ten percent of learners participated in expert-led presentations offered about gender and immunization, every learner had to think through and write up gender analysis. And every learner had to give feedback on the gender analyses of three colleagues.

    The social nature of giving and received structured peer feedback, supported by expert-designed resources, creates accountability and motivation for integrating gender considerations. Participants educate one another on blindspots, helping embed attention to gender issues.

    Compared to traditional expert-led capacity building, this peer-led approach empowered participants to learn from each other’s experience, situating gender in their real-world practice, rather than as an abstract concept that requires global experts to explain it. This participant-driven process with built-in feedback mechanisms is likely to have helped make the increased gender awareness actionable.

    Gender analysis: what we learned about gender barriers

    • The most cited barrier was “low education and health literacy” affecting immunization uptake. As one plan stated, “lower educational levels of maternal caregivers are more commonly related to under-vaccination”.
    • Other major barriers were difficulties accessing services due to “gender-related factors influencing mobility, location, availability, or quality of health services” and lack of male involvement in decisions, as “men make most of the household decisions while they often do not have sufficient information”.
    • Proposed strategies focused on areas like “incentive schemes” and “on-the-job support” for female health workers, “community engagement” to improve literacy, and better “engagement of men” in immunization activities.

    TGLF’s peer learning approach likely contributed to raising awareness of gender issues and ability to propose context-specific solutions, though some implicit biases may have affected peer evaluations.

    Overall, the analysis shows mainstreaming gender was an effective part of this capacity building program, and the authors appear convinced of its potential to lead to more gender-equitable and effective immunization policies and services.

    However, the authors’ claim that “gender inequality and harmful gender norms in many settings create barriers and are the main reasons for suboptimal immunization coverage” is not substantiated by the available data. The action plans do provide some contextual descriptions of gender barriers and describe an intent to take action. But descriptions shared by learners were not verified, and the course did not offer any support to learners in implementing their proposed actions.

    Reference

    Nyasulu, B.J., Heidari, S., Manna, M., Bahl, J., Goodman, T., 2023. Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030. Frontiers in Global Women’s Health 4, 1230109. https://doi.org/10.3389/fgwh.2023.1230109

    Illustration: 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

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

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

    What difference can peer-led learning and action make for national EPI planners seeking new strategies to support HPV vaccine introduction or reintroduction?

    The stakes are high: HPV vaccination efforts, if successful, will avert 3.4 million deaths by 2030.

    On Friday, EPI focal points for HPV and other national-level MOH colleagues from 31 countries convened under the banner of the Movement for Immunization Agenda 2030 (IA2030), which connects over 60,000 primarily sub-national health staff worldwide.

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

    This time, it was national HPV vaccination focal points and other national EPI planners who joined to share experience between countries of ‘what works’ (and how).

    They also discussed how the Geneva Learning Foundation’s unique peer learning-to-action pathway could help them overcome barriers they are facing to ensure that local communities understand and support the benefits of this vaccine.

    Such a pathway can complement existing, top-down forms of vertical technical assistance and may provide a new ‘lever’ for national planners.

    In June and October 2023, health workers – primarily from districts and facilities – in over 60 countries shared 298 lessons learned and success stories about HPV vaccination in the Foundation’s Teach to Reach peer learning events. Watch the video: Why HPV matters for women who deliver vaccines.

    The active participation of national EPI managers from Burkina Faso and key stakeholders Sierra Leone led to the consultative engagement in January.

    Although HPV vaccine is not new, the global community’s effort to introduce it has been stymied by a number of factors.

    Doing what has been done before is unlikely to produce the change that is needed.

    For example, it remains unclear how early gains achieved through campaigns can sustainably become part of routine immunization.

    TGLF’s Insights Unit will now produce a short summary of key learning from this inter-country peer learning exchange, which will be shared back with participants.

    If you are interested in learning more about the Movement for Immunization Agenda 2030 (IA2030) or the Geneva Learning Foundation’s HPV vaccination learning-to-action pathway, please do get in touch.

  • What did we learn from the Movement for Immunization Agenda 2030 (IA2030) in its first two years?

    What did we learn from the Movement for Immunization Agenda 2030 (IA2030) in its first two years?

    At a World Health Organization conference in Panama, The Geneva Learning Foundation is hosting an Innovations Café today.

    The session’s title is “Connected learning to accelerate local impact at global scale: Year 1 of the Movement for Immunization Agenda 2030 (IA2030)”.

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

    Immunization Agenda 2030 (IA2030) is the world’s strategy, adopted by the World Health Assembly in 2020, to achieve the global goals for immunization.

    In March 2022, The Geneva Learning Foundation (TGLF) launched a call to form a movement in support of IA2030.

    By June 2023, over 16,000 health workers were participating.

    More than 80% work in districts and health facilities and over half are government workers.

    70% work in fragile contexts such as armed conflict, remote areas, urban poverty, and other challenges.

    This ground-up commitment has the potential to complement the top-down work of the IA2030 global partners, if this community of practitioners is recognized, empowered, and listened to by global health agencies and donors.

    In today’s session, you will hear first-hand from IA2030 Movement Members.

    How has participation in this Movement helped them to better serve the immunization and primary health care needs of the local communities they serve?

    In Year 1 of this Movement, we demonstrated the feasibility of establishing a global peer learning platform for immunization practitioners, with the creation of a movement of more than 10,000 health workers in support of IA2030 goals. Learn more about Year 1 outcomes.

    In Year 2, as the Movement continued to grow rapidly in over 100 countries, we generated evidence of practitioner demand and public health impact, captured in academic papers and multiple detailed case studies. Request your invitation to the IA2030 Movement’s Knowledge-to-Action Hub to get access to research outputs.

    Learn more about how new digital learning approach can open access to international global health conferences otherwise restricted to the select few.

  • Why an open-source manifesto for global health?

    Why an open-source manifesto for global health?

    Lire la version française: Pourquoi un manifeste open-source pour la santé globale?

    The global immunization community is now focused on “the big catch-up”, dealing with recovery of immunization services from the consequences of the COVID-19 pandemic, as countries – and immunization staff on the frontlines – work toward the goals of Immunization Agenda 2030 (IA2030).

    At the Seventy-Fourth World Health Assembly, the Director General of the World Health Organization had called for “a broad social movement for immunization that will ensure that immunization remains high on global and regional health agendas and help to generate a groundswell of support or social movement for immunization”.

    A Movement is larger than any one individual or organization. The Geneva Learning Foundation is one of many working to support this Movement. In March 2022, we launched a call for immunization staff at all levels of the health system to connect across boundaries of geography and hierarchy – to commit to working together to achieve the goals of Immunization Agenda 2030 (IA2030).

    In 2022, over 10,000 health professionals, primarily government workers from districts and facilities, joined this movement and shared ideas and practices, analyzed root causes of their local immunization challenges, and developed and implemented corrective actions to tackle them, together. Learn more…

    Today, we share an open-source Manifesto for how health services could develop in ways that we think would make them more effective, recognizing health workers and communities – and the expertise and experience they hold because they are “there every day” – at the centre of public health systems.

    No vision or strategy can or should be developed as a pronouncement by a single organization of how things should be.

    • This Manifesto is an open-source draft because, in today’s complex world, we tackle challenges that no one country or organization can possibly overcome alone.
    • For such a manifesto to be meaningful requires the participation, and contribution of those on the frontlines of global health, in dialogue with global, regional, and country leaders.

    This is why we are inviting you – along with more than 10,000 members of the Movement for Immunization Agenda 2030 (IA2030 – to bring to life and shape this Manifesto.

    Version 1.0 of the manifesto was first shared in a special issue of The Double Loop, the Geneva Learning Foundation’s insights newsletter. Learn more…

  • Pourquoi un manifeste open-source pour la santé globale?

    Pourquoi un manifeste open-source pour la santé globale?

    Read this in English: Why an open-source manifesto for global health?

    La communauté mondiale de la vaccination se concentre désormais sur le « grand rattrapage », en priorisant le rétablissement des services de vaccination suite aux conséquences de la pandémie de COVID-19, alors que les pays—et le personnel de la vaccination en première ligne—s’efforcent d’atteindre les objectifs du Programme pour la vaccination à l’horizon 2030 (IA2030).

    Lors de la soixante-quatorzième Assemblée mondiale de la santé, le directeur général de l’Organisation mondiale de la santé avait lancé un appel en faveur d’un « vaste mouvement social pour la vaccination qui veillera à ce que la vaccination reste une priorité dans les programmes de santé internationaux et régionaux et contribuera à susciter une vague de soutien ou un mouvement social en faveur de la vaccination ».

    Un mouvement est plus grand qu’un seul pays ou une seule organisation. La Fondation Apprendre Genève est l’une des nombreuses organisations à œuvrer pour insuffler ce Mouvement. En mars 2022, nous avons lancé un appel au personnel chargé de la vaccination à tous les niveaux du système de santé pour tisser des liens par-delà des frontières géographiques et s’engager à travailler ensemble pour atteindre les objectifs de «IA2030». En 2022, plus de 10 000 professionnels de la santé, principalement des fonctionnaires et des acteurs de la société civile issus des districts et des établissements de santé, ont rejoint ce mouvement. Ensemble, ils ont partagé des idées et des pratiques, analysé les causes profondes de leurs difficultés locales en matière de vaccination, et élaboré et mis en œuvre des mesures correctives pour surmonter leurs défis.

    Aujourd’hui, nous partageons ce manifeste «open source» sur la façon dont les services de santé pourraient se développer de manière à les rendre plus efficaces, nous reconnaissons les professionnels de la santé et les communautés—ainsi que l’expertise et l’expérience qu’ils détiennent parce qu’ils sont « là tous les jours »—au centre des systèmes de santé publique.

    Ce Manifeste est un projet «open source» car, dans le monde complexe d’aujourd’hui, nous sommes confrontés à des défis qu’aucun pays ou organisation ne peut relever seul.

    • Aucune vision ou stratégie ne saurait être élaborée en tant que déclaration d’une seule organisation sur la façon dont les choses devraient être.
    • Pour qu’un tel manifeste ait un sens, il faut la participation et la contribution de ceux qui sont en première ligne de la santé mondiale, dans le cadre d’un dialogue avec les dirigeants internationaux, régionaux et nationaux.

    C’est pourquoi nous vous invitons à donner vie et forme à ce Manifeste, et à rejoindre les plus de 10,000 membres du Mouvement pour la vaccination à l’horizon 2030 dont l’action et la réflexion ont été sources d’inspiration du Manifeste.

    Le manifeste a d’abord été diffusé sous la forme d’un numéro spécial de The Double Loop (La Double Boucle), le bulletin de l’Unité de recherche de la Fondation. Pour en savoir plus…

  • Rising together: promoting inclusivity and collaboration in global health 

    Rising together: promoting inclusivity and collaboration in global health 

    The ways of knowing of health professionals who work on the front lines are distinct because no one else is there every day. Yet they are typically absent from the global table, even though the significance of local knowledge and action is increasingly recognized. In the quest to achieve global health goals, what value should professionals within global health agencies ascribe to local experience? How do we cultivate a more inclusive and collaborative environment? And why should we bother?

    A recent roundtable discussion, attended by technical officers and senior leaders, provided an occasion to present and explain how the Geneva Learning Foundation’s Immunization Agenda 2030 (IA2030) platform and network could be used to support “consultative engagement” between global and local leaders. This platform and network is reaching over 50,000 health professionals, helping them build connections with each other – defying boundaries of geography and health system levels – to transform learning into action. 

    One global observer expressed concern that all this learning, sharing, and action might be “a bunch of hot air”. This can, at best, be interpreted as doubt towards the value of lived experience, and, at worst, as a brutal dismissal of the will and commitment expressed by thousands of health professionals working, more often than not, in difficult circumstances.

    How should we understand and respond to such skepticism?

    Between March and September 2022, 10,000 health professionals working on the frontlines of immunization made a personal, moral commitment to making a difference in their communities, above and beyond their professional roles. Together, they decided to make their country’s commitment to IA2030 a personal and professional commitment – because they wanted to. This cannot be insignificant.

    In the first year of our IA2030 programme, we observed remarkable gains from such peer learning in the confidence and self-esteem of participants. It has already led to a year of intense sharing of experience, leading to over one thousand health professions taking corrective actions to tackle the root causes of their local challenges, using their own local resources and capacities, and sharing challenges, successes, and lessons learned. Such higher-order learning in the affective domain has already been shown to support deepening competencies needed to tackle complex problems.

    To overcome current immunization challenges, it may be useful to first recognize the value of diverse perspectives, acknowledging that each individual’s lived experience can provide unique insights and knowledge. Building meaningful, respectful connections to those on the frontlines creates new possibilities for how this can be combined with the world’s collective knowledge: the norms, standards, and other guidelines that global agencies produce. By doing so, we can create a more inclusive culture, ensuring not only that every voice is heard and valued, but that these voices combine to figure out the “how” of solving global health challenges that play out at the local level.

    Moreover, we must avoid perpetuating self-fulfilling prophecies that could undermine the motivation and participation. Heat generated by the voices and collective commitment of thousands of local health workers mobilizing and learning together to take action will evaporate into thin air if the global community fails to listen, respond and support them. A less cynical, more inclusive approach might help us raise the upswell of support in favor of immunization. It is essential that we encourage active involvement and recognize the dedication of those who strive to make a difference in the communities they serve. By fostering a supportive environment when we sit at a global roundtable, we can help dispel skepticism and promote the engagement of health professionals at all levels.

    Lastly, it is important to challenge any biases or preconceived notions that may hinder our ability to appreciate the knowledge held by others. As we continue to advocate for local action and recognize the significance of local actors, we must be mindful of potential biases that could inadvertently devalue the contributions of those we seek to support. By being aware of these biases, we can work towards a more equitable global health community where everyone’s knowledge and experience are valued.

    Promoting inclusivity and collaboration in global health agencies is critical to achieving our shared objectives. By recognizing the value of local perspectives, challenging biases, and promoting active engagement, we can create a more supportive environment for health professionals around the world and ensure that their collective efforts are recognized and supported.

    It is important to consider such rejection in the context of the growing emphasis on local action and the recognition of local actors within the global community. As we work towards a more inclusive and collaborative environment, we must ensure that we genuinely appreciate and support local efforts.

  • Credible knowers

    Credible knowers

    “Some individuals are acknowledged as credible knowers within global health, while the knowledge held by others may be given less credibility.” – (Himani Bhakuni and Seye Abimbola in The Lancet, 2021)

    “Immunization Agenda 2030” or “IA2030” is a strategy that was unanimously adopted at the World Health Assembly in 2020. The global community that funds and supports vaccination globally is now exploring what it needs to do differently to transform the Agenda’s goal of saving 50 million lives by the end of the decade into reality. Last year, over 10,000 national and sub-national health staff from 99 countries pledged to achieve this goal when they joined the Geneva Learning Foundation’s first IA2030 learning and action research programme. Discover what we learned in Year 1… Learn more about the Foundation’s platform and network… What is the Movement for Immunization Agenda 2030 (IA2030)?

    In global health, personal experience is assumed to be anecdotal, the lowest form of evidence. We are learning, as one of many organizations contributing to Immunization Agenda 2030 (IA2030), to reconsider this assumption.

    An ongoing ‘consultative engagement’ in which a group of global experts has been listening and learning with health professionals working in districts and facilities provides a practical example that changing how we know can lead to significant change in what we do – and what results and outcomes may come of it.

    On 12 December 2022, the Geneva Learning Foundation (TGLF) hosted a special event with the Immunization Agenda 2030 Working Group on Immunization for Primary Healthcare and Universal Health Coverage, which includes representatives from leading global agencies that support immunization efforts worldwide. 

    Over 4,000 people participated. Most were health workers from districts and health facilities in Asia, Africa, and Latin America. In the run-up to the event, they shared 139 context-specific experiences about their daily work – challenges, lessons learned, and successes – in integrating immunization as part of primary health care practices. The live event opened with such stories and then transitioned into a formal presentation of the framework. This helped everyone make sense of both the “why” and the “how” of the new framework.

    However, this was not the first time that the global group was in listening mode. In fact, the new framework was the capstone in a year-long ‘consultative engagement’ that had begun at Teach to Reach 4 on 10 December 2021, attended by 5,906 health professionals who deliver vaccines in districts and facilities. (Teach to Reach is the Foundation’s networking event series, during which participants meet to share experience and global experts listen and learn. You can view the sessions on primary health care here and here.)

    Global health organizations often issue new frameworks and guidance, sometimes accompanied by funding for capacity development. However, dissemination often relies upon conventional high-cost, low-volume approaches, such as face-to-face training or information transmission through digital channels, even though fairly definitive evidence suggests severe limitations to their effectiveness.

    To address these challenges, the Geneva Learning Foundation and its partners are launching the IA2030 Movement Knowledge to Action Hub, a platform for sharing local expertise and experience across geographical and health system level boundaries. The goal is to research and implement new ways to convert this knowledge into action, results and, ultimately, impact.

    The Double Loop, a monthly insights newsletter edited by Ian Steed and Charlotte Mbuh, is one component of this Hub. The newsletter asked questions to all 4,000 participants of the December 2022 event, 30 days and 90 days later, to gather feedback on the new framework.

    Here are the questions we asked three months on:

    1. Since you discovered the Framework for Action: Immunization for Primary Health Care, have you referred to this framework at least once? If you have not used it, can you tell us why? How could this Framework be improved to be more useful to you?
    2. If you have referred to this Framework, tell us what did you do with the information in the Framework? How did your colleagues respond to the Framework?
    3. How did this Framework make a difference in solving a real-world problem you are facing? How did things turn out? Explain what you are doing differently to integrate health services, empower people and communities, and lead multisectoral policy and action.

    Within days, we received hundreds of answers:

    • Some health professionals apologized, often citing field work, emergency response, and other pressing priorities. This can help better understand the strengths and weaknesses of learning culture (the capacity for change), which the Foundation’s Insights Unit has been researching in the field of immunization since 2020.  
    • Others praised the framework in generic terms (“It’s a great framework”), but did not share any specific examples of actual review, use, or application. Some speak to sometimes peculiar practices of accountability in immunization, where top-down hierarchies remain the norm and provide incentive to always provide positive accounts and responses, whatever the reality may be.
    • A few respondents candidly explained that the Framework does not fit their local needs, as it was primarily designed for national planners. This begs the question of how such local adaptation and tailoring might happen.
    • Finally, we discovered credible, specific narratives of actual use, including adaptation at the local levels. These provide fascinating examples of how a global guidance, developed through a year-long consultative engagement, is actually being translated into practice.

    Our Insights Unit is analyzing these narratives, as this exercise is helping us learn how to scale the IA2030 Movement Knowledge to Action Hub to involve the more than 10,000 health professionals who joined the Movement in its first year.

    The Double Loop regularly shares feedback from its readers as “insights on sights”. You can already read a sample of responses about the framework.

    On 31 March 2023, our team will meet with the IA2030 Working Group to share and discuss the insights gathered through this process.

    The Working Group has also changed through this process. In January 2023, it invited its first sub-national member, Dr. María Monzón from Argentina, who brings her own professional experience and expertise from running a primary health care center. She will also serve as the voice of over 10,000 Movement Leaders, immunization staff from 99 countries and all levels of the health system, who met and have been intensively collaborating for over a year in the Foundation’s IA2030 programme. 

    Surprisingly, one global immunization technical expert shared his concern that thousands of professionals learning from each other to strengthen their resolve and action might amount to “just a bunch of hot air”. This will only be the case if the global immunization community fails to respond and support, even as it proclaims a genuine willingness to recognize local voices as credible knowers. In another blog post, I’ll share some thoughts on what it might take to rise together.

  • Reinventing the path from knowledge to action in global health

    Reinventing the path from knowledge to action in global health

    At the Geneva Learning Foundation (TGLF), we have just begun to share a publication like no other. It is titled Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers.

    You can access the full report here in French and in English. Short summaries are also available in three special issues of The Double Loop, the Foundation’s free Insights newsletter, now available in both English and French. The report, prefaced by Heidi Larson who leads the Vaccine Confidence Project, includes DOI to facilitate citation in academic research. (The Foundation uses a repository established and maintained by the Geneva-based CERN for this purpose.)

    However, knowing that academic papers have (arguably) an average of three readers, we have a different aspiration for dissemination.

    As a global community, we recognize the significance of local action to achieve the global goals.

    The report documents vaccine confidence practices just weeks before the introduction of COVID-19 vaccines. It is grounded in the experience of 734 practitioners from local communities, districts, regions, and national teams, who developed case studies documenting a situation in which they were able to successfully lead individuals and groups toward better understanding and acceptance of the benefits of vaccines and vaccination.

    Immunization staff from all levels of the health system became citizen scientists, active knowledge-makers drawing on their personal experience of a situation in which they successfully overcame the barriers to vaccine acceptance in the community.

    Experiential learning offers a unique opportunity to discover unfiltered experiences and insights from thousands of people whose daily lives revolve around delivering immunization services. But what happens once experience has been shared? What is to be done with what we learn?

    Sharing this report, we have found, has triggered remarkable dialogue and led to the co-creation of a steadily growing collection of new practices actually used to build vaccine confidence (as opposed to the many theoretical frameworks on the topic), submitted through our new Insights system. New stories and their analysis are being shared back with local practitioners and with TGLF’s Insights partners, fostering continuous learning that is an action imperative of a strong learning culture. (For Insights, we work with Bridges to Development, the Centre for Change and Complexity in Learning (C3L), and the International Vaccine Access Center at Johns Hopkins.)

    In the coming weeks, we will be inviting 10,000 leaders of the Movement for Immunization Agenda 2030 to share this report to their colleagues, teams, and organizations (in both ministries of health and civil society organizations). They will be sharing back their own insights on how the findings can be used to improve demand for vaccines – and colleagues who listen to their presentation of the report will also be able to share back what they learn, connecting with each other through our Insights system.

    Then, the Foundation’s Impact Accelerator will track if and how insights from this report are linked to reported positive outcomes, and we should be able to document this, at least in some cases. This will not only foster double-loop learning but also explicitly link learning to implementation and results.

    In this way, local practitioners will be putting to use global knowledge grounded in their local experiences, for their own needs. We believe that this provides a complementary, more organic mechanism than current top-down processes for developing normative guidance driven by global assumptions and priorities.

    As Kate O’Brien, WHO’s Director of Immunization, said during a recent Insights Live session: “The global role on immunization is actually to bring together everything that is known by people at the grassroots level. That’s where the action is. Global guidance is basically one means to share knowledge and expertise that’s coming from the grassroots level around the world with others who may not have had that experience yet.”

    What we are doing with this report is part of a larger initiative to build the IA2030 Movement Knowledge to Action Hub. New knowledge produced by local practitioners will be available as both static and living documents that local and global practitioners can add their inputs to, at any time. This Hub will be launched at Teach to Reach 7 on 14 October 2022, with over 13,000 local practitioners registered for this event.

    Image: Many paths to moving mountains. The Geneva Learning Foundation Collection.