Zero-Dose Learning Agenda

The Zero-Dose Learning Agenda (ZDLA) was a 2-year learning initiative by the Gates Foundation to better understand how to accelerate progress toward the IA2030 goal of achieving a 50% reduction in ZD. Through ZDLA, partners applied learn-by-doing (LxD) techniques and practices in high-ZD settings.

This page provides a variety of resources for immunization decision-makers, implementers, and funders interested in exploring, integrating, and scaling evidence-based interventions that reach unvaccinated children using innovative LxD approaches.

• Overview Materials
• Learn-by-doing Approaches (LxD) and Lessons Learned
• Costing
• Drivers of Zero-Dose
• Gender
• Democratic Republic of the Congo (DRC)
• Ethiopia
• India
• Kenya
• Nigeria
• Pakistan

This two-year initiative (2023–2025) operated across select subnational areas in Democratic Republic of the Congo (DRC), Ethiopia, India, Kenya, Nigeria, and Pakistan where partners:

• Diagnosed drivers of ZD and understand their root causes;
• Worked collaboratively with end-users, including caregivers, community leaders, healthcare workers, and government officials, to co-design, implement, and iteratively adapt interventions;
• Reflected gender-related barriers and responsiveness; and,
• Captured costing information.

Overview materials

Resources that provide an overview of the ZDLA initiative and learnings.

Learn-by-doing Approaches (LxD) and Lessons Learned

Resources that explore LxD approaches, lessons, and learnings from ZDLA, including case studies, as well as practical ways to apply LxD techniques in new or existing work.

Costing 

Resources on the financial and economic costs of ZDLA interventions and LxD processes, including cost-per-zero-dose-child estimates and implications for scaling.

Drivers of Zero-Dose

Resources examining drivers and root causes of zero-dose status across ZDLA sites.

Resources not available.

Gender

Resources on gender-intentional design and implementation within ZDLA, including LxD approaches used.

Resources not available.

Democratic Republic of the Congo (DRC)

Country-specific resources from ZDLA implementation in Tshopo province, including lessons and learnings from high-ZD-prevalence rural and urban settings.

Ethiopia

Country-specific resources from ZDLA implementation in three different settings: an urban slum in Addis Ababa, pastoralist communities in Afar, and agrarian areas in Oromia.

India

Country-specific resources from ZDLA implementation in Uttar Pradesh and Bihar states, covering frontline worker capacity building, product-based tools, and fathers' group approaches across rural and urban settings.

Kenya

Country-specific resources from ZDLA implementation in Homa Bay and Turkana counties, including lessons on community-based outreach and father's groups.

Nigeria

Country-specific resources from ZDLA implementation in Kano state, including driver findings, intervention learnings, and examples of LxD tools being integrated into routine EPI processes.

Pakistan

Country-specific resources from ZDLA implementation in Karachi, covering interventions in urban high-ZD settings and lessons learned about working with non-traditional service delivery partners to improve connections to routine immunization.