Learning-by-Doing to Adapt a Digital Community Engagement Strategy for Identifying and Reaching Zero-Dose Children in Kano State, Nigeria: A Program Case Study
- 1Datharm, Abuja, Nigeria
Abstract
BackgroundKano State has one of the highest concentrations of zero-dose (ZD) children in Nigeria, challenging equitable immunization coverage. Digital engagement tools meant to strengthen timely data to address such gaps often underperform due to limited adaptability to user needs. Learning-by-doing (LxD), which brings together human-centered design and adaptive management, offers more context-responsive solutions.
Intervention and Implementation ApproachMCH-Track, a digital platform for tracking and referral for childhood vaccinations was used by 56 female community mobilizers in two local government areas (LGAs) out of the 44 LGAs in Kano State, Nigeria. We conducted a program case study from: 1) August 2024-April 2025 (initial implementation); and 2) adapted implementation (May 2025-November 2025), where LxD was incorporated to address emergent challenges. LxD included structured shadowing, monthly interviews with users, after-action reviews, and change log to track adaptations alongside routine services. Performance was monitored using four indicators: feedback actioned, response time-to-user feedback, ease-of-use score, and mobilizer performance in tracking ZD children.
FindingsAfter incorporating LxD, 17 issues were identified and led to 12 prioritized adaptations. All logged issues received responses, with median response time declining to approximately two weeks, while community mobilizers reported higher usability of the digital platform (e.g., mean ease-of-use score of 4.1 out of 5). Enhanced root-cause analysis enabled trend tracking and clearer escalation pathways for systemic issues like micro-stockouts at immunization points. Empathy tool records revealed mobilizer struggles with platform. This was immediately logged, prompting user experience redesign into a seamless, single-step process from registration-to-referral. During the LxD implementation period, an average of 33 ZD children per month were identified via MCH-Track, a substantial increase from the pre-LxD period (an average of 11 ZD children identified per month). Average referral-to-access rates also improved during the LxD period, rising from 44% of identified and referred ZD children accessing immunization services pre-LxD to 70% after incorporating LxD practices.
ConclusionEmbedding LxD within MCH-Track strengthened co-creation, streamlined workflows, and improved community mobilizer performance, demonstrating the value of adaptive management in reaching ZD children.
Teaser MessageIntegrating learning-by-doing approaches - mixture of human-centered design and adaptive management - into a digital community-engagement platform improved understanding of previously under-recognized vaccination barriers, implementing locally tailored adaptations, and strengthening frontline responsiveness to reach zero-dose children in Kano State, Nigeria.
Key MessagesO_ST_ABSKey FindingsC_ST_ABSO_LICo-creation with community mobilizers and transparent change log use translated frontline feedback into trackable system improvements, improved birth-registration-to-referral workflows, and enhanced identification and follow-up of zero-dose children. C_LIO_LIEmbedding iterative rapid cycles within the digital community-engagement platform addressed weak feedback loops and unified decisions between mobilizers and supervisors. C_LIO_LIIncorporating monthly learn-by-doing cycles into MCH-Track implementation strengthened how community mobilizers helped households overcome vaccination barriers through root-cause-analysis. For instance, insights from After-Action Reviews revealed "programmatic mistrust" was linked to "male-resistance", a key barrier to vaccination. C_LI
Key ImplicationsO_LIHealth system managers and implementing partners could benefit from incorporating learn-by-doing approaches - human-centered design plus adaptive management - into existing platforms (e.g, Health Partners Forums) and prioritizing co-creation with communities who face challenges with services, gender dynamics, and trust. C_LIO_LIProgram managers can combine digital tools with structured feedback cycles to better identify and respond to healthcare worker needs, increase efficiency and quality. C_LIO_LIEmbedding adaptive learning processes within routine immunization governance and financing structures could promote more responsive and resilient programming. C_LI
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BibTeX
@misc{nagogo2026learningbydoing,
title = {{Learning-by-Doing to Adapt a Digital Community Engagement Strategy for Identifying and Reaching Zero-Dose Children in Kano State, Nigeria: A Program Case Study}},
author = {A. Ahmad K.U Nagogo and N. S. Nass and A. Muhammad and R. Abubakar and M. B. Nurudeen and Y. Mohammed and S. Sani and J. Sequeira and P. Y. Liu and K. Maloney and A. Saad and Y. A. Yusufari and S. A. Ibrahim and N. Fullman},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.08.26365040},
url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26365040v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Learning-by-Doing to Adapt a Digital Community Engagement Strategy for Identifying and Reaching Zero-Dose Children in Kano State, Nigeria: A Program Case Study
AU - A. Ahmad K.U Nagogo
AU - N. S. Nass
AU - A. Muhammad
AU - R. Abubakar
AU - M. B. Nurudeen
AU - Y. Mohammed
AU - S. Sani
AU - J. Sequeira
AU - P. Y. Liu
AU - K. Maloney
AU - A. Saad
AU - Y. A. Yusufari
AU - S. A. Ibrahim
AU - N. Fullman
PY - 2026
DA - 2026/10/08
PB - medRxiv
DO - 10.64898/2026.10.08.26365040
UR - https://www.medrxiv.org/content/10.64898/2026.10.08.26365040v1
AB - BackgroundKano State has one of the highest concentrations of zero-dose (ZD) children in Nigeria, challenging equitable immunization coverage. Digital engagement tools meant to strengthen timely data to address such gaps often underperform due to limited adaptability to user needs. Learning-by-doing (LxD), which brings together human-centered design and adaptive management, offers more context-responsive solutions. Intervention and Implementation ApproachMCH-Track, a digital platform for tracking and referral for childhood vaccinations was used by 56 female community mobilizers in two local government areas (LGAs) out of the 44 LGAs in Kano State, Nigeria. We conducted a program case study from: 1) August 2024-April 2025 (initial implementation); and 2) adapted implementation (May 2025-November 2025), where LxD was incorporated to address emergent challenges. LxD included structured shadowing, monthly interviews with users, after-action reviews, and change log to track adaptations alongside routine services. Performance was monitored using four indicators: feedback actioned, response time-to-user feedback, ease-of-use score, and mobilizer performance in tracking ZD children. FindingsAfter incorporating LxD, 17 issues were identified and led to 12 prioritized adaptations. All logged issues received responses, with median response time declining to approximately two weeks, while community mobilizers reported higher usability of the digital platform (e.g., mean ease-of-use score of 4.1 out of 5). Enhanced root-cause analysis enabled trend tracking and clearer escalation pathways for systemic issues like micro-stockouts at immunization points. Empathy tool records revealed mobilizer struggles with platform. This was immediately logged, prompting user experience redesign into a seamless, single-step process from registration-to-referral. During the LxD implementation period, an average of 33 ZD children per month were identified via MCH-Track, a substantial increase from the pre-LxD period (an average of 11 ZD children identified per month). Average referral-to-access rates also improved during the LxD period, rising from 44% of identified and referred ZD children accessing immunization services pre-LxD to 70% after incorporating LxD practices. ConclusionEmbedding LxD within MCH-Track strengthened co-creation, streamlined workflows, and improved community mobilizer performance, demonstrating the value of adaptive management in reaching ZD children. Teaser MessageIntegrating learning-by-doing approaches - mixture of human-centered design and adaptive management - into a digital community-engagement platform improved understanding of previously under-recognized vaccination barriers, implementing locally tailored adaptations, and strengthening frontline responsiveness to reach zero-dose children in Kano State, Nigeria. Key MessagesO_ST_ABSKey FindingsC_ST_ABSO_LICo-creation with community mobilizers and transparent change log use translated frontline feedback into trackable system improvements, improved birth-registration-to-referral workflows, and enhanced identification and follow-up of zero-dose children. C_LIO_LIEmbedding iterative rapid cycles within the digital community-engagement platform addressed weak feedback loops and unified decisions between mobilizers and supervisors. C_LIO_LIIncorporating monthly learn-by-doing cycles into MCH-Track implementation strengthened how community mobilizers helped households overcome vaccination barriers through root-cause-analysis. For instance, insights from After-Action Reviews revealed "programmatic mistrust" was linked to "male-resistance", a key barrier to vaccination. C_LI Key ImplicationsO_LIHealth system managers and implementing partners could benefit from incorporating learn-by-doing approaches - human-centered design plus adaptive management - into existing platforms (e.g, Health Partners Forums) and prioritizing co-creation with communities who face challenges with services, gender dynamics, and trust. C_LIO_LIProgram managers can combine digital tools with structured feedback cycles to better identify and respond to healthcare worker needs, increase efficiency and quality. C_LIO_LIEmbedding adaptive learning processes within routine immunization governance and financing structures could promote more responsive and resilient programming. C_LI
ER -