Listening and Learning at Teach to Reach 7 (IA2030 Listening and Learning Report 4)

The seventh Teach to Reach: Connect online event, hosted by the Learning Geneva Foundation (Podcast | Telegram | YouTube | Twitter) in October 2022, provided a platform for members of the Movement for Immunization Agenda 2030 (IA2030) to share their experiences and develop an international network. Teach to Reach events are unique in that they prioritize the contributions of those working in national immunization programs. International experts are called upon as “guides on the side” rather than “sage on the stage”.

This report, introduced by WHO and UNICEF, aims to analyze the experiences and stories shared during or after Teach to Reach 7 to better understand (1) what participants reported learning from each other through peer learning and (2) what international practitioners can learn from these experiences.

“As we work towards achieving the Immunization Agenda 2030 goals, it is crucial to support and empower health professionals at the local level. This report serves as a testament to their unwavering commitment and the power of sharing experience. By listening to their stories and insights, we can better understand and address the challenges they face, ultimately fostering a stronger and more resilient global immunization system.” – Dr Kate O’Brien, Director of the Department for Immunization, Vaccines, and Biologicals (IVB), World Health Organization (WHO) and Ephrem T. Lemango, Associate Director of Immunization at UNICEF.

Teach to Reach 7’s overarching theme was to explore local practitioner responses to the continued backsliding in vaccination coverage reported by UNICEF and WHO in July 2022, beginning an exploration of what sustainable recovery means at the local level.

The event encompassed plenary sessions as well as time for networking, when participants are randomly paired and have time for private conversations. These networking sessions had a particular focus on (1) use of the TGLF Ideas Engine, a living repository of advice, ideas and practices provided by participants on the TGLF learning programme; (2) interpersonal communication and the use of the UNICEF guide on interpersonal communication; and (3) use of root cause analysis to identify underlying reasons for low coverage.

Alongside networking, plenary sessions focused on: (1) sharing experiences in development and implementation of IA2030-related Action Plans developed by TGLF programme participants; (2) local challenges and recovery post-pandemic; and (3) the impact of the COVID-19 pandemic on existing immunization programmes.

Key Insights

The experiences shared by 14,134 health professionals (7,667 English-speaking and 6,467 French-speaking) and the feedback gathered after the event provided additional insight into the challenges facing immunization professionals in low- and middle-income countries and how they are addressing them.

Foundation programme participants highlighted many issues that are known to be problems for immunization programs in low- and middle-income countries. These include stock-outs, inaccurate denominators, access to hard-to-reach populations (rural and urban), displacement and follow-up of defaulters, and hesitancy.

Gender barriers were also discussed, including women’s lack of autonomy in some cultures, the need to engage men and encourage their involvement in childhood immunization, and the importance of addressing gender discrimination in the workplace (explored further in TGLF Case Study 11).

Vaccine hesitancy, particularly related to COVID-19 vaccination, remains a frequently recurring challenge. Hesitancy among colleagues and other healthcare workers was highlighted as a significant issue for some. Several strategies for dealing with hesitancy were discussed, including demonstrating one’s own vaccination status or experience of COVID-19, using photographs or short video clips, and mobilizing community influencers. Often, a patient and persistent approach, building relationships and trust, was required to bring people around.

“During one of our meetings with the community, the elites made us understand that we often make decisions for them and this does not allow them to help us. The village chief said, ‘What we are thinking of doing for them without their involvement is a coup d’etat’ and that really touched me.” – Man, district level, Chad.

The root cause study identified specific problems affecting service utilization and suggested corrective actions. In particular, the importance of community discussions to understand attitudes and behaviors and the use of local data were widely recognized.

Effective interpersonal communication was broadly identified as an essential aspect of community engagement, community receptivity to immunization messages, and building trust with individuals and communities. It also benefits improved teamwork, the importance of which to the performance of immunization programs has been repeatedly noted. Expert guidance on this topic was widely appreciated and participants were enthusiastic about using UNICEF guidance materials.

The power of peer learning

Within a growing ecosystem of digital learning opportunities offered by global partners, TGLF’s array of peer learning opportunities, including Teach to Reach Connect 7, may therefore represent a novel approach by which immunization workers can be exposed to effective real-world practices, grounded in overcoming common operational challenges, and draw inspiration from the use of such practices by their peers, while at the same time benefiting from the global perspective provided by expert facilitators contributing to the learning programme.

In addition, many participants highlighted the benefits of networking with peers from other countries, who could offer practical advice on tackling specific immunization challenges but also encourage a sense of belonging to a wider community, making more real the concept of a “Movement for Immunization Agenda 2030 (IA2030)”. Exposure to the work of others, their successes, and common challenges, was frequently said to be inspiring.

Although some evidence was provided that participation in the peer learning programme has led to improvements in participants’ capabilities, and immunization programme performance, further work is needed to provide more rigorous evidence of positive impacts and the routes through which these positive impacts are achieved.

This Immunization Agenda 2030 (IA2030) report is part of the IA2030 Movement’s Knowledge-to-Action Hub. Learn more about the Hub…Learn more about the Movement…