The Participatory Approach to Learning in Systems (PALS) is an innovative approach that is applied in Nigerian healthcare settings to improve infection prevention and control (IPC) practices by mobilising, enabling and empowering healthcare workers at the facility level to become Change Agents. The approach recognises IPC improvement not only as a clinical matter that requires biomedical IPC knowledge, but also as a com­plex social practice of quality development. PALS acknowledges the local conditions and situation of a health facility and its personnel as the starting point of tailored IPC improvement processes of the organisation as a physical as well as a cultural system.

Consequently, the content of IPC trainings shifts from only technical knowledge to social and enabling skills to achieve bringing IPC knowledge into practice. The training program builds on the key pillars of teamwork, equitable communication and leverages the experiences of local players and the local conditions in the health facility to address identified challenges. The approach adds a social and systemic organi­zational lens to the clinical or technical knowledge to make effective implementation possible.

The PALS training approach was implemented in Nigeria as “Training of Trainers” at national level and Training of Change Agents at state level. The publications “Trainer Handbook” and “Change Agent Training Book” and “PALS Booklet for Hospital Management” are designed to stimulate and help participants of the PALS IPC Training Programme to deepen their understanding of the “Participatory Approach to Learning in Systems (PALS)”.

PALS can only be experienced; it cannot be taught.

PALS cannot be internalised through reading or teaching alone, but must be experienced in order to question, discuss, and understand it and build the cor­responding competencies and attitudes. This manual helps to guide practi­tioners in this experiential endeavour, and the multimodule training programme follows this need and is characterised by a specific didactic format.

We hope that others find it useful to approach organisational development efforts in health facilities or other settings. In addition, it is our collective wish that it stimulates further partic­ipatory project management and teamwork in national and international public health collaboration.

Further information about the project and the PALS approach for training and practice can be found on the project website: nicadeipcpals.gov.ng. The project NiCaDe IPC is part of the Global Health Protection Programme (GHPP).