Making connections: Ghana’s Alumni of The Geneva Learning Foundation meet in Accra

The Geneva Learning Foundation (TGLF) will host its first physical-world meeting of Ghana Scholars and Alumni on Wednesday, October 30, 2024 in Accra. Seventy-two health professionals from across Ghana’s health system will participate in the evening event.

The participants include staff from the Ghana Health Service, teaching hospitals, district health directorates, and non-governmental organizations. They represent all levels of the health system, with 8 working at the national level, 8 at regional facilities, 39 in district health services, and 13 in community-based programs.

“This is a great opportunity for all health workers for impact,” says one participant, reflecting the anticipation among attendees.

These professionals are alumni of TGLF’s programs, including the Movement for Immunization Agenda 2030 (IA2030) and Teach to Reach initiatives, which focus on transforming global health strategies into practical, locally-adapted solutions.

“TGLF’s learning platforms give us great information and knowledge that are feasible and can be applied in the field,” notes Gordon Yibey from the Asutifi South District.

The meeting will feature a message from the Programme Manager of Ghana’s Expanded Programme on Immunisation (EPI), followed by discussions on strengthening partnerships with Ghana Health Service and advancing immunization and responding to health of impacts of climate change, malaria, and NTDs. Participants will share experiences from their work and discuss challenges in implementing health programs across different contexts.

To enable broad participation, the organizers have arranged a hybrid format. 31 participants will attend in person, while 39 will join remotely. This approach allows health workers from northern regions and remote districts to contribute their perspectives without traveling to Accra.

As one participant from a civil society organization explains, “I will join remotely to avoid travelling and accommodation inconveniences since I am not a resident in Accra.”

Another participant from Kintampo in the Bono East Region captures the spirit of anticipation: “Even though I’m not based in Accra, I can’t wait. I must be there as a member of TGLF Alumni.”

The non-governmental health sector will be represented by staff of organizations that include the Community and Family Aid Foundation-Ghana, Seek to Save Foundation, and Restorative Seed Society, which work to complement government health services in various communities.

Healthcare facilities with participating staff include teaching hospitals in Tamale, Sunyani, and Korle Bu, district hospitals, polyclinics, and community health centers. Several nursing training colleges will also participate, bringing perspectives from health education.

The evening’s agenda includes discussions on:

• Current challenges in Ghana’s health system
• Implementation of Immunization Agenda 2030
• Impact of climate change on health services and disease patterns
• Malaria control and elimination strategies
• Neglected Tropical Diseases, with specific focus on female genital schistosomiasis (FGS)
• Service integration opportunities for primary health care (PHC)
• Professional development opportunities
• Collaboration between different levels and domains of the health system

The meeting aims to facilitate knowledge sharing among health professionals and explore ways to strengthen Ghana’s health services through collaborative approaches grounded in The Geneva Learning Foundation’s innovative model to catalyze change led by health professionals working with communities.

Another participant from looks ahead: “What next, after this historic encounter in Ghana for sustainable improvement and continued knowledge brokering exchange?”

Painting: The Geneva Learning Foundation Collection © 2024

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Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration

As immunization programs worldwide struggle to recover from pandemic disruptions, the Movement for Immunization Agenda 2030 (IA2030) offers a novel, practitioner-led approach to accelerate progress towards global vaccination goals.

From March to June 2022, the Geneva Learning Foundation (TGLF) conducted the first Full Learning Cycle (FLC) of the Movement for IA2030, engaging 6,185 health professionals from low- and middle-income countries.

A cornerstone of this programme was a series of 44 experience-sharing sessions held between 7 March and 13 June 2022. These sessions brought together between 20 and 400 practitioners per session to discuss and solve real-world immunization challenges.

IA2030 case study 16, by Charlotte Mbuh and François Gasse, offers valuable insights from these experience-sharing session:

what we learned from the experiences themselves and how it can help practitioners; and

what we learned about the significance and potential of the peer learning process itself.

Download the full case study: IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation.

For every challenge shared during the experience sharing sessions, there was always at least one member who had encountered or was encountering the same challenge and had carried out measures to resolve it.

These sessions provided a space to share practical stories that are making a difference – and supported participants in considering their relevance to their own situations.

Experience sharing also helped build confidence and motivation.

Members were able to identify with experiences shared, realizing they were not alone in facing similar challenges.

The sessions covered a wide range of critical immunization topics.

For instance, a participant from Nigeria discussed strategies for reaching zero-dose children in Borno state.

Facing the challenge of reaching approximately 600,000 unvaccinated children, the presenter received practical suggestions from peers, including developing a zero-dose reduction operational plan, leveraging new vaccine introductions, and partnering with the private sector for evening vaccination services.

In another session, a subnational Ministry of Health staff member from Côte d’Ivoire presented challenges related to cross-border immunization campaigns.

Peers shared experiences of organizing cross-border meetings to identify unvaccinated children, synchronize efforts, and involve community representatives in the process.

Such context-specific, experience-based advice exemplifies the unique value of peer learning in addressing complex health system challenges.

The case study of 44 sessions highlights how these sessions fostered multiple types of learning simultaneously.

Participants reported learning from each other’s experiences, experiencing the power of solving problems together across distances, feeling a growing sense of belonging to a community, and connecting across country borders and health system levels.

A district-level Ministry of Health staff member from Ghana encapsulated the impact: “I have linked up with expert vaccinators worldwide through experience sharing and twinning. I have become more competent and knowledgeable in the area of immunization, and work confidently.”

This sentiment was echoed by many participants who found value not only in acquiring new knowledge but also in expanding their professional networks and gaining confidence in their problem-solving abilities.

The case study also reveals the adaptability of the approach in responding to unique contexts.

This resilience underscores the potential of digital platforms to democratize access to expertise and foster global collaboration.

However, the study also identifies areas for improvement.

• Participants expressed a desire for more follow-up support and opportunities to continue their peer learning groups beyond the initial sessions.
• Additionally, the need for better integration of community engagement strategies was identified as a key area for future development.

To contextualize these findings, we can turn to a 2022 study by Watkins et al., which evaluated a prototype of these experience-sharing sessions known as Immunization Training Challenge Hackathons (ITCH), conducted in 2020.

The ITCH methodology, developed by The Geneva Learning Foundation (TGLF), informed the design of the 2022 IA2030 Movement sessions.

Watkins et al. found that the ITCH approach fostered four simultaneous types of learning: peer, remote, social, and networked.

Peer Learning: This involves participants learning directly from each other’s experiences and knowledge. In the context of immunization, imagine a scenario where a vaccination program manager from rural India shares their successful strategy for improving vaccine cold chain management with a colleague facing similar challenges in sub-Saharan Africa. This direct exchange of practical, context-specific knowledge can complement more theoretical training, as it is based on real-world application.

Remote Learning: This refers to the ability to learn and solve problems collaboratively across geographical distances. For an immunization specialist, this might seem counterintuitive, as many believe that hands-on, in-person training is essential. However, the ITCH sessions demonstrated that meaningful learning can occur remotely. For example, a team in Bangladesh could describe their approach to overcoming vaccine hesitancy, and a team in Nigeria could immediately adapt and apply those strategies to their local context, all without the need for costly and time-consuming travel.

Social Learning: This concept emphasizes the importance of learning within a network. In the immunization field, professionals often work in isolation, especially at sub-national levels. The ITCH sessions created a sense of belonging to a global network, community, and platform of immunization practitioners. This social aspect can boost motivation, reduce feelings of isolation, and foster a collective approach to problem-solving that transcends individual or even national boundaries.

Networked Learning: This type of learning emerges from connections made across different levels of health systems and across country borders. For an epidemiologist, this might be analogous to how disease surveillance networks function across borders. In the ITCH context, it means that a district-level immunization officer could learn from and share ideas with national-level policymakers from other countries, fostering a more holistic understanding of immunization challenges and solutions.

These four types of learning operate simultaneously during ITCH sessions, creating a synergistic effect. 

For instance, a participant might learn a new cold chain management technique (peer learning) from a colleague in another country (remote learning), feel supported by the global community in implementing this new technique (social learning), and then share their adaptation of this technique with others across various levels of the health system (networked learning).

From an epidemiological perspective, this approach to learning could be compared to how we understand disease transmission and intervention effectiveness.

Just as multiple factors contribute to disease spread and control, these multiple learning types contribute to knowledge dissemination and capacity building in the immunization field.

The value of this approach lies in its potential to rapidly disseminate practical, context-specific knowledge and solutions across a global network of immunization professionals.

This can lead to faster adoption of best practices, more innovative problem-solving, and ultimately, improvements in immunization program performance that could contribute to better disease control outcomes.

While this approach may seem unconventional compared to traditional training methods in the immunization field, the evidence presented by Watkins et al. suggests that it can be a powerful complement to existing capacity-building efforts, particularly in resource-constrained settings where access to formal training opportunities may be limited.

This multifaceted approach allowed participants to not only acquire new knowledge but also to expand their professional networks and gain confidence in their problem-solving abilities—findings that align closely with the outcomes observed in the 2022 IA2030 Movement sessions.

The Watkins study emphasized the importance of building confidence and motivation through peer learning experiences, a theme strongly echoed in the Mbuh case study.

Furthermore, Watkins et al. highlighted the potential of this approach to create a “space of possibility” for innovation and problem-solving, which is evident in the diverse and creative solutions shared during the 2022 sessions.

Both studies underscore the significance of peer-led, digital learning experiences in accelerating progress towards global health goals.

By fostering peer learning and digital collaboration, these approaches empower health workers to turn global strategies into effective local action.

References

Mbuh, C., Gasse, F., Jones, I., Sadki, R., Brooks, A., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7014392

Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4

Image: The Geneva Learning Foundation Collection © 2024

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50 years of the Expanded Programme on Immunization

In two articles published during the fiftieth year of the World Health Organization’s Expanded Programme on Immunization (EPI), Samarasekera and Shattock provide valuable insights into EPI’s remarkable impact on reducing childhood mortality and morbidity since its launch in 1974.

Shattock et al. present a detailed quantitative analysis of the lives saved and health gains attributed to vaccination.

They estimate that “since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year.” 

The authors further emphasize the long-term benefits of vaccination, noting that “for every death averted, 66 years of full health were gained on average, translating to 10.2 billion years of full health gained.”

These findings underscore the transformative impact of the Expanded Programme on Immunization on global health outcomes.

Bill Moss of the International Vaccines Access Center (IVAC) calls this “one of humankind’s greatest achievements”.

Inherent uncertainties based on the modeling approaches, data limitations and gaps, and challenges in attributing causality over a 50-year time horizon do not diminish their significance.

Fresh challenges

Samarasekera highlights several fresh challenges as EPI moves into its next 50 years:

COVID-19 pandemic disruptions: The pandemic has led to 67 million children globally missing out on one or more vaccines. This has resulted in outbreaks of vaccine-preventable diseases, with measles outbreaks being reported in twice as many countries in 2023 compared to 2022. Due to pandemic disruption, many unimmunized children are now older than 2 years, requiring new approaches to reach them and prevent further outbreaks.

Sustainable funding: Countries are facing challenges in sustaining funding for immunization programs due to debt crises, conflicts, and climate change.

Improving collaboration during emergencies: There is a need for quicker access to vaccines and better coordination among stakeholders during humanitarian crises and outbreaks.

Reaching the “last child”: Challenges persist in reaching children in conflict areas, active war zones, and those facing humanitarian crises, with immunization coverage in these settings being as low as 50-60%.

While both articles recognize the urgent need to address these setbacks and reach underserved populations, they tend to emphasize the role of global agencies and donors in driving progress.

For example, Samarasekera highlights the importance of initiatives like Gavi, the Vaccine Alliance, which was established in 2000 “to close the equity gap in access to vaccines,” and the Accelerated Development and Introduction Plans, which “expedited vaccine introduction in Gavi-supported countries.”

While global plans and funding have been – and remain – undoubtedly crucial, this begs three questions:

How to carry out such coordinated action and advocacy?

Who will do it?

What, if anything, should be different, compared to what was done in the past?

Can we assume deployment?

Both articles acknowledge that today’s challenges are different, and that immunization strategies should be grounded in local realities.

Samarasekera’s report suggests exploring ideas such as involving community health workers more effectively, introducing newly approved vaccines (e.g., for malaria), and innovating vaccine delivery methods (e.g., microarray patches, single-dose vaccines).

Ephrem T. Lemango, for example, emphasizes the role of health workers : “They are the most trusted source of information” for communities. “If we can skill these community health workers to vaccinate, provide them the required vaccines, then the likelihood of reaching the last child could be much more imminent”.

Samarasekera also quotes O’Brien, who stresses that “every government that has had backsliding needs a plan, and most governments have made a plan and are starting to deploy. We have a very narrow window to get this completed.” 

Neither article delves deeply into the specific strategies or mechanisms that connect global policy and funding to local action.

Can “deployment” be assumed?

There is wide recognition that local adaptation is a key challenge.

This is most obvious in zones of armed conflict or when faced with the breakdown of trust in vaccines or government

At the end of the day, it is health workers at the local levels that get the job of vaccination done.

They are also the first to see epidemic outbreaks and to recognize changes in community trust.

Does the future of vaccination require new ways of thinking and doing to adapt or invent strategies to lead to improved, sustained health outcomes?

Global advocacy for community health workers to be paid is undeniably important.

But paid to do what, how, and with what degree of recognition and support of their capacities, leadership, and expertise?

This is where learning from the Movement for Immunization Agenda 2030 (IA2030) may offer useful insights that complement the top-down, global-level efforts emphasized in the articles.

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

Launched by the Geneva Learning Foundation in March 2022, the Movement is a global network of over 10,000 health workers from 99 countries who have pledged to work together to achieve the goals of the Immunization Agenda 2030, the global strategy adopted by the World Health Assembly in 2020.

Through peer learning and locally-led action, IA2030 members are sharing experiences, identifying root causes of immunization challenges, and implementing corrective actions tailored to their specific contexts.

What does that actually mean?

Wasnam Faye, a Senegalese midwife, moved the needle of vaccination coverage in a poor-performing remote health outpost from 8% to over 80%.

How did she do it?

At Teach to Reach, she met a doctor from the Democratic Republic of Congo who shared his EPI know-how with her, over WhatsApp.

She then invited and trained caregivers to become peer educators, also building on what she heard at Teach to Reach.

She then realized that she could speak about HPV vaccination for their daughters to mothers who came for cervical cancer screening.

In global health, individual case studies and lived experience are often dismissed as anecdotal evidence.

Each edition of Teach to Reach connects over 15,000 health workers, who share experience around their local challenges.

At that scale, the cumulative insights gained take us beyond anecdotes and enable us to document how change happens at the local levels.

Watch: Teach to Reach Insights Live with Orin Levine

Rethinking immunization’s learning culture: Capacity for change, innovation, and risk

To catch up and achieve the goals set for 2030, these articles suggest that a combination of increased funding, political commitment, and innovative strategies will be needed.

It is important to recognize that top-down control and directive management appear to have been key to how immunization programmes achieved impressive results in previous decades.

This explains why some EPI stakeholders may have an innovation challenge: why risk making changes or consider new models? 

Addressing these underlying issues may require strengthening learning culture.

“Learning culture” is a new concept in global health that provides the missing link between learning and performance.

It measures the capacity for change and the leadership to recognize and support that capacity over time.

That requires sustained financing, including specific funding required to test and scale new models and approaches. 

But who will risk funding new ways to tackle the challenges facing immunization programs, such as weak health systems, inadequate infrastructure, and community trust?

References

Faye, W., Jones, I., Mbuh, C., & Sadki, R. (2023). Wasnam Faye. Vaccine angels – Give us the opportunity and we can perform miracles. (IA2030 Case study 18) (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7785244

Jones, I., Eller, K., Mbuh, C., Steed, I., & Sadki, R. (2024). Making connections at Teach to Reach 8 (IA2030 Listening and Learning Report 6) (1.0). Teach to Reach: Connect 8, Geneva, Switzerland. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.8398550

Jones, I., Sadki, R., Brooks, A., Gasse, F., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Movement Year 1 report. Consultative engagement through a digitally enabled peer learning platform (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7119648

Samarasekera, U., 2024. 50 years of the Expanded Programme on Immunization. The Lancet 403, 1971–1972. https://doi.org/10.1016/S0140-6736(24)01016-X

Shattock, A.J., et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. The Lancet S014067362400850X. https://doi.org/10.1016/S0140-6736(24)00850-X

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

The Immunization Agenda 2030 (IA2030) and the Movement for Immunization Agenda 2030 represent two interconnected but distinct aspects of a global effort to enhance immunization coverage and impact.

What is Immunization Agenda 2030?

Immunization Agenda 2030 or “IA2030” is a global strategy endorsed by the World Health Assembly, aiming to maximize the lifesaving impact of vaccines over the decade from 2021 to 2030.

• It sets an ambitious vision for a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being.
• The strategy was designed before the COVID-19 pandemic, with the goal of saving 50 million lives through increased vaccine coverage and addresses several strategic priorities, including making immunization services accessible as part of primary care, ensuring everyone is protected by immunization regardless of location or socioeconomic status, and preparing for disease outbreaks.
• IA2030 emphasizes country ownership, broad partnerships, and data-driven approaches. It seeks to integrate immunization with other essential health services, ensuring a reliable supply of vaccines and promoting innovation in immunization programs.

Watch the Immunization Agenda 2030 (IA2030) inaugural lecture by Anne Lindstrand (WHO) and Robin Nandy (UNICEF)

https://www.youtube.com/watch?v=NnvPRt-HJaI

What is the Movement for Immunization Agenda 2030?

The Movement for Immunization Agenda 2030, on the other hand, is a collaborative, community-driven effort to operationalize the goals of IA2030 at the local and national – and to foster double-loop learning for international partners.

It emerged in response to the Director-General’s call for a “groundswell of support” for immunization and combines a network, platform, and community of action.

The Movement focuses on turning the commitment to IA2030 into locally-led, context-specific actions, encouraging peer exchange, and sharing progress and results to foster a sense of ownership among immunization practitioners and the communities they serve. It has:

• has demonstrated a scalable model for facilitating peer exchange among thousands of motivated immunization practitioners.
• emphasizes locally-developed solutions, connecting local innovation to global knowledge, and is instrumental in resuscitating progress towards more equitable immunization coverage.
• operates as a platform for learning, sharing, and collaboration, aiming to ground action in local realities to reach the unreached and accelerate progress towards the IA2030 goals.

In April 2021, over 5,000 immunization professionals came together during World Immunization Week to listen and learn from challenges faced by immunization colleagues from all over the world. Watch the Special Event to hear practitioners from all over the world share the challenges they face. Learn more…

https://youtu.be/5MLtvzbii0U

What is the difference between the Agenda for IA2030 and the Movement for IA2030?

• Scope and Nature: IA2030 is a strategic framework with a global vision for immunization over the decade, while the Movement for IA2030 is a dynamic, community-driven effort to implement that vision through local action and global collaboration.
• Operational Focus: IA2030 outlines the strategic priorities and goals for immunization efforts by global funders and agencies, whereas the Movement focuses on mobilizing support, facilitating peer learning, and sharing innovative practices to achieve those goals.
• Engagement and Collaboration: While IA2030 is a product of global consensus and sets the agenda for immunization, the Movement actively engages immunization professionals, stakeholders, and communities in a bottom-up approach to foster ownership and tailor strategies to local contexts.

What is the role of The Geneva Learning Foundation (TGLF)?

The Geneva Learning Foundation (TGLF) plays a pivotal role in facilitating the Movement for Immunization Agenda 2030 (IA2030). A Swiss non-profit organization with the mission to research and develop new ways to learn and lead, TGLF is instrumental in implementing large-scale, collaborative efforts to support the goals of IA2030. Here are the key roles TGLF fulfills within the Movement:

Facilitation and leadership: TGLF leads the facilitation of the Movement for IA2030, providing a platform for immunization professionals to collaborate, share knowledge, and drive action towards the IA2030 goals.

Learning-to-action approach: TGLF contributes to transforming technical assistance (TA) to strengthen immunization programs. This involves challenging traditional power dynamics and empowering immunization professionals to apply local knowledge to solve problems, support peers in doing the same, and contribute to global knowledge.

Peer learning scaffolding and facilitation: TGLF has demonstrated the feasibility of establishing a global peer learning platform for immunization practitioners. This platform enables health professionals to contribute knowledge, share experiences, and learn from each other, thereby fostering a community of practice that spans across borders.

Advocacy and mobilization: TGLF calls on immunization professionals to join the Movement for IA2030, aiming to mobilize a global community to share experiences and work collaboratively towards the IA2030 objectives. This includes engaging over 60,000 immunization professionals from 99 countries.

Governance, code of conduct, and ethical standards: Participants in TGLF’s programs are required to adhere to a strict Code of Conduct that emphasizes integrity, honesty, and the highest ethical, scientific, and intellectual standards. This includes accurate attribution of sources and appropriate collection and use of data. Movement Members are also expected respect and abide by any restrictions, requirements, and regulations of their employer and government.

Research and evaluation: TGLF may facilitate the connections between peers, for example to help them give and receive feedback on their local projects and other knowledge produced by learners. Insights and evidence from local action may also contribute in communication, advocacy, and training efforts. TGLF also invites learners to participate in research and evaluation to further the understanding of effective learning and performance management approaches for frontline health workers.

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