Despite national immunization programs, a significant number of children in Zambia remain unvaccinated or under-vaccinated. In support of the Zero-Dose Learning Agenda (ZDLA) and with funding from the Gates Foundation, PATH’s Living Labs and the Zambian Ministry of Health are co-designing grassroots solutions with communities, health workers, and policymakers to close this immunization gap for good.
The ZDLA set out to identify the root causes of this issue across three levels:
- National and subnational levels: Logistical challenges such as supply chain gaps and data tracking hurdles.
- Health facility level: Overworked staff, low morale, and difficulty tracing missed-dose children.
- Community level: Misinformation, cultural resistance, and limited access to reliable vaccination information.
This multi-tiered challenge called for a localized, user-driven approach to identify what was really preventing full immunization coverage.
Human-centered design in action
Living Labs applied a human-centered design (HCD) approach to tackle these barriers. Through co-creation sessions, we worked directly with:
- End-users: Health care workers, Ministry of Health staff, civil society leaders, and caregivers, and
- Facilities: Selected from high-priority districts in collaboration with the Ministry of Health.
Challenges were mapped, prioritized, and reframed as opportunities for innovation—grounded in the realities of everyday users.
To bring new participants into the HCD process, Living Labs built on previous engagements through our User Advisory Group (UAG) and offered hands-on crash courses in design thinking. These sessions helped frontline staff and community members understand HCD and begin designing solutions that would work in their settings.
Ground-level insights that drove innovation
The co-creation sessions uncovered deeply rooted social and structural challenges. For example,
- Some parents visit health facilities, but not for vaccination.
- Certain churches forbid their members from vaccinating their children.
- Some girls refuse vaccines due to parental warnings linking them to satanism.
- Many people receive only the first dose of the human papillomavirus (HPV) or measles vaccine and do not return for the second dose.
- Concerns about side effects have led some parents to avoid vaccination entirely.
- When village leaders get vaccinated, it encourages community participation.
- As children age, mothers often shift focus to younger siblings, reducing follow-up care for older children.
These insights informed practical and culturally appropriate solutions, rooted in empathy and evidence.
Sr. Lombe presenting on the Identify, Access, Determine, Refer and Remind (IADRR) concept during the ZDLA co-creation sprint in Livingstone: Photo: PATH/Tony Mapulanga.
From insight to action
One of the standout innovations to emerge from the ZDLA is the Identify, Access, Determine, Refer and Remind (IADRR) concept. This simple, user-friendly tool acts as a job aid to help health workers quickly identify zero-dose or under-immunized children.
Other key solutions included Social and Behavior Change Communication (SBCC) sessions, which directly addressed vaccine hesitancy through group dialogue and myth-busting in communities with high resistance. With prototypes in hand and implementation guides in place, health workers and community members began testing the tools in real-world settings.
User feedback has been central to refining the tools. For instance, based on feedback, the teams translated tools into local languages, printed larger posters for better visibility, and identified schools as key sites to promote HPV vaccination.
“We have adapted the concept to work for cervical cancer screening.”— Frontline health worker, Mulobezi District, Western Province
Health care workers and the Living Labs team at the ZDLA co-creation workshop. Photo: PATH/Tony Mapulanga.
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Health care workers in group discussions brainstorming on their thematic areas during a ZDLA co-creation workshop. Photo: PATH/Tony Mapulanga.
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A UAG member presenting the Crazy 8 ideas developed by her group during a co-creation session. Photo: PATH/John Zgambo.
3 of 3Early impact and what’s next
Initial results point to real promise, including improved detection of zero-dose and under-vaccinated children, more efficient workflows for health workers, and greater vaccine uptake through tailored community engagement. With momentum building, there are plans to expand and adapt the IADRR and SBCC concepts to other districts and health priorities.
What started as a learning agenda is fast becoming a replicable model for community-driven health innovation.
By listening to the people most affected—health workers, parents, and community leaders—the ZDLA has sparked practical innovations that are improving immunization coverage and saving young lives. And this is just the beginning.
“Our performance for the quarter has surpassed our targets.”— Frontline health worker, Mulobezi District, Western Province
