In 2019, experts from NCDC and RKI developed a training approach that looks at IPC through a social lens and considers the organizational and systemic aspects of IPC improvement: the “Participatory Approach to Learning in Systems – PALS”. The training approach is based upon theoretical concepts of inquiry learning and practiced thoroughly as a participatory approach. Elements of “Theme-Centered- Interaction” (TCI) are incorporated into the training approach in order to display the influencing factors for IPC and to reflect a systemic view. In this way, health care workers are trained in competencies, techniques and attitudes for promoting change, to be able to initiate and promote IPC improvement. To build up training capacities in Nigeria, selected IPC experts  and educationalists were trained as “PALS Trainers”. They themselves in turn trained and mentored teams of health care workers to be “Change Agents” for IPC improvement in their health facilities.

In July 2019, 22 future trainers started their training programme with a two-week full-time basic IPC course at the College of Medicine at University Lagos covering the medical-technical aspects of infection prevention and control. Subsequently, they conducted an IPC risk assessment as a field assignment in their work setting. The first module of PALS training for trainers took place in November 2019 and in January 2020 with two workshops in Abuja, and an intermediate field phase. This part of the training focused on the HOW of change processes: How can IPC be put into practice? How can change processes, which address local needs and conditions, be activated? Theoretical and practical sessions were combined to train communication, participation, systemic perspectives and team building. At the same time, the training supported the to-be trainers to shift from the perspective of IPC implementation to that of teaching, and to take first steps in their future role as trainers.

In March 2020, due to the COVID-19 outbreak, project activities were adapted to support the outbreak response in Nigeria: the project team at NCDC helped different sectors of the Nigerian health system to develop IPC protocols and guidelines and travelled across the nation to facilitate IPC trainings. The engagement with the newly trained PALS trainers continued with a series of webinars that focused on the application of PALS competences to prevent COVID 19 transmission in the immediate working environment of the participants. In September 2020, trainers deployed to act as trainers for the first time. They trained over 250 IPC focal persons of secondary health facilities in COVID-19 IPC trainings that included PALS elements and considered behavioral change, and thereby gained their first trainer experience.

In 2021 the implementation of the PALS training programme resumed with a “refresher workshop” for trainers in Abuja in July, that allowed for reflection on the experience acquired during the COVID-19 response and ensured continuation to the learning process. Trainers prepared the Change Agent trainings in state teams with the support of the project team. Recognizing the importance of leadership support for IPC improvement processes in health facilities, medical directors and chief medical directors participated in a PALS introductory workshop and were further involved in the programme during CA trainings and through advocacy visits. The Change Agent training consisted of two workshops with an intermittent field phase, followed by a 6-month mentoring period. Workshops were implemented in the autumn of 2021 in Edo, Ondo, Ebonyi and FCT. Ninety-two health workers of 23 health facilities were trained by PALS trainers (under expert advice and supervision of the project team).

Throughout the practice phase (January – July 2022), PALS trainers mentored the Change Agents and supported them in the application of PALS and implementation of IPC improvement activities in health facilities. The trainers in turn were mentored by the project team. The training of trainers concluded with a workshop for assessment and certification of 19 trainers in July 2022. The Change Agent training was completed in September 2022 with closure events in the participating states.

Throughout the whole project period, data documenting the training development and training implementation (of Trainers, Medical Directors and Change Agents), as well as the learning process of trainers and the IPC improvement activities in health facilities were collected to inform the monitoring and evaluation of the project. In September 2020, a baseline IPC assessment (IPCAF) was conducted in all participating health facilities. A qualitative study by an external researcher was conducted to contribute additional evidence from an outside perspective.