Insights from national stakeholders and health workers on learning and performance interventions in immunisation programs: a multi-country situational analysis.

Background: Health workers play a key role in providing high-quality health services, but health worker practice improvements remain limited despite significant investments in learning and performance interventions. We conducted a situational analysis to explore factors affecting health worker performance, focusing on barriers and facilitators and integrating digital solutions. Methods: In the analysis we focussed on paid professional health workers. Primary data collection occurred between April-May 2022 across seven countries, involving key informant interviews with immunisation program managers and human resource representatives. In three countries, human-centred design meetings included surveys on preferred interventions for improving learning and performance. Secondary data included a desk review of the literature, including recent strategy documents from the Gavi Alliance. We used a virtual session with human-centred design facilitators to create a health worker learning journey map. Results: Our findings show a shift towards digital and innovative approaches in learning, though traditional methods, such as in-service training and supervision, still dominate. Most initiatives depend on donor funding. There is a lack of evidence on the effectiveness of digital solutions. Integration with health workers' continuing professional development processes is limited, but career advancement motivates engagement. Challenges include inadequate staffing, limited training opportunities, and poor digital infrastructure. Preferred methods include workplace-based learning and digitally supported training. Evidence supports quality improvement or group problem-solving to improve practices, while other approaches, such as eLearning or blended learning and mentorship, require further evaluation. Conclusions: Stakeholders, including donors, should prioritise support for more effective learning approaches, combining strategies to improve outcomes. While stakeholders desire to expand digital learning, given the limited evidence, prioritising effectiveness evaluations are crucial. Educating stakeholders on evidence-based practices, promoting combined strategies, evaluating unproven interventions, and aligning donor funding with effective approaches is critical to enhancing interventions.