Abstract / Summary
Background: Kano 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 Approach: MCH-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. Findings: After 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. Conclusion: Embedding LxD within MCH-Track strengthened co-creation, streamlined workflows, and improved community mobilizer performance, demonstrating the value of adaptive management in reaching ZD children.