Achieving Zero-Dose Children: A New Era of Learning and Performance Management in Global Immunization Efforts

“Concurrently, a health workforce shortage is worsening, and concerns about health workers’ working conditions persist,” said a report highlighting the dire state of global healthcare. In a world where 1.5 million lives are lost annually to vaccine-preventable diseases and 25 million children remain under-immunized, the need for effective solutions becomes increasingly urgent.

While efforts are being made to address health workforce shortages in low- and middle-income countries (LMICs), it is essential not to neglect the existing healthcare workforce. Recognizing the importance of improving their performance, new and innovative approaches to learning and performance management (LPM) are being explored.

The traditional lecture-style classroom training and routine supervision have fallen short of expectations in enhancing health worker performance and quality of care. It is evident that a paradigm shift is needed. “Widely used traditional lecture-style classroom in-service training and routine supervision have not had the expected impact on health worker performance or quality of care,” the report stated.

Enter Learning and Performance Management (LPM), a comprehensive strategy aimed at improving and maintaining the performance of health workers. This umbrella term encompasses various approaches, with a substantial body of evidence from LMICs indicating which strategies have proven effective, even in the face of workforce shortages.

Not all approaches are created equal, however. Multifaceted strategies that combine training with other interventions, such as supervision or group problem-solving, have shown greater effects on health worker performance than isolated interventions. Equipping health workers with the necessary tools and supplies is vital, but it must be complemented by interventions that have a proven impact on their performance.

Training conducted on-site, where health workers operate, and incorporating clinical practice have been found to be more effective. Supervision also yields better results when supervisors receive supervision themselves, engage in problem-solving with health workers, and provide mentorship. Listening to the needs and preferences of health workers is crucial when designing LPM strategies. Workplace-based learning, clinical practice rotations, and decision-support tools have emerged as the top three preferred learning approaches among health workers.

A case study on Somalia’s successful implementation of a digital solution for COVID-19 vaccine delivery exemplifies the transformative potential of LPM. Through a mobile and web application built on CommCare, the country recorded more than 200,000 vaccinees, ensuring efficient and equitable vaccine delivery. This digital solution streamlined workflow, eliminated the constraints of a paper-based system, and provided reliable data on vaccinees for the first time. It facilitated tracking of campaign progress, equitable distribution, and follow-up on vaccination status.

When developing LPM strategies, it is crucial to take practical steps such as conducting a situational analysis, considering existing resources and partnerships, and focusing on programmatically important issues within the program’s sphere of influence. The use of digital interventions for LPM has surged during the COVID-19 pandemic. However, their effects on health worker performance have been mixed, emphasizing the importance of evidence-based decisions considering effectiveness, context suitability, and cost.

Monitoring health worker performance, assessing the impact of interventions, and adapting them as necessary are crucial components of any LPM strategy. By rethinking traditional approaches to healthcare worker learning and performance management, we have the power to enhance health worker performance, improve the quality of care, and ultimately achieve better population health outcomes.

Evidence-based LPM approaches, tailored to the unique needs and context of each country, hold the key to reaching zero-dose children and making a tangible difference in global health. It is time to embrace innovation, invest in our healthcare workforce, and revolutionize healthcare through effective learning and performance management. Together, we can create a healthier and brighter future for all.