Outcomes and Lessons Learned From Immunization in Practice Training

Background The Kurdistan Region of Iraq (KRI) faces persistent challenges in immunization service delivery due to workforce shortages, limited training opportunities, and unequal resource distribution. Most vaccinators lack formal training and rely on informal mentorship, often resulting in knowledge and skill gaps. In response, the Kurdistan Region Ministry of Health (KMOH), with support from the United Nations Children's Fund (UNICEF), implemented training sessions based on the World Health Organization (WHO) Immunization in Practice (IIP) guide to enhance vaccinators' competencies. Objectives This study aimed to (1) assess knowledge improvement following IIP training, (2) analyze participant feedback, and (3) evaluate the training modality against adult learning principles. Methodology A retrospective quantitative study design was applied to analyze 23 IIP training sessions conducted from October 2024 to January 2025 across Erbil and Sulaymaniyah Directorates of Health (DOHs). A total of 474 vaccinators participated. Data were collected through pre- and post-tests, feedback forms, and training observations. Quantitative data were analyzed using descriptive statistics and paired t-tests, while open-ended feedback and observations were used to provide contextual understanding of the findings. Results Immediate knowledge scores significantly improved in both DOHs. In Erbil, the average score increased from 7.32 to 11.52, equal to an improvement of +4.20 points. In Sulaymaniyah, the average score increased from 8.45 to 11.76, equal to an improvement of +3.31 points (p < 0.001). The participants' feedback was highly positive, especially regarding trainer performance. However, gaps were noted in content relevance, technical clarity, and training environment.  Conclusion IIP training sessions enhanced vaccinators' immediate knowledge and were well-received. Future trainings should integrate more skill-based activities, improve logistical preparedness, and adopt a learner-centered approach to maximize impact and sustainability within the immunization workforce.