Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme

What happens when you actually ask health workers what they think? When 4,434 health workers from every corner of Nigeria analyzed why too many children in their communities remained unvaccinated, half discovered their initial assumptions were completely wrong. “The hardest part of writing the analysis was that I ended up being surprised at the answer I got at the end of it all,” reflected one participant in this unprecedented peer learning exercise launched in July 2024. In the Immunization Agenda 2030 Collaborative, a peer learning network and community launched by The Geneva Learning Foundation (TGLF) with UNICEF, Gavi, and NPHCDA, Nigeria’s immunization challenges were examined by the doctors, nurses, midwives, pharmacists, community health workers, and health managers who face these problems every day. What they found challenges decades of conventional wisdom about why global health programs underperform. The problem isn’t necessarily that health workers don’t know what to do. They may hold the solutions—and know how to implement them with existing resources. The problem is that this valuable knowledge about ‘what works’ remains under-recognized and under-utilized. Nigeria Immunization Agenda 2030 Collaborative: Piloting a National Peer Learning Programme documents how peer learning revealed that progress is often limited by implementation gaps, not knowledge gaps. The report surfaces hundreds of locally-tested solutions for both supply-side challenges (from data disconnects to cold chain failures) and demand-side barriers (from scheduling conflicts to community trust issues), grounded in ground-level practices. More remarkably, it demonstrates how peer learning networks can achieve transformative scale at unprecedented speed and cost-effectiveness. Within two weeks, over 4,000 health workers from all 36 states – primarily from the North – were connected across Nigeria’s complex federal system. Within four weeks, they had generated 400 root cause analyses of local immunization challenges. Within six weeks, participants began credibly reporting improved health outcomes. One year later, the network continues solving problems together without any external support. Demonstrating the value of an integrated, sector-wide approach, this methodology rapidly traveled beyond immunization to disability inclusion, malaria programming, and outbreak response. Participants describe discovering “I did not realize how much I could do with what we already have”—a finding with particular relevance as countries navigate funding constraints while pursuing ambitious health goals. This report offers critical insights for anyone working to close the gap between well-designed health strategies and the communities they’re meant to serve. The implications extend far beyond immunization—and far beyond Nigeria. The evidence reveals the untapped potential within every health system.