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

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-solving	How ZDLH-X provides a model
Learning from each other	The 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 collaboration	The 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 Recommendations	Implementation 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.