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Knowing-in-action: Bridging the theory-practice divide in global health
The gap between theoretical knowledge and practical implementation remains one of the most persistent challenges in global health. This divide manifests in multiple ways: research that fails to address practitioners’ urgent needs, innovations from the field that never inform formal evidence systems, and capacity building approaches that cannot meet the massive scale of learning required. Donald Schön’s seminal 1995 analysis of the “dilemma of rigor or relevance” in professional practice offers crucial insights for “knowing-in-action“.
Schön’s analysis: The dilemma of rigor or relevance
Schön begins by examining how knowledge becomes institutionalized through education. Using elementary school mathematics as an example, he describes how knowledge is broken into discrete units (“math facts”), organized into progressive modules, assembled into curricula, and measured through standardized tests. This systematization shapes not just content but the entire organization of time, space, and institutional arrangements.
From this foundation, Schön introduces his central metaphor of two contrasting landscapes in professional practice that prevent “knowing-in-action”. As he describes it:
“In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.”
The cruel irony, Schön observes, lies in the relative importance of these terrains: “The problems of the high ground tend to be relatively unimportant to individuals or to society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.”
This creates what Schön calls the “dilemma of rigor or relevance” – practitioners must choose between remaining on the high ground where they can maintain technical rigor or descending into the swamp where they must rely on experience, intuition, and what he terms “muddling through.”
The historical roots of the divide
Schön traces this dilemma to the epistemology embedded in modern research universities. Drawing on Edward Shils’s historical analysis, he describes how American scholars returning from Germany after the Civil War brought back “the German idea of the university as a place in which to do research that contributes to fundamental knowledge, preferably through science.”
This was, as Schön notes, “a very strange idea in 1870,” running counter to the prevailing British model of universities as sanctuaries for liberal arts or finishing schools for gentlemen. The new model first took root at Johns Hopkins University, whose president embraced the “bizarre notion that professors should be recruited, promoted, and granted tenure on the basis of their contributions to fundamental knowledge.”
This shift created what Schön terms the “Veblenian bargain” (named after Thorstein Veblen), establishing a separation between:
- Research universities focused on “true scholarship” and fundamental knowledge
- Professional schools dedicated to practical training
Knowing-in-action in global health: From fragmentation to integration
The historical division between theory and practice that Schön identified continues to shape global health in profound and often problematic ways. This manifests in three interconnected challenges that demand our urgent attention: the knowledge-practice gap, the scale challenge, and the complexity challenge. Yet emerging approaches suggest potential paths forward, particularly through structured peer learning networks that could help bridge Schön’s “high ground” and “swamp.”
Three fundamental challenges
Challenge #1: The knowing-in-action divide
The separation between research institutions and field practice creates not just an academic concern but a practical crisis in healthcare delivery. Consider the response to COVID-19: while research institutions rapidly generated new knowledge about the virus, frontline health workers struggled to translate this into practical approaches for their specific contexts. Their hard-won insights about what worked in different settings rarely made it back into formal evidence systems, epitomizing the one-way flow of knowledge that impoverishes both research and practice.
This pattern repeats across global health. Research agendas, shaped by academic incentives and funding priorities, often fail to address practitioners’ most pressing challenges. A community health worker in rural Bangladesh facing complex challenges around vaccine hesitancy may struggle to find relevant guidance – while global experts are convinced that they already have all the answers. Meanwhile, local solutions to building vaccine confidence remain uncaptured by formal knowledge systems.
The rise of implementation science attempts to bridge this divide, yet often remains subordinate to “pure” research in academic hierarchies. This reflects Schön’s observation about the privileging of high ground problems over swampy ones, even when the latter hold greater practical significance.
Challenge #2: The scale imperative
Traditional approaches to professional education face fundamental limitations in meeting the massive need for health worker capacity building. The World Health Organization projects a shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries. Conventional training approaches that rely on cascading knowledge through workshops and formal courses can reach only a fraction of those who need support.
More fundamentally, these knowledge transmission models prove inadequate for addressing complex local realities. A standardized curriculum developed by experts, no matter how well-designed, cannot anticipate the diverse challenges health workers face across different contexts. When a district immunization manager in Nigeria must adapt vaccination strategies for nomadic populations during a drought, they need more than pre-packaged knowledge – they need ways to learn from others who are facing similar challenges.
Resource constraints further limit the reach of conventional approaches. The cost of traditional training programmes, both in money and time away from service delivery, makes it impossible to scale them to meet the need. Yet the human cost of this capacity gap, measured in preventable illness and death, demands urgent solutions.
Challenge #3: The complexity conundrum
Contemporary global health faces challenges that fundamentally resist standardized technical solutions. Climate change exemplifies this complexity, creating cascading effects on health systems and communities that cannot be addressed through linear interventions. When rising temperatures alter disease patterns while simultaneously disrupting cold chains for vaccine delivery, no single technical fix suffices.
Similarly, emerging and re-emerging infectious diseases demand responses that cross traditional boundaries between animal and human health, environmental factors, and social determinants. Health workforce development must grapple with complex systemic issues around motivation, retention, and capacity building. The COVID-19 pandemic demonstrated how traditional approaches to health system strengthening often prove inadequate in the face of complex adaptive challenges.
Emerging solutions: A new paradigm for learning and practice
Recent innovations suggest promising approaches to bridging these divides through structured peer learning networks. Digital platforms enable health workers to share experiences and solutions across geographical boundaries, creating new possibilities for scaled learning that maintains local relevance.
Solution #1: The power of structured peer learning
Experience from digital learning networks demonstrates how structured peer interaction can enable more efficient and effective knowledge sharing than traditional top-down approaches. When health workers can directly connect with peers facing similar challenges, they not only share solutions but collectively generate new knowledge through their interactions.
These networks provide mechanisms for validating practical knowledge through peer review processes that complement traditional academic validation. A successful intervention developed by a rural clinic in Thailand can be critically examined by peers, adapted for different contexts, and rapidly disseminated across the network. This creates a more dynamic and responsive knowledge ecosystem than traditional publication cycles allow.
Solution #2: Network effects and collective intelligence
The potential of practitioner networks extends beyond simple knowledge sharing. When properly structured, these networks create possibilities for:
- Rapid adaptation to emerging challenges through real-time sharing of experiences
- Collective problem-solving that draws on diverse perspectives and contexts
- Systematic capture and analysis of field innovations
- Development of context-specific solutions that build on shared learning
Most importantly, these networks can help bridge Schön’s high ground and swamp by creating dialogue between different forms of knowledge and practice. They provide spaces where academic research can inform field practice while simultaneously allowing field insights to shape research agendas.
Four principles toward knowing-in-action for global health
Drawing on Schön’s call for a “new epistemology,” we can identify four principles for transforming how we know what we know in global health:
Principle #1: Valuing multiple forms of knowledge
The complexity of contemporary health challenges demands recognition of multiple valid forms of knowledge. The practical wisdom developed by a community health worker through years of service deserves attention alongside randomized controlled trials. This requires challenging existing hierarchies of evidence while maintaining rigorous standards for validating knowledge claims.
Principle #2: Enabling knowledge creation from practice
Health workers must be supported as knowledge producers, not just knowledge consumers. This means creating structures for systematically capturing and validating field insights, building evidence from implementation experience, and enabling continuous learning from practice. Digital platforms can provide scaffolding for this knowledge creation while ensuring quality through peer review processes.
Principle #3: Scaling through networked learning
Traditional scaling approaches that rely on standardization and top-down dissemination must be complemented by networked learning to create and amplify knowing-in-action. This means building systems that can:
- Connect practitioners across contexts and boundaries
- Enable peer validation of knowledge
- Support rapid dissemination of innovations
- Build collective intelligence through structured interaction
Principle #4: Embracing complexity
Rather than seeking to reduce complexity through standardization, health systems must build capacity for working effectively within complex adaptive systems. This means supporting adaptive learning, enabling context-specific solutions, and building capacity for systems thinking at all levels.
The challenges facing global health today demand new ways of creating, validating, and sharing knowledge. By embracing approaches that bridge Schön’s high ground and swamp, we may find paths toward health systems that are both more rigorous and more relevant to the communities they serve.
Looking forward
Schön’s analysis helps explain why traditional approaches to global health knowledge and learning often fall short. More importantly, it points toward solutions that could help bridge the theory-practice divide to support knowing-in-action:
- New digital platforms that enable peer learning at scale
- Networks that connect practitioners across contexts
- Approaches that validate practical knowledge
- Systems that support rapid learning and adaptation
Schön’s insights remain remarkably relevant to contemporary global health challenges. His call for a new epistemology that can bridge theory and practice speaks directly to our current needs. By embracing new approaches to learning and knowledge creation that honor both rigor and relevance, we may find ways to address the complex challenges that lie ahead.
The key lies not in choosing between high ground and swamp, but in building new kinds of bridges between them – bridges that can support the massive scale of learning needed while maintaining the local relevance essential for impact. Recent innovations in peer learning networks and digital platforms suggest this bridging may be increasingly possible, offering hope for more effective global health practice in an increasingly complex world.
The challenge now is to develop and implement these bridging approaches at the scale needed to support global health workers worldwide. This will require new ways of thinking about knowledge, learning, and practice – ways that honor both the rigor of research and the wisdom of experience. The future of global health may depend on our success in this endeavor.
Reference
Schön, Donald A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673
Image: The Geneva Learning Foundation Collection © 2024
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#1 #2 #3 #4 #CollectiveIntelligence #DonaldASchön #epistemology #globalHealth #knowDoGap #networkedLearning #peerLearning #scale
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Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems
Global health continues to grapple with a persistent tension between standardized, evidence-based interventions developed by international experts and the contextual, experiential local knowledge held by local health workers. This dichotomy – between global expertise and local knowledge – has become increasingly problematic as health systems face unprecedented complexity in addressing challenges from climate change to emerging diseases.
The limitations of current approaches
The dominant approach privileges global technical expertise, viewing local knowledge primarily through the lens of “implementation barriers” to be overcome. This framework assumes that if only local practitioners would correctly apply global guidance, health outcomes would improve.
This assumption falls short in several critical ways:
- It fails to recognize that local health workers often possess sophisticated understanding of how interventions need to be adapted to work in their contexts.
- It overlooks the way that local knowledge, built through direct experience with communities, often anticipates problems that global guidance has yet to address.
- It perpetuates power dynamics that systematically devalue knowledge generated outside academic and global health institutions.
The hidden costs of privileging global expertise
When we examine actual practice, we find that privileging global over local knowledge can actively harm health system performance:
- It creates a “capability trap” where local health workers become dependent on external expertise rather than developing their own problem-solving capabilities.
- It leads to the implementation of standardized solutions that may not address the real needs of communities.
- It demoralizes community-based staff who see their expertise and experience consistently undervalued.
- It slows the spread of innovative local solutions that could benefit other contexts.
Evidence from practice
Recent experiences from the COVID-19 pandemic provide compelling evidence for the importance of local knowledge. While global guidance struggled to keep pace with evolving challenges, local health workers had to figure out how to keep health services going:
- Community health workers in rural areas adapted strategies.
- District health teams created new approaches to maintain essential services during lockdowns.
- Facility staff developed creative solutions to manage PPE shortages.
These innovations emerged not from global technical assistance, but from local practitioners applying their deep understanding of community needs and system constraints, and by exploring new ways to connect with each other and contribute to global knowledge.
Towards a new synthesis
Rather than choosing between global and local knowledge, we need a new synthesis that recognizes their complementary strengths. This requires three fundamental shifts:
1. Reframing local knowledge
- Moving from viewing local knowledge as merely contextual to seeing it as a source of innovation.
- Recognizing frontline health workers as knowledge creators, not just knowledge recipients.
- Valuing experiential learning alongside formal evidence.
2. Rethinking technical assistance
- Shifting from knowledge transfer to knowledge co-creation.
- Building platforms for peer learning and exchange.
- Supporting local problem-solving capabilities.
3. Restructuring power relations
- Creating mechanisms for local knowledge to inform global guidance.
- Developing new metrics that value local innovation.
- Investing in local knowledge documentation and sharing.
Practical implications
This new synthesis has important practical implications for how we approach health system strengthening:
Investment priorities
- Funding mechanisms need to support local knowledge creation and sharing
- Technical assistance should focus on building local problem-solving capabilities
- Technology investments should enable peer learning and knowledge exchange
Capacity building
- Training should emphasize critical thinking and adaptation skills as constitutive of new forms of leadership
- Learning programmes should connect peers across contexts
- Evaluation should measure local innovation and problem-solving
Knowledge management (KM)
- Systems need to recognize that knowledge is found in the connections between humans (and increasingly machines), so that improving KM is about more ‘pipes’ (connections) and better quality-ones
- Platforms should therefore enable peer learning and exchange
- Evidence must include practitioner experience and insights
New paths forward
Moving beyond the false dichotomy between global and local knowledge opens new possibilities for strengthening health systems. By recognizing and valuing both forms of knowledge, we can create more effective, resilient, and equitable health systems.
The challenges facing health systems are too complex for any single source of knowledge to address alone. Only by bringing together global expertise and local knowledge can we develop the solutions needed to improve health outcomes for all.
References
Braithwaite, J., Churruca, K., Long, J.C., Ellis, L.A., Herkes, J., 2018. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med 16, 63. https://doi.org/10.1186/s12916-018-1057-z
Farsalinos, K., Poulas, K., Kouretas, D., Vantarakis, A., Leotsinidis, M., Kouvelas, D., Docea, A.O., Kostoff, R., Gerotziafas, G.T., Antoniou, M.N., Polosa, R., Barbouni, A., Yiakoumaki, V., Giannouchos, T.V., Bagos, P.G., Lazopoulos, G., Izotov, B.N., Tutelyan, V.A., Aschner, M., Hartung, T., Wallace, H.M., Carvalho, F., Domingo, J.L., Tsatsakis, A., 2021. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports 8, 1–9. https://doi.org/10.1016/j.toxrep.2020.12.001
Jerneck, A., Olsson, L., 2011. Breaking out of sustainability impasses: How to apply frame analysis, reframing and transition theory to global health challenges. Environmental Innovation and Societal Transitions 1, 255–271. https://doi.org/10.1016/j.eist.2011.10.005
Salve, S., Raven, J., Das, P., Srinivasan, S., Khaled, A., Hayee, M., Olisenekwu, G., Gooding, K., 2023. Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies. PLOS Glob Public Health 3, e0001447. https://doi.org/10.1371/journal.pgph.0001447
Yamey, G., 2012. What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Global Health 8, 11. https://doi.org/10.1186/1744-8603-8-11
Share this:
#climateChangeAndHealth #decolonization #evidenceBasedInterventions #expertise #globalHealth #healthSystems #implementationScience #localKnowledge
-
Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems
Global health continues to grapple with a persistent tension between standardized, evidence-based interventions developed by international experts and the contextual, experiential local knowledge held by local health workers. This dichotomy – between global expertise and local knowledge – has become increasingly problematic as health systems face unprecedented complexity in addressing challenges from climate change to emerging diseases.
The limitations of current approaches
The dominant approach privileges global technical expertise, viewing local knowledge primarily through the lens of “implementation barriers” to be overcome. This framework assumes that if only local practitioners would correctly apply global guidance, health outcomes would improve.
This assumption falls short in several critical ways:
- It fails to recognize that local health workers often possess sophisticated understanding of how interventions need to be adapted to work in their contexts.
- It overlooks the way that local knowledge, built through direct experience with communities, often anticipates problems that global guidance has yet to address.
- It perpetuates power dynamics that systematically devalue knowledge generated outside academic and global health institutions.
The hidden costs of privileging global expertise
When we examine actual practice, we find that privileging global over local knowledge can actively harm health system performance:
- It creates a “capability trap” where local health workers become dependent on external expertise rather than developing their own problem-solving capabilities.
- It leads to the implementation of standardized solutions that may not address the real needs of communities.
- It demoralizes community-based staff who see their expertise and experience consistently undervalued.
- It slows the spread of innovative local solutions that could benefit other contexts.
Evidence from practice
Recent experiences from the COVID-19 pandemic provide compelling evidence for the importance of local knowledge. While global guidance struggled to keep pace with evolving challenges, local health workers had to figure out how to keep health services going:
- Community health workers in rural areas adapted strategies.
- District health teams created new approaches to maintain essential services during lockdowns.
- Facility staff developed creative solutions to manage PPE shortages.
These innovations emerged not from global technical assistance, but from local practitioners applying their deep understanding of community needs and system constraints, and by exploring new ways to connect with each other and contribute to global knowledge.
Towards a new synthesis
Rather than choosing between global and local knowledge, we need a new synthesis that recognizes their complementary strengths. This requires three fundamental shifts:
1. Reframing local knowledge
- Moving from viewing local knowledge as merely contextual to seeing it as a source of innovation.
- Recognizing frontline health workers as knowledge creators, not just knowledge recipients.
- Valuing experiential learning alongside formal evidence.
2. Rethinking technical assistance
- Shifting from knowledge transfer to knowledge co-creation.
- Building platforms for peer learning and exchange.
- Supporting local problem-solving capabilities.
3. Restructuring power relations
- Creating mechanisms for local knowledge to inform global guidance.
- Developing new metrics that value local innovation.
- Investing in local knowledge documentation and sharing.
Practical implications
This new synthesis has important practical implications for how we approach health system strengthening:
Investment priorities
- Funding mechanisms need to support local knowledge creation and sharing
- Technical assistance should focus on building local problem-solving capabilities
- Technology investments should enable peer learning and knowledge exchange
Capacity building
- Training should emphasize critical thinking and adaptation skills as constitutive of new forms of leadership
- Learning programmes should connect peers across contexts
- Evaluation should measure local innovation and problem-solving
Knowledge management (KM)
- Systems need to recognize that knowledge is found in the connections between humans (and increasingly machines), so that improving KM is about more ‘pipes’ (connections) and better quality-ones
- Platforms should therefore enable peer learning and exchange
- Evidence must include practitioner experience and insights
New paths forward
Moving beyond the false dichotomy between global and local knowledge opens new possibilities for strengthening health systems. By recognizing and valuing both forms of knowledge, we can create more effective, resilient, and equitable health systems.
The challenges facing health systems are too complex for any single source of knowledge to address alone. Only by bringing together global expertise and local knowledge can we develop the solutions needed to improve health outcomes for all.
References
Braithwaite, J., Churruca, K., Long, J.C., Ellis, L.A., Herkes, J., 2018. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med 16, 63. https://doi.org/10.1186/s12916-018-1057-z
Farsalinos, K., Poulas, K., Kouretas, D., Vantarakis, A., Leotsinidis, M., Kouvelas, D., Docea, A.O., Kostoff, R., Gerotziafas, G.T., Antoniou, M.N., Polosa, R., Barbouni, A., Yiakoumaki, V., Giannouchos, T.V., Bagos, P.G., Lazopoulos, G., Izotov, B.N., Tutelyan, V.A., Aschner, M., Hartung, T., Wallace, H.M., Carvalho, F., Domingo, J.L., Tsatsakis, A., 2021. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports 8, 1–9. https://doi.org/10.1016/j.toxrep.2020.12.001
Jerneck, A., Olsson, L., 2011. Breaking out of sustainability impasses: How to apply frame analysis, reframing and transition theory to global health challenges. Environmental Innovation and Societal Transitions 1, 255–271. https://doi.org/10.1016/j.eist.2011.10.005
Salve, S., Raven, J., Das, P., Srinivasan, S., Khaled, A., Hayee, M., Olisenekwu, G., Gooding, K., 2023. Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies. PLOS Glob Public Health 3, e0001447. https://doi.org/10.1371/journal.pgph.0001447
Yamey, G., 2012. What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Global Health 8, 11. https://doi.org/10.1186/1744-8603-8-11
Share this:
#climateChangeAndHealth #decolonization #evidenceBasedInterventions #expertise #globalHealth #healthSystems #implementationScience #localKnowledge
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You are not alone: Health workers are sharing how they protected their communities when extreme weather hit
Today, The Geneva Learning Foundation launched a new set of “Teach to Reach Questions” focused on how health workers protect community health during extreme weather events. This initiative comes at a crucial time, as world leaders at COP29 discuss climate change’s mounting impacts on health.
As climate change intensifies extreme weather events worldwide, health workers are often the first to respond when disasters strike their communities. Their experiences – whether facing floods, droughts, heatwaves, or storms – contain vital lessons that could help others prepare for and respond to similar challenges.
Read the eyewitness report: From community to planet: Health professionals on the frontlines of climate change, Online. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
Why ask health workers about floods, droughts, and heatwaves?
“Traditional surveys often ask for general information or statistics,” explains Charlotte Mbuh of The Geneva Learning Foundation. “Teach to Reach Questions are different. We ask health workers to share specific moments – a time when they had to act quickly during a flood, or how they kept services running during a drought. These stories of extreme weather events reveal not just what happened, but how people actually solved problems on the ground.”
The questions cover six key scenarios:
- Disease outbreaks during floods
- Health impacts of drought
- Care delivery during heatwaves
- Mental health support before, during, and after
- Maintaining healthcare access
- Quick action and local solutions to protect health
Each scenario includes detailed prompts that help health workers recall and share the specifics of their experience: What exactly did they do? Who helped? What obstacles did they face? How did they know their actions made a difference?
Strengthening local action: From individual experience to collective learning to protect community health
What makes Teach to Reach Questions unique is not just how they are asked, but what happens next. Every experience of an extreme weather event shared becomes part of a larger learning process that benefits the entire community.
“We don’t just collect these experiences – we give them back,” says Reda Sadki, President of The Geneva Learning Foundation. “Whether someone shares their own story or not, they gain access to the complete collection of experiences of extreme weather events. This creates a virtuous cycle of peer learning, where solutions discovered in one community can help another on the other side of the world.”
The process unfolds in four phases:
- Experience Collection: Health workers share their stories through structured questions ahead of the live Teach to Reach event
- Live Event: During the Teach to Reach live event, Contributors who shared their experience are invited to do so in plenary sessions. Everyone can listen in – and join one-to-one networking sessions to learn from the experiences of colleagues from all over the world.
- Analysis and Synthesis: After the live event, the Foundation’s Insights team works with the Teach to Reach community to identify patterns, innovations, and key lessons
- Knowledge Sharing: Insights are returned to the community through comprehensive collections of experiences, thematic insights reports, and Insights Live sessions
Building momentum for Teach to Reach 11
These questions are part of the lead-up to Teach to Reach 11, scheduled for December 5-6, 2024. The experiences shared will inform discussions among the 23,000+ registered participants from over 70 countries.
“But the learning starts now,” emphasizes Mbuh. “Health workers who request their invitation today can immediately begin sharing and learning from peers. The earlier they join, the more they can benefit from this collective knowledge exchange.”
Why protecting community health against extreme weather events matters
As extreme weather events become more frequent and severe, the expertise of health workers who have already faced these challenges becomes increasingly valuable.
“These aren’t just stories – they’re a vital source of knowledge for protecting community health in a changing climate,” says Sadki. “By sharing them widely, we help ensure that health workers everywhere are better prepared when extreme weather strikes their communities.”
Health professionals interested in participating can request their invitation.
Listen to the Teach to Reach podcast:
- in English on RSS , Apple, Spotify, YouTube or Amazon podcast services.
- En français sur les services de podcast par RSS, Apple, Spotify, YouTube ou Amazon.
Is your organisation interested in learning from health workers? Learn more about becoming a Teach to Reach partner.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#climateAndHealth #climateChange #continuousLearning #extremeWeather #globalHealth #health #peerLearning #TeachToReach #TheGenevaLearningFoundation
-
You are not alone: Health workers are sharing how they protected their communities when extreme weather hit
Today, The Geneva Learning Foundation launched a new set of “Teach to Reach Questions” focused on how health workers protect community health during extreme weather events. This initiative comes at a crucial time, as world leaders at COP29 discuss climate change’s mounting impacts on health.
As climate change intensifies extreme weather events worldwide, health workers are often the first to respond when disasters strike their communities. Their experiences – whether facing floods, droughts, heatwaves, or storms – contain vital lessons that could help others prepare for and respond to similar challenges.
Read the eyewitness report: From community to planet: Health professionals on the frontlines of climate change, Online. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
Why ask health workers about floods, droughts, and heatwaves?
“Traditional surveys often ask for general information or statistics,” explains Charlotte Mbuh of The Geneva Learning Foundation. “Teach to Reach Questions are different. We ask health workers to share specific moments – a time when they had to act quickly during a flood, or how they kept services running during a drought. These stories of extreme weather events reveal not just what happened, but how people actually solved problems on the ground.”
The questions cover six key scenarios:
- Disease outbreaks during floods
- Health impacts of drought
- Care delivery during heatwaves
- Mental health support before, during, and after
- Maintaining healthcare access
- Quick action and local solutions to protect health
Each scenario includes detailed prompts that help health workers recall and share the specifics of their experience: What exactly did they do? Who helped? What obstacles did they face? How did they know their actions made a difference?
Strengthening local action: From individual experience to collective learning to protect community health
What makes Teach to Reach Questions unique is not just how they are asked, but what happens next. Every experience of an extreme weather event shared becomes part of a larger learning process that benefits the entire community.
“We don’t just collect these experiences – we give them back,” says Reda Sadki, President of The Geneva Learning Foundation. “Whether someone shares their own story or not, they gain access to the complete collection of experiences of extreme weather events. This creates a virtuous cycle of peer learning, where solutions discovered in one community can help another on the other side of the world.”
The process unfolds in four phases:
- Experience Collection: Health workers share their stories through structured questions ahead of the live Teach to Reach event
- Live Event: During the Teach to Reach live event, Contributors who shared their experience are invited to do so in plenary sessions. Everyone can listen in – and join one-to-one networking sessions to learn from the experiences of colleagues from all over the world.
- Analysis and Synthesis: After the live event, the Foundation’s Insights team works with the Teach to Reach community to identify patterns, innovations, and key lessons
- Knowledge Sharing: Insights are returned to the community through comprehensive collections of experiences, thematic insights reports, and Insights Live sessions
Building momentum for Teach to Reach 11
These questions are part of the lead-up to Teach to Reach 11, scheduled for December 5-6, 2024. The experiences shared will inform discussions among the 23,000+ registered participants from over 70 countries.
“But the learning starts now,” emphasizes Mbuh. “Health workers who request their invitation today can immediately begin sharing and learning from peers. The earlier they join, the more they can benefit from this collective knowledge exchange.”
Why protecting community health against extreme weather events matters
As extreme weather events become more frequent and severe, the expertise of health workers who have already faced these challenges becomes increasingly valuable.
“These aren’t just stories – they’re a vital source of knowledge for protecting community health in a changing climate,” says Sadki. “By sharing them widely, we help ensure that health workers everywhere are better prepared when extreme weather strikes their communities.”
Health professionals interested in participating can request their invitation.
Listen to the Teach to Reach podcast:
- in English on RSS , Apple, Spotify, YouTube or Amazon podcast services.
- En français sur les services de podcast par RSS, Apple, Spotify, YouTube ou Amazon.
Is your organisation interested in learning from health workers? Learn more about becoming a Teach to Reach partner.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#climateAndHealth #climateChange #continuousLearning #extremeWeather #globalHealth #health #peerLearning #TeachToReach #TheGenevaLearningFoundation
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Why answer Teach to Reach Questions?
Have you ever wished you could talk to another health worker who has faced the same challenges as you? Someone who found a way to keep helping people, even when things seemed impossible? That’s exactly the kind of active learning that Teach to Reach Questions make possible. They make peer learning easy for everyone who works for health.
What are Teach to Reach Questions?
Once you join Teach to Reach (what is it?), you’ll receive questions about real-world challenges that matter to health professionals.
How does it work?
- You choose what to share: Answer only questions where you have actual experience. No need to respond to everything – focus on what matters to you.
- Share specific moments: Instead of general information, we ask about real situations you’ve faced. What exactly happened? What did you do? How did you know it worked?
- Learn from others: Within weeks, you’ll receive a collection of experiences shared by health workers from over 70 countries. See how others solved problems similar to yours.
What’s different about these questions?
Unlike typical surveys that just collect data, Teach to Reach Questions are active learning that:
- Focus on your real-world experience.
- Help you reflect on what worked (and what didn’t).
- Connect you to solutions from other health workers.
- Give back everything shared to help everyone learn.
See what we give back to the community. Get the English-language collection of Experiences shared from Teach to Reach 10. The new compendium includes over 600 health worker experiences about immunisation, climate change, malaria, NTDs, and digital health. A second collection of more than 600 experiences shared by French-speaking participants is also available.
What’s in it for you?
Peer learning happens when we learn from each other. Your answers can help others – and their answers can help you.
- Get recognized: You’ll be honored as a Teach to Reach Contributor and receive certification.
- Learn practical solutions: See how other health workers tackle challenges like yours.
- Make connections: At Teach to Reach, you’ll meet others who have been sharing and learning about the same issues.
- Access support: Global partners will share how they can support solutions you and other health workers develop.
A health worker’s experience
Here is what on community health worker from Kenya said:
“When flooding hit our area, I felt so alone trying to figure out how to keep helping people. Through Teach to Reach, I learned that a colleague in another country had faced the same problem. Their solution helped me prepare better for the next flood. Now I’m sharing my experience to help others.”
Think about how peer learning could help you when more than 23,000 health professionals are asked to share their experience on a challenge that matters to you.
Ready to start?
- Request your invitation to Teach to Reach now.
- Look for questions in your inbox.
- Share your experience on topics you know about.
- Receive the complete collection of shared experiences.
- Join us in December to meet others face-to-face.
Remember: Your experience, no matter how small it might seem to you, could be exactly what another health worker needs to hear.
The sooner you join, the more you’ll learn from colleagues worldwide.
Together, we can turn what each of us knows into knowledge that helps everyone.
Listen to the Teach to Reach podcast:
- in English on RSS , Apple, Spotify, YouTube or Amazon podcast services.
- En français sur les services de podcast par RSS, Apple, Spotify, YouTube ou Amazon.
Is your organisation interested in learning from health workers? Learn more about becoming a Teach to Reach partner.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#continuousLearning #experientialLearning #fieldBasdLearning #healthWorkers #learningCulture #learningStrategy #methodology #pedagogy #peerLearning #TeachToReach #TeachToReachQuestions #TheGenevaLearningFoundation
-
Why answer Teach to Reach Questions?
Have you ever wished you could talk to another health worker who has faced the same challenges as you? Someone who found a way to keep helping people, even when things seemed impossible? That’s exactly the kind of active learning that Teach to Reach Questions make possible. They make peer learning easy for everyone who works for health.
What are Teach to Reach Questions?
Once you join Teach to Reach (what is it?), you’ll receive questions about real-world challenges that matter to health professionals.
How does it work?
- You choose what to share: Answer only questions where you have actual experience. No need to respond to everything – focus on what matters to you.
- Share specific moments: Instead of general information, we ask about real situations you’ve faced. What exactly happened? What did you do? How did you know it worked?
- Learn from others: Within weeks, you’ll receive a collection of experiences shared by health workers from over 70 countries. See how others solved problems similar to yours.
What’s different about these questions?
Unlike typical surveys that just collect data, Teach to Reach Questions are active learning that:
- Focus on your real-world experience.
- Help you reflect on what worked (and what didn’t).
- Connect you to solutions from other health workers.
- Give back everything shared to help everyone learn.
See what we give back to the community. Get the English-language collection of Experiences shared from Teach to Reach 10. The new compendium includes over 600 health worker experiences about immunisation, climate change, malaria, NTDs, and digital health. A second collection of more than 600 experiences shared by French-speaking participants is also available.
What’s in it for you?
Peer learning happens when we learn from each other. Your answers can help others – and their answers can help you.
- Get recognized: You’ll be honored as a Teach to Reach Contributor and receive certification.
- Learn practical solutions: See how other health workers tackle challenges like yours.
- Make connections: At Teach to Reach, you’ll meet others who have been sharing and learning about the same issues.
- Access support: Global partners will share how they can support solutions you and other health workers develop.
A health worker’s experience
Here is what on community health worker from Kenya said:
“When flooding hit our area, I felt so alone trying to figure out how to keep helping people. Through Teach to Reach, I learned that a colleague in another country had faced the same problem. Their solution helped me prepare better for the next flood. Now I’m sharing my experience to help others.”
Think about how peer learning could help you when more than 23,000 health professionals are asked to share their experience on a challenge that matters to you.
Ready to start?
- Request your invitation to Teach to Reach now.
- Look for questions in your inbox.
- Share your experience on topics you know about.
- Receive the complete collection of shared experiences.
- Join us in December to meet others face-to-face.
Remember: Your experience, no matter how small it might seem to you, could be exactly what another health worker needs to hear.
The sooner you join, the more you’ll learn from colleagues worldwide.
Together, we can turn what each of us knows into knowledge that helps everyone.
Listen to the Teach to Reach podcast:
- in English on RSS , Apple, Spotify, YouTube or Amazon podcast services.
- En français sur les services de podcast par RSS, Apple, Spotify, YouTube ou Amazon.
Is your organisation interested in learning from health workers? Learn more about becoming a Teach to Reach partner.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#continuousLearning #experientialLearning #fieldBasdLearning #healthWorkers #learningCulture #learningStrategy #methodology #pedagogy #peerLearning #TeachToReach #TeachToReachQuestions #TheGenevaLearningFoundation
-
Health at COP29: Workforce crisis meets climate crisis
Health workers are already being transformed by climate change. COP29 stakeholders can either support this transformation to strengthen health systems, or risk watching the health workforce collapse under mounting pressures.
The World Health Organization’s “COP29 Special Report on Climate Change and Health: Health is the Argument for Climate Action“ highlights the health sector’s role in climate action.
Health professionals are eyewitnesses and first responders to climate impacts on people and communities firsthand – from escalating respiratory diseases to spreading infections and increasing humanitarian disasters.
The report positions health workers as “trusted members of society” who are “uniquely positioned” to champion climate action.
The context is stark: WHO projects a global shortage of 10 million health workers by 2030, with six million in climate-vulnerable sub-Saharan Africa. Meanwhile, our communities and healthcare systems already bear the costs of climate change through increasing disease burdens and system strain.
Health workers are responding, because they have to. Their daily engagement with climate-affected communities offers insights that can strengthen both health systems and climate response – if we learn to listen.
A “fit-for-purpose” workforce requires rethinking learning and leadership
WHO’s report acknowledges that “scale-up and increased investments are necessary to build a well-distributed, fit-for-purpose workforce that can meet accelerating needs, especially in already vulnerable settings.” The report emphasizes that “governments and partners must prioritize access to decent jobs, resources, and support to deliver high-quality, climate-resilient health services.” This includes ensuring “essential protective equipment, supplies, fair compensation, and safe working conditions such as adequate personnel numbers, skills mix, and supervisory capacity.”
Resources, skills, and supervision are building blocks of every health system.
They are necessary but likely to be insufficient.
Such investments could be maximized through cost-effective, scalable peer learning networks that enable rapid knowledge sharing and solution development – as well as their locally-led implementation.
The WHO report calls for “community-led initiatives that harness local knowledge and practices.”
Our analyses – formed by listening to and learning from thousands of health professionals participating in the Teach to Reach peer learning platform – suggest that the expertise developed by health professionals through daily engagement with communities facing climate impacts is key to problem-solving, to implementing local solutions, and to ensure that communities are part and parcel of such solutions.
Why move beyond seeing health workers as implementers of policies or recipients of training?
We stand to gain much more if their leadership is recognized, nurtured, and supported.
This is a notion of leadership that diverges from convention: if health workers have leadership potential, it is because they are uniquely positioned to turn what they know – because they are there every day – into action.
Peer learning has the potential to significantly accelerate progress toward country and global goals for climate change and health.
By making connections, a health professional expands the horizon of what they are able to know.
At the Geneva Learning Foundation, we have seen that such leadership emerges when health workers are empowered to:
- share and validate their experiential knowledge;
- develop, test, and implement solutions with the communities they serve, using local resources;
- connect with peers facing similar challenges; and
- inform policy based on ground-level realities.
Working with a global community of community-based health workers, we co-developed the Teach to Reach platform, community, and network to listen and learn at scale. Unlike traditional training programs, Teach to Reach creates a peer learning ecosystem where:
- Health workers from over 70 countries connect directly to share experiences.
- Solutions are crowdsourced from those closest to the challenges.
- Knowledge flows horizontally rather than just vertically.
- Local innovations are rapidly shared and adapted across contexts.
For example, in June 2024, over 21,000 health professionals participated in Teach to Reach 10, generating hundreds of real-world stories and insights about climate change impacts on health.
The platform has proven particularly valuable in fragile contexts and resource-limited settings, where traditional capacity building approaches often struggle to reach or engage health workers effectively.
This approach does not replace formal institutions or traditional scientific methods – instead, it creates new pathways for knowledge to flow rapidly between communities, while building the collective capacity needed to respond to accelerating climate impacts on health.
Already, this demonstrates the untapped potential for health workers to contribute to our collective understanding and response.
But we do not stop there.
As we count down to Teach to Reach 11, participants are now sharing how they have actually used and applied this peer knowledge to make progress against their local challenges.
They cannot do it alone.
This is why we ask global partners to join and contribute to this emergent, locally-led leadership for change.
How different is this ‘ask’ from that of global partners asking health workers to contribute to the climate change and health agenda?
WHO’s COP29 report makes a powerful case that “community-led initiatives that harness local knowledge and practices in both climate action and health strategies are fundamental for creating interventions that are both culturally appropriate and effective.”
Furthermore, it recognizes that “these initiatives ensure that climate and health solutions are tailored to the specific needs and realities of those most impacted by climate change but also grounded in their lived realities.”
What framework for collaboration?
The path forward requires what the report describes as “cooperation across sectors, stakeholders and rights-holders – governmental institutions, local authorities, local leaders including religious authorities and traditional medicine practitioners, NGOs, businesses, the health community, Indigenous Peoples as well as local communities.”
Our experience with Teach to Reach demonstrates how such cooperation can be facilitated at scale through digital platforms that enable peer learning and knowledge sharing. Key elements include:
- a structured yet flexible framework for sharing experiences and insights;
- direct connections between health workers at all levels of the system;
- rapid feedback loops between local implementation and broader learning;
- support for health workers to document and share their innovations; and
- mechanisms to validate and spread effective local solutions.
WHO’s recognition that health workers have “a moral, professional and public responsibility to protect and promote health, which includes advocating for climate action, leveraging prevention for climate mitigation and cost savings, and safeguarding healthy environments” sets a clear mandate.
This WHO report highlights the need for new ways of supporting community-led learning and action to:
- support the rapid sharing of local solutions;
- build health worker capacity through peer learning;
- connect communities facing similar challenges; and
- enable health workers to lead change in their communities
Reference
Neira, M. et al. (2024) COP 29 Special Report on Climate Change and Health: Health is the Argument for Climate Action. Geneva, Switzerland: World Health Organization.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#climateAction #climateAndHealth #COP29 #COP29SpecialReportOnClimateChangeAndHealthHealthIsTheArgumentForClimateAction #healthWorkers #HRH #leadership #localAction #MariaNeira #resilience #WorldHealthOrganization
-
Health at COP29: Workforce crisis meets climate crisis
Health workers are already being transformed by climate change. COP29 stakeholders can either support this transformation to strengthen health systems, or risk watching the health workforce collapse under mounting pressures.
The World Health Organization’s “COP29 Special Report on Climate Change and Health: Health is the Argument for Climate Action“ highlights the health sector’s role in climate action.
Health professionals are eyewitnesses and first responders to climate impacts on people and communities firsthand – from escalating respiratory diseases to spreading infections and increasing humanitarian disasters.
The report positions health workers as “trusted members of society” who are “uniquely positioned” to champion climate action.
The context is stark: WHO projects a global shortage of 10 million health workers by 2030, with six million in climate-vulnerable sub-Saharan Africa. Meanwhile, our communities and healthcare systems already bear the costs of climate change through increasing disease burdens and system strain.
Health workers are responding, because they have to. Their daily engagement with climate-affected communities offers insights that can strengthen both health systems and climate response – if we learn to listen.
A “fit-for-purpose” workforce requires rethinking learning and leadership
WHO’s report acknowledges that “scale-up and increased investments are necessary to build a well-distributed, fit-for-purpose workforce that can meet accelerating needs, especially in already vulnerable settings.” The report emphasizes that “governments and partners must prioritize access to decent jobs, resources, and support to deliver high-quality, climate-resilient health services.” This includes ensuring “essential protective equipment, supplies, fair compensation, and safe working conditions such as adequate personnel numbers, skills mix, and supervisory capacity.”
Resources, skills, and supervision are building blocks of every health system.
They are necessary but likely to be insufficient.
Such investments could be maximized through cost-effective, scalable peer learning networks that enable rapid knowledge sharing and solution development – as well as their locally-led implementation.
The WHO report calls for “community-led initiatives that harness local knowledge and practices.”
Our analyses – formed by listening to and learning from thousands of health professionals participating in the Teach to Reach peer learning platform – suggest that the expertise developed by health professionals through daily engagement with communities facing climate impacts is key to problem-solving, to implementing local solutions, and to ensure that communities are part and parcel of such solutions.
Why move beyond seeing health workers as implementers of policies or recipients of training?
We stand to gain much more if their leadership is recognized, nurtured, and supported.
This is a notion of leadership that diverges from convention: if health workers have leadership potential, it is because they are uniquely positioned to turn what they know – because they are there every day – into action.
Peer learning has the potential to significantly accelerate progress toward country and global goals for climate change and health.
By making connections, a health professional expands the horizon of what they are able to know.
At the Geneva Learning Foundation, we have seen that such leadership emerges when health workers are empowered to:
- share and validate their experiential knowledge;
- develop, test, and implement solutions with the communities they serve, using local resources;
- connect with peers facing similar challenges; and
- inform policy based on ground-level realities.
Working with a global community of community-based health workers, we co-developed the Teach to Reach platform, community, and network to listen and learn at scale. Unlike traditional training programs, Teach to Reach creates a peer learning ecosystem where:
- Health workers from over 70 countries connect directly to share experiences.
- Solutions are crowdsourced from those closest to the challenges.
- Knowledge flows horizontally rather than just vertically.
- Local innovations are rapidly shared and adapted across contexts.
For example, in June 2024, over 21,000 health professionals participated in Teach to Reach 10, generating hundreds of real-world stories and insights about climate change impacts on health.
The platform has proven particularly valuable in fragile contexts and resource-limited settings, where traditional capacity building approaches often struggle to reach or engage health workers effectively.
This approach does not replace formal institutions or traditional scientific methods – instead, it creates new pathways for knowledge to flow rapidly between communities, while building the collective capacity needed to respond to accelerating climate impacts on health.
Already, this demonstrates the untapped potential for health workers to contribute to our collective understanding and response.
But we do not stop there.
As we count down to Teach to Reach 11, participants are now sharing how they have actually used and applied this peer knowledge to make progress against their local challenges.
They cannot do it alone.
This is why we ask global partners to join and contribute to this emergent, locally-led leadership for change.
How different is this ‘ask’ from that of global partners asking health workers to contribute to the climate change and health agenda?
WHO’s COP29 report makes a powerful case that “community-led initiatives that harness local knowledge and practices in both climate action and health strategies are fundamental for creating interventions that are both culturally appropriate and effective.”
Furthermore, it recognizes that “these initiatives ensure that climate and health solutions are tailored to the specific needs and realities of those most impacted by climate change but also grounded in their lived realities.”
What framework for collaboration?
The path forward requires what the report describes as “cooperation across sectors, stakeholders and rights-holders – governmental institutions, local authorities, local leaders including religious authorities and traditional medicine practitioners, NGOs, businesses, the health community, Indigenous Peoples as well as local communities.”
Our experience with Teach to Reach demonstrates how such cooperation can be facilitated at scale through digital platforms that enable peer learning and knowledge sharing. Key elements include:
- a structured yet flexible framework for sharing experiences and insights;
- direct connections between health workers at all levels of the system;
- rapid feedback loops between local implementation and broader learning;
- support for health workers to document and share their innovations; and
- mechanisms to validate and spread effective local solutions.
WHO’s recognition that health workers have “a moral, professional and public responsibility to protect and promote health, which includes advocating for climate action, leveraging prevention for climate mitigation and cost savings, and safeguarding healthy environments” sets a clear mandate.
This WHO report highlights the need for new ways of supporting community-led learning and action to:
- support the rapid sharing of local solutions;
- build health worker capacity through peer learning;
- connect communities facing similar challenges; and
- enable health workers to lead change in their communities
Reference
Neira, M. et al. (2024) COP 29 Special Report on Climate Change and Health: Health is the Argument for Climate Action. Geneva, Switzerland: World Health Organization.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#climateAction #climateAndHealth #COP29 #COP29SpecialReportOnClimateChangeAndHealthHealthIsTheArgumentForClimateAction #healthWorkers #HRH #leadership #localAction #MariaNeira #resilience #WorldHealthOrganization
-
How can we reliably spread evidence-based practices at the speed and scale modern health challenges demand?
At a symposium of the American Society for Tropical Medicine and Hygiene (ASTMH) Annual Meeting, I explored how peer learning could help us tackle five critical challenges that limit effectiveness in global health.
- Performance: How do we move beyond knowledge gains to measurable improvements in health outcomes?
- Scale and access: How do we reach and include tens of thousands of health workers, not just dozens?
- Applicability: How do we ensure learning translates into changed practice?
- Diversity: How do we leverage different perspectives and contexts rather than enforce standardization?
- Complexity: How do we support locally-led leadership for change to tackle complex challenges that have no standard solutions?
https://www.youtube.com/watch?v=Q08dbbzUzzc
For epidemiologists working on implementation science, peer learning provides a new path for solving one of global health’s most persistent challenges: how to reliably spread evidence-based practices at the speed and scale modern health challenges demand.
The evidence suggests we should view peer learning not just as a training approach, but as a mechanism for viral spread of effective practices through health systems.
How do we get to attribution?
Of course, an epidemiologist will want to know if and how improved health outcomes can be attributed to peer learning interventions.
The Geneva Learning Foundation (TGLF) addresses this fundamental challenge in implementation science – proving attribution – through a three-stage process that combines quantitative indicators with qualitative validation.
The process begins with baseline health indicators relevant to each context (such as vaccination coverage rates, if it is immunization), which are then tracked through regular “acceleration reports” that capture both metrics and implementation progress.
Rather than assuming causation from correlation, participants must explicitly rate the extent to which they attribute observed improvements to their intervention.
The critical innovation comes in the third stage: those claiming attribution must “prove it” to the community of peers, by providing specific evidence of how their actions led to the observed changes – a requirement that both controls for self-reporting limitations and generates rich qualitative data about implementation mechanisms.
This methodology has proven particularly valuable in complex interventions where randomized controlled trials may be impractical or insufficient.
What are examples of peer learning in action?
Here are three examples from The Geneva Learning Foundation’s work that demonstrate scale, reach, and sustainability.
Within four weeks, a single Teach to Reach cohort of 17,662 health workers across over 80 countries generated 1,800 context-specific experiences describing the “how” of implementation, especially at the district and community levels.
In Côte d’Ivoire, working with Gavi and The Geneva Learning Foundation, the national immunization team used TGLF’s model to support community engagement. Within two weeks, over 500 health workers representing 85% of the country’s districts had begun implementing locally-led innovations. 82% of participants said they would use TGLF’s model for their own needs, without requiring any further assistance or support.
In TGLF’s COVID-19 Peer Hub, 30% of participants successfully implemented recovery plans within three months – a rate seven times higher than a control group that did not use TGLF’s model.
Participants who actively engaged with peers were not only more likely to report successful implementation, but could demonstrate concrete evidence of how peer interactions contributed to their success, creating a robust framework for understanding not just whether interventions work, but how and why they succeed or fail across different contexts.
Quantifying learning
Using a simple methodology that measures learning efficacy across five key variables – scalability, information fidelity, cost effectiveness, feedback quality, and uniformity – we calculated that properly structured peer learning networks achieve an efficacy score of 3.2 out of 4, significantly outperforming both traditional cascade training (1.4) and expert coaching (2.2).
But the real breakthrough came when considering scale. When calculating the Efficacy-Scale Score (ESS) – which multiplies learning efficacy by the number of learners reached – the differences became stark:
- Peer Learning: 3,200 (reaching 1,000 learners)
- Cascade Training: 700 (reaching 500 learners)
- Expert Coaching: 132 (reaching 60 learners)
Learn more: Calculating the relative effectiveness of expert coaching, peer learning, and cascade training
The mathematics of scale
For epidemiologists, the mechanics of this scaling effect may feel familiar.
In traditional expert-led training, if N is the total number of learners and M is the number of available experts who can each effectively coach K learners, we quickly hit a ceiling where N far exceeds M×K.
TGLF’s model transforms this equation by structuring interactions so each learner gives and receives feedback from exactly three peers, guided by expert-designed rubrics.
This creates a linear scaling pattern where total learning interactions = 3N, allowing for theoretically unlimited scale while maintaining quality through structured feedback loops.
Information loss and network resilience
One of the most interesting findings concerns information fidelity. In cascade training, knowledge degradation follows a predictable pattern:
where Kn is the knowledge at the nth level of the cascade and α is the loss rate at each step. This explains why cascade training, despite its theoretical appeal, consistently underperforms.
In contrast, TGLF’s peer learning-to-action networks showed remarkable resilience. By creating multiple pathways for knowledge transmission and building in structured feedback loops, the system maintains high information fidelity even at scale.
Learn more: Why does cascade training fail?
References
Arling, P.A., Doebbeling, B.N., Fox, R.L., 2011. Improving the Implementation of Evidence-Based Practice and Information Systems in Healthcare: A Social Network Approach. International Journal of Healthcare Information Systems and Informatics 6, 37–59. https://doi.org/10.4018/jhisi.2011040104
Hogan, M.J., Barton, A., Twiner, A., James, C., Ahmed, F., Casebourne, I., Steed, I., Hamilton, P., Shi, S., Zhao, Y., Harney, O.M., Wegerif, R., 2023. Education for collective intelligence. Irish Educational Studies 1–30. https://doi.org/10.1080/03323315.2023.2250309
Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4
Share this:
#AmericanSocietyForTropicalMedicineAndHygiene #ASTMH #attribution #cascadeTraining #globalHealth #implementationScience #peerLearning #TheGenevaLearningFoundation #TropMed24
-
How can we reliably spread evidence-based practices at the speed and scale modern health challenges demand?
At a symposium of the American Society for Tropical Medicine and Hygiene (ASTMH) Annual Meeting, I explored how peer learning could help us tackle five critical challenges that limit effectiveness in global health.
- Performance: How do we move beyond knowledge gains to measurable improvements in health outcomes?
- Scale and access: How do we reach and include tens of thousands of health workers, not just dozens?
- Applicability: How do we ensure learning translates into changed practice?
- Diversity: How do we leverage different perspectives and contexts rather than enforce standardization?
- Complexity: How do we support locally-led leadership for change to tackle complex challenges that have no standard solutions?
https://www.youtube.com/watch?v=Q08dbbzUzzc
For epidemiologists working on implementation science, peer learning provides a new path for solving one of global health’s most persistent challenges: how to reliably spread evidence-based practices at the speed and scale modern health challenges demand.
The evidence suggests we should view peer learning not just as a training approach, but as a mechanism for viral spread of effective practices through health systems.
How do we get to attribution?
Of course, an epidemiologist will want to know if and how improved health outcomes can be attributed to peer learning interventions.
The Geneva Learning Foundation (TGLF) addresses this fundamental challenge in implementation science – proving attribution – through a three-stage process that combines quantitative indicators with qualitative validation.
The process begins with baseline health indicators relevant to each context (such as vaccination coverage rates, if it is immunization), which are then tracked through regular “acceleration reports” that capture both metrics and implementation progress.
Rather than assuming causation from correlation, participants must explicitly rate the extent to which they attribute observed improvements to their intervention.
The critical innovation comes in the third stage: those claiming attribution must “prove it” to the community of peers, by providing specific evidence of how their actions led to the observed changes – a requirement that both controls for self-reporting limitations and generates rich qualitative data about implementation mechanisms.
This methodology has proven particularly valuable in complex interventions where randomized controlled trials may be impractical or insufficient.
What are examples of peer learning in action?
Here are three examples from The Geneva Learning Foundation’s work that demonstrate scale, reach, and sustainability.
Within four weeks, a single Teach to Reach cohort of 17,662 health workers across over 80 countries generated 1,800 context-specific experiences describing the “how” of implementation, especially at the district and community levels.
In Côte d’Ivoire, working with Gavi and The Geneva Learning Foundation, the national immunization team used TGLF’s model to support community engagement. Within two weeks, over 500 health workers representing 85% of the country’s districts had begun implementing locally-led innovations. 82% of participants said they would use TGLF’s model for their own needs, without requiring any further assistance or support.
In TGLF’s COVID-19 Peer Hub, 30% of participants successfully implemented recovery plans within three months – a rate seven times higher than a control group that did not use TGLF’s model.
Participants who actively engaged with peers were not only more likely to report successful implementation, but could demonstrate concrete evidence of how peer interactions contributed to their success, creating a robust framework for understanding not just whether interventions work, but how and why they succeed or fail across different contexts.
Quantifying learning
Using a simple methodology that measures learning efficacy across five key variables – scalability, information fidelity, cost effectiveness, feedback quality, and uniformity – we calculated that properly structured peer learning networks achieve an efficacy score of 3.2 out of 4, significantly outperforming both traditional cascade training (1.4) and expert coaching (2.2).
But the real breakthrough came when considering scale. When calculating the Efficacy-Scale Score (ESS) – which multiplies learning efficacy by the number of learners reached – the differences became stark:
- Peer Learning: 3,200 (reaching 1,000 learners)
- Cascade Training: 700 (reaching 500 learners)
- Expert Coaching: 132 (reaching 60 learners)
Learn more: Calculating the relative effectiveness of expert coaching, peer learning, and cascade training
The mathematics of scale
For epidemiologists, the mechanics of this scaling effect may feel familiar.
In traditional expert-led training, if N is the total number of learners and M is the number of available experts who can each effectively coach K learners, we quickly hit a ceiling where N far exceeds M×K.
TGLF’s model transforms this equation by structuring interactions so each learner gives and receives feedback from exactly three peers, guided by expert-designed rubrics.
This creates a linear scaling pattern where total learning interactions = 3N, allowing for theoretically unlimited scale while maintaining quality through structured feedback loops.
Information loss and network resilience
One of the most interesting findings concerns information fidelity. In cascade training, knowledge degradation follows a predictable pattern:
where Kn is the knowledge at the nth level of the cascade and α is the loss rate at each step. This explains why cascade training, despite its theoretical appeal, consistently underperforms.
In contrast, TGLF’s peer learning-to-action networks showed remarkable resilience. By creating multiple pathways for knowledge transmission and building in structured feedback loops, the system maintains high information fidelity even at scale.
Learn more: Why does cascade training fail?
References
Arling, P.A., Doebbeling, B.N., Fox, R.L., 2011. Improving the Implementation of Evidence-Based Practice and Information Systems in Healthcare: A Social Network Approach. International Journal of Healthcare Information Systems and Informatics 6, 37–59. https://doi.org/10.4018/jhisi.2011040104
Hogan, M.J., Barton, A., Twiner, A., James, C., Ahmed, F., Casebourne, I., Steed, I., Hamilton, P., Shi, S., Zhao, Y., Harney, O.M., Wegerif, R., 2023. Education for collective intelligence. Irish Educational Studies 1–30. https://doi.org/10.1080/03323315.2023.2250309
Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4
Share this:
#AmericanSocietyForTropicalMedicineAndHygiene #ASTMH #attribution #cascadeTraining #globalHealth #implementationScience #peerLearning #TheGenevaLearningFoundation #TropMed24
-
Strengthening primary health care in a changing climate
A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.
Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.
First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.
This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.
Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.
They must manage both the immediate health impacts and the longer-term consequences of these events.
This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.
The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.
In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”
They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”
The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”
They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.
Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.
This is what they know because they are there every day.
Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.
While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.
The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.
This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.
Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.
It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.
Our research has documented how health workers are already responding to climate-related health challenges.
For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions
Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.
Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.
However, these perspectives need not be mutually exclusive.
TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.
New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.
This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.
Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.
When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.
A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.
Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.
TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.
This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.
Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.
While formal research and policy development necessarily take time, climate impacts are already affecting communities.
TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.
The model also addresses the issue of trust.
Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.
Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.
By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.
Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.
References
Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#AndyHaines #AnyaGopfert #climateAndHealth #ElizabethWambuiKimaniMurage #epistemology #globalHealth #healthWorkforce #HumanResourcesForHealth #PHC #phronesis #primaryHealthCare #situatedKnowledge
-
Strengthening primary health care in a changing climate
A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.
Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.
First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.
This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.
Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.
They must manage both the immediate health impacts and the longer-term consequences of these events.
This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.
The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.
In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”
They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”
The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”
They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.
Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.
This is what they know because they are there every day.
Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.
While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.
The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.
This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.
Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.
It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.
Our research has documented how health workers are already responding to climate-related health challenges.
For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions
Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.
Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.
However, these perspectives need not be mutually exclusive.
TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.
New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.
This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.
Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.
When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.
A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.
Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.
TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.
This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.
Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.
While formal research and policy development necessarily take time, climate impacts are already affecting communities.
TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.
The model also addresses the issue of trust.
Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.
Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.
By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.
Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.
References
Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#AndyHaines #AnyaGopfert #climateAndHealth #ElizabethWambuiKimaniMurage #epistemology #globalHealth #healthWorkforce #HumanResourcesForHealth #PHC #phronesis #primaryHealthCare #situatedKnowledge
-
Anecdote or lived experience: reimagining knowledge for climate-resilient health systems
A health worker in rural Kenya notices that malaria cases are appearing earlier in the season than usual.
A nurse in Bangladesh observes that certain neighborhoods are experiencing more heat-related illnesses despite similar temperatures.
These observations often remain trapped in the realm of “anecdotal evidence.”
The dominant epistemological framework in public health traditionally dismisses such knowledge as unreliable, subjective, and of limited scientific value.
This dismissal stems from a deeply-rooted global health paradigm that privileges quantitative data, randomized controlled trials, and statistical significance over the nuanced, contextual understanding that emerges from direct experience.
The phrase “it’s just anecdotal” has become a subtle but powerful way of delegitimizing knowledge that does not conform to established scientific methodologies.
Yet this epistemological stance creates a significant blind spot in our understanding of how climate change affects health at the community level.
Climate change manifests in complex, locally specific ways that often elude traditional epidemiological surveillance systems.
The health worker who notices shifting disease patterns or the community nurse who identifies vulnerable populations possesses what philosopher Donald Schön termed “knowing-in-action” – a form of knowledge that emerges from sustained engagement with complex, dynamic situations.
Experiential knowledge often precedes formal scientific understanding, particularly in the context of climate change where impacts are emerging and evolving rapidly.
Health workers’ observations are not mere anecdotes but rather early warning signals of climate-health relationships that would take years to document through traditional research methods.
Why would we build early warning systems that ignore the significance or value of health worker observations and insights?
Is the risk of error greater than the risk of inaction?
In late 2023, more than 1 million people were displaced by flooding from intense rainfall in parts of Somalia, Kenya, and Ethiopia, attributed to a combination of climate change and the Indian Ocean Dipole, a natural climate phenomenon.
Are there signals that health workers might be attuned to, alongside weather systems to measure them?
The challenge, then, is not to replace scientific methodologies but to develop new epistemological frameworks that can integrate different forms of knowing.
This requires recognizing that knowledge exists on a spectrum rather than in hierarchical tiers.
Experiential knowledge, systematic observation, statistical analysis, and randomized controlled trials each offer different and complementary insights into complex climate-health relationships.
A new epistemological framework would recognize that the health worker who notices changing disease patterns is engaging in what anthropologist James Scott calls “mētis” – a form of practical knowledge that comes from intimate familiarity with local conditions.
Is this knowledge necessarily less valuable than statistical data or no data?
It is different and often provides crucial context that helps interpret quantitative findings.
Let us imagine how this integration might work in practice.
In the Philippines, a climate-health surveillance system could combine traditional epidemiological data with structured documentation of health workers’ observations.
Health workers would use a mobile app to share unusual patterns or emerging concerns with each other.
This could then be analyzed alongside conventional surveillance data.
Such an approach could identify climate-health relationships that are not visible through standard surveillance alone.
Health workers can also form “knowledge circles” in which they regularly meet to share observations and insights about climate-related health impacts.
These observations can then be systematically documented and analyzed, creating a bridge between experiential knowledge and formal evidence bases.
When patterns emerge across multiple knowledge circles, they trigger more formal investigation.
This shift requires rethinking how we validate knowledge.
Instead of asking whether an observation is “merely anecdotal,” we might ask: What does this observation tell us about local conditions? How does it complement our quantitative data? What patterns emerge when we more systematically collect and analyze experiential knowledge?
The implications of this epistemological shift extend beyond climate change.
By recognizing the value of experiential knowledge, health systems will become more adaptive and responsive to emerging challenges.
Health workers, feeling their knowledge is valued, become more engaged in systematic observation and documentation.
Communities, seeing their experiences reflected in health system responses, develop greater trust in health institutions.
However, this shift faces significant challenges.
Academic institutions, funding bodies, and policy makers often remain wedded to traditional hierarchies of evidence.
Publishing systems privilege certain types of knowledge over others.
Career advancement often depends on producing conventional scientific evidence rather than integrating different forms of knowing.
Overcoming these challenges requires institutional change.
Medical and public health education needs to incorporate training in recognizing and documenting experiential knowledge.
Research methodologies need to expand to include systematic ways of collecting and analyzing practical knowledge.
Funding mechanisms need to support projects that bridge different epistemological approaches.
The climate crisis demands this evolution in how we think about knowledge.
As health systems face unprecedented challenges, we cannot afford to ignore any source of understanding about how climate change affects human health.
The health worker’s observation, the community’s experience, and the statistician’s analysis all have crucial roles to play in building climate-resilient health systems.
This is not about replacing scientific rigor but about expanding our understanding of what constitutes valid knowledge.
By creating frameworks that can integrate different forms of knowing, we strengthen our ability to respond effectively to the complex challenges posed by climate change.
The future of climate-resilient health systems depends not just on what we know, but on how we think about knowing itself.
References
Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.10204660
Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.11194918
Romanello, M., et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34.
Scott, J.C., 2020. Seeing like a state: how certain schemes to improve the human condition have failed. ed, Yale agrarian studies. Yale University Press, New Haven, CT London.
Share this:
#anecdotes #climateAndHealth #climateChange #DonaldSchön #epidemiology #epistemology #JamesScott #knowingInAction #livedExperience #mētis #peerLearning
-
Anecdote or lived experience: reimagining knowledge for climate-resilient health systems
A health worker in rural Kenya notices that malaria cases are appearing earlier in the season than usual.
A nurse in Bangladesh observes that certain neighborhoods are experiencing more heat-related illnesses despite similar temperatures.
These observations often remain trapped in the realm of “anecdotal evidence.”
The dominant epistemological framework in public health traditionally dismisses such knowledge as unreliable, subjective, and of limited scientific value.
This dismissal stems from a deeply-rooted global health paradigm that privileges quantitative data, randomized controlled trials, and statistical significance over the nuanced, contextual understanding that emerges from direct experience.
The phrase “it’s just anecdotal” has become a subtle but powerful way of delegitimizing knowledge that does not conform to established scientific methodologies.
Yet this epistemological stance creates a significant blind spot in our understanding of how climate change affects health at the community level.
Climate change manifests in complex, locally specific ways that often elude traditional epidemiological surveillance systems.
The health worker who notices shifting disease patterns or the community nurse who identifies vulnerable populations possesses what philosopher Donald Schön termed “knowing-in-action” – a form of knowledge that emerges from sustained engagement with complex, dynamic situations.
Experiential knowledge often precedes formal scientific understanding, particularly in the context of climate change where impacts are emerging and evolving rapidly.
Health workers’ observations are not mere anecdotes but rather early warning signals of climate-health relationships that would take years to document through traditional research methods.
Why would we build early warning systems that ignore the significance or value of health worker observations and insights?
Is the risk of error greater than the risk of inaction?
In late 2023, more than 1 million people were displaced by flooding from intense rainfall in parts of Somalia, Kenya, and Ethiopia, attributed to a combination of climate change and the Indian Ocean Dipole, a natural climate phenomenon.
Are there signals that health workers might be attuned to, alongside weather systems to measure them?
The challenge, then, is not to replace scientific methodologies but to develop new epistemological frameworks that can integrate different forms of knowing.
This requires recognizing that knowledge exists on a spectrum rather than in hierarchical tiers.
Experiential knowledge, systematic observation, statistical analysis, and randomized controlled trials each offer different and complementary insights into complex climate-health relationships.
A new epistemological framework would recognize that the health worker who notices changing disease patterns is engaging in what anthropologist James Scott calls “mētis” – a form of practical knowledge that comes from intimate familiarity with local conditions.
Is this knowledge necessarily less valuable than statistical data or no data?
It is different and often provides crucial context that helps interpret quantitative findings.
Let us imagine how this integration might work in practice.
In the Philippines, a climate-health surveillance system could combine traditional epidemiological data with structured documentation of health workers’ observations.
Health workers would use a mobile app to share unusual patterns or emerging concerns with each other.
This could then be analyzed alongside conventional surveillance data.
Such an approach could identify climate-health relationships that are not visible through standard surveillance alone.
Health workers can also form “knowledge circles” in which they regularly meet to share observations and insights about climate-related health impacts.
These observations can then be systematically documented and analyzed, creating a bridge between experiential knowledge and formal evidence bases.
When patterns emerge across multiple knowledge circles, they trigger more formal investigation.
This shift requires rethinking how we validate knowledge.
Instead of asking whether an observation is “merely anecdotal,” we might ask: What does this observation tell us about local conditions? How does it complement our quantitative data? What patterns emerge when we more systematically collect and analyze experiential knowledge?
The implications of this epistemological shift extend beyond climate change.
By recognizing the value of experiential knowledge, health systems will become more adaptive and responsive to emerging challenges.
Health workers, feeling their knowledge is valued, become more engaged in systematic observation and documentation.
Communities, seeing their experiences reflected in health system responses, develop greater trust in health institutions.
However, this shift faces significant challenges.
Academic institutions, funding bodies, and policy makers often remain wedded to traditional hierarchies of evidence.
Publishing systems privilege certain types of knowledge over others.
Career advancement often depends on producing conventional scientific evidence rather than integrating different forms of knowing.
Overcoming these challenges requires institutional change.
Medical and public health education needs to incorporate training in recognizing and documenting experiential knowledge.
Research methodologies need to expand to include systematic ways of collecting and analyzing practical knowledge.
Funding mechanisms need to support projects that bridge different epistemological approaches.
The climate crisis demands this evolution in how we think about knowledge.
As health systems face unprecedented challenges, we cannot afford to ignore any source of understanding about how climate change affects human health.
The health worker’s observation, the community’s experience, and the statistician’s analysis all have crucial roles to play in building climate-resilient health systems.
This is not about replacing scientific rigor but about expanding our understanding of what constitutes valid knowledge.
By creating frameworks that can integrate different forms of knowing, we strengthen our ability to respond effectively to the complex challenges posed by climate change.
The future of climate-resilient health systems depends not just on what we know, but on how we think about knowing itself.
References
Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.10204660
Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.11194918
Romanello, M., et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34.
Scott, J.C., 2020. Seeing like a state: how certain schemes to improve the human condition have failed. ed, Yale agrarian studies. Yale University Press, New Haven, CT London.
Share this:
#anecdotes #climateAndHealth #climateChange #DonaldSchön #epidemiology #epistemology #JamesScott #knowingInAction #livedExperience #mētis #peerLearning
-
Why become a Teach to Reach Partner?
We need new ways to tackle global health challenges that impact local communities.
It is obvious that technology alone is not enough.
We need human ingenuity, collaboration, and the ability to share across borders and boundaries.
That is why I am excited about Teach to Reach.
Imagine if we could tap into the collective intelligence of over 20,000 health professionals working on the front lines in low- and middle-income countries.
What insights could we gain?
What innovations might we uncover?
This is exactly what Teach to Reach is doing.
In June 2024, Teach to Reach 10 brought together 21,398 participants from across the health system – from community health workers to national policymakers.
This diverse group represents an incredible wealth of knowledge and experience that has often been overlooked in global health decision-making.
Bridge the gap between policy and practice
One of the most exciting aspects of Teach to Reach is how it bridges the gap between policy and practice.
Too often, there is a disconnect between those making decisions at the global level and those implementing programs on the ground.
Teach to Reach creates a direct line of communication, allowing frontline workers to influence policy and program design in real-time.
This approach not only leads to more effective interventions but also empowers health workers, increasing their engagement and motivation.
Scale knowledge transfer and translation efficiently
In global health, we are always looking for ways to scale solutions efficiently.
This scaling effect is particularly crucial in low-resource settings, where formal learning opportunities may be limited.
Teach to Reach applies this principle to peer learning.
Then there is speed.
The platform can disseminate best practices and local solutions much more rapidly than traditional top-down approaches.
There is also the “know-do” gap or the “applicability problem”.
Teach to Reach supports continuous learning by sharing experience, focused on how to get results, especially at the local community level.
Measuring impact and driving innovation
The Teach to Reach platform uses a comprehensive framework to track the value of participation for individuals and the benefits for partners.
But we do not stop there.
Teach to Reach is just one component in the Geneva Learning Foundation’s model to support new learning and leadership to drive change.
We then track and measure what participants do with the knowledge gained and the experiences shared.
We do this all the way to the time where improved health outcomes can be attributed to a discovery or significant learning made at Teach to Reach.
Moreover, Teach to Reach serves as an innovation hub, surfacing diverse ideas and solutions from the field.
For organizations looking to drive innovation in their global health programs, this platform offers a new path to creative problem-solving with those closest to the challenges.
A call to action for global health leaders
If you are a leader in the global health space, I urge you to consider partnering with Teach to Reach.
Here are 5 ways in which partners have found utility in Teach to Reach:
- Inform a strategy with ground-level insights.
- Expand reach across multiple countries and health system levels.
- Tap into a diverse pool of local solutions – and help augment and scale them.
- Demonstrate commitment to supporting locally-led, community-based positive change.
- Accelerate progress towards global health goals through collaborative learning.
In today’s interconnected world, our ability to solve global health challenges depends on our capacity to learn from one another and scale effective solutions quickly.
Teach to Reach is pioneering a new approach that harnesses the power of peer learning to do just that.
Investing in Teach to Reach can help unlock the full potential of our global health workforce and make significant strides towards a healthier, more equitable world.
The future of global health is collaborative.
Teach to Reach provides a way to turn the rhetoric of collaboration into practical action.
Share this:
#CollectiveIntelligence #globalHealth #innovation #localCommunities #peerLearning #TeachToReach
-
Why become a Teach to Reach Partner?
We need new ways to tackle global health challenges that impact local communities.
It is obvious that technology alone is not enough.
We need human ingenuity, collaboration, and the ability to share across borders and boundaries.
That is why I am excited about Teach to Reach.
Imagine if we could tap into the collective intelligence of over 20,000 health professionals working on the front lines in low- and middle-income countries.
What insights could we gain?
What innovations might we uncover?
This is exactly what Teach to Reach is doing.
In June 2024, Teach to Reach 10 brought together 21,398 participants from across the health system – from community health workers to national policymakers.
This diverse group represents an incredible wealth of knowledge and experience that has often been overlooked in global health decision-making.
Bridge the gap between policy and practice
One of the most exciting aspects of Teach to Reach is how it bridges the gap between policy and practice.
Too often, there is a disconnect between those making decisions at the global level and those implementing programs on the ground.
Teach to Reach creates a direct line of communication, allowing frontline workers to influence policy and program design in real-time.
This approach not only leads to more effective interventions but also empowers health workers, increasing their engagement and motivation.
Scale knowledge transfer and translation efficiently
In global health, we are always looking for ways to scale solutions efficiently.
This scaling effect is particularly crucial in low-resource settings, where formal learning opportunities may be limited.
Teach to Reach applies this principle to peer learning.
Then there is speed.
The platform can disseminate best practices and local solutions much more rapidly than traditional top-down approaches.
There is also the “know-do” gap or the “applicability problem”.
Teach to Reach supports continuous learning by sharing experience, focused on how to get results, especially at the local community level.
Measuring impact and driving innovation
The Teach to Reach platform uses a comprehensive framework to track the value of participation for individuals and the benefits for partners.
But we do not stop there.
Teach to Reach is just one component in the Geneva Learning Foundation’s model to support new learning and leadership to drive change.
We then track and measure what participants do with the knowledge gained and the experiences shared.
We do this all the way to the time where improved health outcomes can be attributed to a discovery or significant learning made at Teach to Reach.
Moreover, Teach to Reach serves as an innovation hub, surfacing diverse ideas and solutions from the field.
For organizations looking to drive innovation in their global health programs, this platform offers a new path to creative problem-solving with those closest to the challenges.
A call to action for global health leaders
If you are a leader in the global health space, I urge you to consider partnering with Teach to Reach.
Here are 5 ways in which partners have found utility in Teach to Reach:
- Inform a strategy with ground-level insights.
- Expand reach across multiple countries and health system levels.
- Tap into a diverse pool of local solutions – and help augment and scale them.
- Demonstrate commitment to supporting locally-led, community-based positive change.
- Accelerate progress towards global health goals through collaborative learning.
In today’s interconnected world, our ability to solve global health challenges depends on our capacity to learn from one another and scale effective solutions quickly.
Teach to Reach is pioneering a new approach that harnesses the power of peer learning to do just that.
Investing in Teach to Reach can help unlock the full potential of our global health workforce and make significant strides towards a healthier, more equitable world.
The future of global health is collaborative.
Teach to Reach provides a way to turn the rhetoric of collaboration into practical action.
Share this:
#CollectiveIntelligence #globalHealth #innovation #localCommunities #peerLearning #TeachToReach
-
Can Teach to Reach help your organization?
Teach to Reach stands as a unique nexus in the global health landscape, offering unprecedented opportunities for diverse stakeholders to engage, learn, and drive meaningful change.
With over 60,000 participants from more than 90 countries, this platform, network, and community bring together a mix of frontline health workers, policymakers, and key decision-makers.
At Teach to Reach, research institutions and academic researchers engage health workers to translate their findings into policy and practice
For research institutions and academic partners, Teach to Reach provides a site for knowledge translation.
It provides direct access to practitioners and policymakers at all levels, enabling researchers to share findings with those best positioned to apply them in real-world settings.
The platform’s interactive features, such as “Teach to Reach Questions,” allow for rapid data collection and feedback, helping bridge the gap between research and practice.
At Teach to Reach, global agencies can listen and learn with local communities
Global health organizations can leverage Teach to Reach to gain invaluable insights into unmet needs of local communities.
With half of the participants working in districts and local facilities, and many in challenging contexts such as armed conflict zones (1 in 5) or remote rural areas (>60%), partners can engage with ground-level perspectives that inform development, strategies, and programme design.
This direct engagement with frontline workers offers a unique window into the realities of diverse health systems.
At Teach to Global, global actors help elevate the voices and leadership of local actors
For those looking to make a tangible impact on global health equity, Teach to Reach’s scholarship programme offers a compelling opportunity.
Scholarship sponsors support health workers from low and middle-income countries to participate in Teach to Reach.
This investment not only builds individual capacity but strengthens health systems by recognizing and amplifying health worker voices and expertise.
Facilitate meaningful dialogue on critical issues
Global health stakeholders find in Teach to Reach a platform that facilitates meaningful dialogue on critical issues.
The diverse participant base, including national policymakers and heads of national programmes, creates an environment ripe for new kinds of inclusive dialogue that can shape national and global strategies and frameworks.
Become a Teach to Reach sponsor
This mix of participants offers partners a unique opportunity to engage with key decision-makers in an interactive, collaborative setting.
Some partners also become sponsors by contributing to the costs.
For example, partners can sponsor scholarships for health workers to support their participation in Teach to Reach.
This is just one of the ways in which partners can help sustain Teach to Reach as a platform, network, and community.
For private sector organizations, sponsoring Teach to Reach aligns seamlessly with corporate social responsibility goals in global health.
By this platform, organizations can articulate their concrete commitment to strengthening health systems, showing their support to health workers, and promoting health equity.
This engagement goes beyond traditional philanthropy, offering sponsors a way to showcase their dedication to improving global health outcomes while enhancing their reputation in the field.
In essence, Teach to Reach offers a multifaceted value proposition for partners.
It is a place to listen and learn, to share and collaborate, to influence and be influenced.
Whether an organization’s goals revolve around research impact, market insights, policy influence, or social responsibility, Teach to Reach provides a unique, efficient, and impactful site to engage.
By joining this community, partners do not just support a platform – they become part of a movement that is reshaping how we approach global health challenges, one connection at a time.
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#Dialogue #knowledgeTranslation #localAction #localization #peerLearning #TeachToReach
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Can Teach to Reach help your organization?
Teach to Reach stands as a unique nexus in the global health landscape, offering unprecedented opportunities for diverse stakeholders to engage, learn, and drive meaningful change.
With over 60,000 participants from more than 90 countries, this platform, network, and community bring together a mix of frontline health workers, policymakers, and key decision-makers.
At Teach to Reach, research institutions and academic researchers engage health workers to translate their findings into policy and practice
For research institutions and academic partners, Teach to Reach provides a site for knowledge translation.
It provides direct access to practitioners and policymakers at all levels, enabling researchers to share findings with those best positioned to apply them in real-world settings.
The platform’s interactive features, such as “Teach to Reach Questions,” allow for rapid data collection and feedback, helping bridge the gap between research and practice.
At Teach to Reach, global agencies can listen and learn with local communities
Global health organizations can leverage Teach to Reach to gain invaluable insights into unmet needs of local communities.
With half of the participants working in districts and local facilities, and many in challenging contexts such as armed conflict zones (1 in 5) or remote rural areas (>60%), partners can engage with ground-level perspectives that inform development, strategies, and programme design.
This direct engagement with frontline workers offers a unique window into the realities of diverse health systems.
At Teach to Global, global actors help elevate the voices and leadership of local actors
For those looking to make a tangible impact on global health equity, Teach to Reach’s scholarship programme offers a compelling opportunity.
Scholarship sponsors support health workers from low and middle-income countries to participate in Teach to Reach.
This investment not only builds individual capacity but strengthens health systems by recognizing and amplifying health worker voices and expertise.
Facilitate meaningful dialogue on critical issues
Global health stakeholders find in Teach to Reach a platform that facilitates meaningful dialogue on critical issues.
The diverse participant base, including national policymakers and heads of national programmes, creates an environment ripe for new kinds of inclusive dialogue that can shape national and global strategies and frameworks.
Become a Teach to Reach sponsor
This mix of participants offers partners a unique opportunity to engage with key decision-makers in an interactive, collaborative setting.
Some partners also become sponsors by contributing to the costs.
For example, partners can sponsor scholarships for health workers to support their participation in Teach to Reach.
This is just one of the ways in which partners can help sustain Teach to Reach as a platform, network, and community.
For private sector organizations, sponsoring Teach to Reach aligns seamlessly with corporate social responsibility goals in global health.
By this platform, organizations can articulate their concrete commitment to strengthening health systems, showing their support to health workers, and promoting health equity.
This engagement goes beyond traditional philanthropy, offering sponsors a way to showcase their dedication to improving global health outcomes while enhancing their reputation in the field.
In essence, Teach to Reach offers a multifaceted value proposition for partners.
It is a place to listen and learn, to share and collaborate, to influence and be influenced.
Whether an organization’s goals revolve around research impact, market insights, policy influence, or social responsibility, Teach to Reach provides a unique, efficient, and impactful site to engage.
By joining this community, partners do not just support a platform – they become part of a movement that is reshaping how we approach global health challenges, one connection at a time.
Share this:
#Dialogue #knowledgeTranslation #localAction #localization #peerLearning #TeachToReach
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The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges
Less than three weeks after its launch, the Nigeria Immunization Collaborative – a partnership between the Geneva Learning Foundation, the National Primary Health Care Development Agency (NPHCDA), and UNICEF – has already connected over 4,000 participants from all 36 states and more than 300 Local Government Areas (LGAs).
The Collaborative is part of the Movement for Immunization Agenda 2030 (IA2030).
In the Collaborative’s first peer learning exercise that concluded on 6 August 2024, over 600 participants conducted root cause analyses of immunization barriers in their communities.
Participants engaged in a two-week intensive process of analyzing immunization challenges, conducting root cause analyses, and developing actionable plans to address these issues.
They did this without having to stop their daily work or travel, a key characteristic of The Geneva Learning Foundation’s model to support work-based learning.
Watch the General Assembly of the Nigeria Immunization Collaborative on 6 August 2024
https://www.youtube.com/watch?v=zicqexzachA
What are health workers saying about the Collaborative?
For Mariam Mustapha, a participant from Kano State, the Collaborative is “multiple individuals that perform a task”, united around a shared purpose.
She highlighted the importance of engaging with community members, noting, “These people from the community, most of them, they don’t have enough knowledge or they are receiving misinformation about immunization and vaccines.”
The peer learning exercise employed a structured approach, asking participants to explain their immunization challenge, conduct a “5 Whys” analysis to identify root causes, and develop actionable plans within their scope of work.
How does the Collaborative help health workers?
This method proved enlightening for many participants.
John Emmanuel, a community health worker from Bauchi State, shared his experience: “I just discovered that over the years, I have been superficial in my approach. I’ve been one sided. I’ve been actually peripheral in my approach. So during the root cause analysis, I was able to identify the broader perspective of identifying the challenge and then fixing it as it affects my job here in the community.”
The Collaborative also fostered connections between health workers across different regions of Nigeria.
Mohammed Nasir Umar, a JSI HPV program associate in Zamfara State, noted the value of this cross-pollination of ideas: “The root cause analysis really widened my horizon on how I think around the challenges. The ‘5 Whys’ techniques approach was really, really helpful.”
Participants identified a range of immunization challenges, including vaccine hesitancy, lack of information and awareness, sociocultural and religious factors, reaching zero-dose children, incomplete immunization, healthcare worker issues, logistical challenges, political interference, poor documentation, and community trust issues.
But then each one started asking ‘why’, stopping only once they found a root cause that they are in a position to do something about.
Esther Sharma, working with NPHCDA in a local government area, identified a critical issue in her facility: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here.”
Her solution involves ensuring consistent staffing during immunization days, which should encourage more community members to seek vaccination services.
How are new stakeholders participating in the Collaborative?
The Collaborative also welcomed participation from organizations not traditionally involved in immunization services.
Angela Emmanuel, a nurse and founder of the Emmanuel Cancer Foundation in Lagos, found value in the exercise for her work on HPV vaccination and cancer prevention.
She emphasized the need for a more educational approach: “Our motive should be education. Our motive should be the awareness, not just asking them to take this vaccine.”
Chijioke Kaduru, a public health physician who served as a Guide for the Collaborative, reflected: “While some of these challenges are similar in many settings, the local context and the nuances that shape these challenges clearly make them a good opportunity to engage, to interact, to understand them better, and to start to also see the ideas that colleagues have about how to solve those problems.”
By connecting frontline health workers, fostering critical thinking, and encouraging the development of locally-tailored solutions, the Nigeria Immunization Collaborative represents a potentially scalable model for strengthening health systems and improving immunization coverage.
As the exercise concludes, participants are poised to implement their action plans in their respective communities.
How are government workers participating in the Collaborative?
A key focus of the final session was the presentation of root cause analyses by government workers from the Federal and State Primary Health Care Development Agencies.
These presentations provided valuable insights into the challenges faced at various levels of the health system and the innovative solutions being developed.
Maimuna Tata, a deputy in-charge at a health facility in Bunkura local government area of Kano State, presented her analysis of why routine immunization sessions were not being conducted at her facility.
Through her “5 Whys” analysis, she uncovered a systemic issue: “The health facility is newly built and was commissioned after the 2024 micro plan exercise and needs to undergo several processes for provision of routine immunization.”
Tata’s proposed solution demonstrated the kind of innovative thinking the Collaborative aimed to foster: “Instead of them coming for outreach session in the settlement, I think the vaccine should be channeled to the health facility so that the health facility can conduct the sessions. And at the end of the day, we will now be submitting our reports to the health facility, that is the model health facility, pending the time the health facility will be recorded or will be updated in the server.”
Esther Sharma, working with NPHCDA in a local government area, identified a critical staffing issue: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here. I am the routine immuunization focal person where I currently work and when I went there newly, I asked a lot of people, why don’t they come to the hospital for immunization? And they said when they come, they don’t find anybody to attend to them.”
Her solution involves ensuring consistent staffing during immunization days, which she reported has already encouraged more community members to seek vaccination services.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#Collaborative #ImmunizationAgenda2030 #learningCulture #Nigeria #NPHCDA #peerLearning #rootCauseAnalysis #socialLearning #TheGenevaLearningFoundation
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The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges
Less than three weeks after its launch, the Nigeria Immunization Collaborative – a partnership between the Geneva Learning Foundation, the National Primary Health Care Development Agency (NPHCDA), and UNICEF – has already connected over 4,000 participants from all 36 states and more than 300 Local Government Areas (LGAs).
The Collaborative is part of the Movement for Immunization Agenda 2030 (IA2030).
In the Collaborative’s first peer learning exercise that concluded on 6 August 2024, over 600 participants conducted root cause analyses of immunization barriers in their communities.
Participants engaged in a two-week intensive process of analyzing immunization challenges, conducting root cause analyses, and developing actionable plans to address these issues.
They did this without having to stop their daily work or travel, a key characteristic of The Geneva Learning Foundation’s model to support work-based learning.
Watch the General Assembly of the Nigeria Immunization Collaborative on 6 August 2024
https://www.youtube.com/watch?v=zicqexzachA
What are health workers saying about the Collaborative?
For Mariam Mustapha, a participant from Kano State, the Collaborative is “multiple individuals that perform a task”, united around a shared purpose.
She highlighted the importance of engaging with community members, noting, “These people from the community, most of them, they don’t have enough knowledge or they are receiving misinformation about immunization and vaccines.”
The peer learning exercise employed a structured approach, asking participants to explain their immunization challenge, conduct a “5 Whys” analysis to identify root causes, and develop actionable plans within their scope of work.
How does the Collaborative help health workers?
This method proved enlightening for many participants.
John Emmanuel, a community health worker from Bauchi State, shared his experience: “I just discovered that over the years, I have been superficial in my approach. I’ve been one sided. I’ve been actually peripheral in my approach. So during the root cause analysis, I was able to identify the broader perspective of identifying the challenge and then fixing it as it affects my job here in the community.”
The Collaborative also fostered connections between health workers across different regions of Nigeria.
Mohammed Nasir Umar, a JSI HPV program associate in Zamfara State, noted the value of this cross-pollination of ideas: “The root cause analysis really widened my horizon on how I think around the challenges. The ‘5 Whys’ techniques approach was really, really helpful.”
Participants identified a range of immunization challenges, including vaccine hesitancy, lack of information and awareness, sociocultural and religious factors, reaching zero-dose children, incomplete immunization, healthcare worker issues, logistical challenges, political interference, poor documentation, and community trust issues.
But then each one started asking ‘why’, stopping only once they found a root cause that they are in a position to do something about.
Esther Sharma, working with NPHCDA in a local government area, identified a critical issue in her facility: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here.”
Her solution involves ensuring consistent staffing during immunization days, which should encourage more community members to seek vaccination services.
How are new stakeholders participating in the Collaborative?
The Collaborative also welcomed participation from organizations not traditionally involved in immunization services.
Angela Emmanuel, a nurse and founder of the Emmanuel Cancer Foundation in Lagos, found value in the exercise for her work on HPV vaccination and cancer prevention.
She emphasized the need for a more educational approach: “Our motive should be education. Our motive should be the awareness, not just asking them to take this vaccine.”
Chijioke Kaduru, a public health physician who served as a Guide for the Collaborative, reflected: “While some of these challenges are similar in many settings, the local context and the nuances that shape these challenges clearly make them a good opportunity to engage, to interact, to understand them better, and to start to also see the ideas that colleagues have about how to solve those problems.”
By connecting frontline health workers, fostering critical thinking, and encouraging the development of locally-tailored solutions, the Nigeria Immunization Collaborative represents a potentially scalable model for strengthening health systems and improving immunization coverage.
As the exercise concludes, participants are poised to implement their action plans in their respective communities.
How are government workers participating in the Collaborative?
A key focus of the final session was the presentation of root cause analyses by government workers from the Federal and State Primary Health Care Development Agencies.
These presentations provided valuable insights into the challenges faced at various levels of the health system and the innovative solutions being developed.
Maimuna Tata, a deputy in-charge at a health facility in Bunkura local government area of Kano State, presented her analysis of why routine immunization sessions were not being conducted at her facility.
Through her “5 Whys” analysis, she uncovered a systemic issue: “The health facility is newly built and was commissioned after the 2024 micro plan exercise and needs to undergo several processes for provision of routine immunization.”
Tata’s proposed solution demonstrated the kind of innovative thinking the Collaborative aimed to foster: “Instead of them coming for outreach session in the settlement, I think the vaccine should be channeled to the health facility so that the health facility can conduct the sessions. And at the end of the day, we will now be submitting our reports to the health facility, that is the model health facility, pending the time the health facility will be recorded or will be updated in the server.”
Esther Sharma, working with NPHCDA in a local government area, identified a critical staffing issue: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here. I am the routine immuunization focal person where I currently work and when I went there newly, I asked a lot of people, why don’t they come to the hospital for immunization? And they said when they come, they don’t find anybody to attend to them.”
Her solution involves ensuring consistent staffing during immunization days, which she reported has already encouraged more community members to seek vaccination services.
Image: The Geneva Learning Foundation Collection © 2024
Share this:
#Collaborative #ImmunizationAgenda2030 #learningCulture #Nigeria #NPHCDA #peerLearning #rootCauseAnalysis #socialLearning #TheGenevaLearningFoundation
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7 take-aways from Nigeria’s first Immunization Collaborative peer learning exercise
On August 6, 2024, the Nigeria Immunization Agenda 2030 Collaborative concluded its first peer learning exercise with a final Assembly.
This groundbreaking initiative, a partnership between The Geneva Learning Foundation, Nigeria’s National Primary Health Care Development Agency (NPHCDA), and UNICEF, has already engaged over 4,400 health workers from all 36 States and more than 300 Local Government Areas (LGAs) across Nigeria.
The Collaborative’s innovative approach focuses on empowering health workers to identify root causes of local immunization challenges and develop practical, context-specific solutions.
As the initiative continues to grow, with new members joining daily, it could help shift how Nigeria approaches immunization capacity building and problem-solving.
Right after the final Assembly on 6 August 2024, Nigeria immunization specialist Jenny Sequeira and The Geneva Learning Foundation’s deputy director Charlotte Mbuh shared their initial thoughts about the exercise.
Here are 7 key takeaways from their discussion.
1. Critical Thinking Evolution: Participants made significant progress in their analytical skills, moving from vague problem statements to nuanced understanding of local immunization challenges. The “5 Whys” technique proved particularly effective.
2. Power of Peer Review: The structured, time-bound peer review process emerged as a practical learning tool, fostering self-reflection and exposing participants to diverse perspectives.
3. Leveling the Playing Field: The Collaborative created an environment where hierarchies dissolved, enabling workers from the local levels to engage laterally with state and national-level participants.
4. Focus on Actionable Solutions: Participants were encouraged to identify root causes within their control, promoting practical, context-specific solutions.
5. Importance of Community Engagement: The process highlighted the crucial role of engaging communities and addressing barriers to improve vaccine uptake.
6. Emphasis on Implementation: While the RCA exercise was valuable, leaders stressed the critical need for follow-through and implementation of proposed solutions.
7. Cross-Sector Collaboration: The collaborative saw participation from diverse stakeholders, including government agencies, civil society organizations, and private sector entities.
Image: The Geneva Learning Foundation Collection © 2024
#CommunityHealthWorkers #healthWorkers #HRH #IA2030 #immunization #ImmunizationAgenda2030 #Nigeria #NPHCDA #UNICEF #zeroDose -
7 take-aways from Nigeria’s first Immunization Collaborative peer learning exercise
On August 6, 2024, the Nigeria Immunization Agenda 2030 Collaborative concluded its first peer learning exercise with a final Assembly.
This groundbreaking initiative, a partnership between The Geneva Learning Foundation, Nigeria’s National Primary Health Care Development Agency (NPHCDA), and UNICEF, has already engaged over 4,400 health workers from all 36 States and more than 300 Local Government Areas (LGAs) across Nigeria.
The Collaborative’s innovative approach focuses on empowering health workers to identify root causes of local immunization challenges and develop practical, context-specific solutions.
As the initiative continues to grow, with new members joining daily, it could help shift how Nigeria approaches immunization capacity building and problem-solving.
Right after the final Assembly on 6 August 2024, Nigeria immunization specialist Jenny Sequeira and The Geneva Learning Foundation’s deputy director Charlotte Mbuh shared their initial thoughts about the exercise.
Here are 7 key takeaways from their discussion.
1. Critical Thinking Evolution: Participants made significant progress in their analytical skills, moving from vague problem statements to nuanced understanding of local immunization challenges. The “5 Whys” technique proved particularly effective.
2. Power of Peer Review: The structured, time-bound peer review process emerged as a practical learning tool, fostering self-reflection and exposing participants to diverse perspectives.
3. Leveling the Playing Field: The Collaborative created an environment where hierarchies dissolved, enabling workers from the local levels to engage laterally with state and national-level participants.
4. Focus on Actionable Solutions: Participants were encouraged to identify root causes within their control, promoting practical, context-specific solutions.
5. Importance of Community Engagement: The process highlighted the crucial role of engaging communities and addressing barriers to improve vaccine uptake.
6. Emphasis on Implementation: While the RCA exercise was valuable, leaders stressed the critical need for follow-through and implementation of proposed solutions.
7. Cross-Sector Collaboration: The collaborative saw participation from diverse stakeholders, including government agencies, civil society organizations, and private sector entities.
Image: The Geneva Learning Foundation Collection © 2024
#CommunityHealthWorkers #healthWorkers #HRH #IA2030 #immunization #ImmunizationAgenda2030 #Nigeria #NPHCDA #UNICEF #zeroDose -
Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration
As immunization programs worldwide struggle to recover from pandemic disruptions, the Movement for Immunization Agenda 2030 (IA2030) offers a novel, practitioner-led approach to accelerate progress towards global vaccination goals.
From March to June 2022, the Geneva Learning Foundation (TGLF) conducted the first Full Learning Cycle (FLC) of the Movement for IA2030, engaging 6,185 health professionals from low- and middle-income countries.
A cornerstone of this programme was a series of 44 experience-sharing sessions held between 7 March and 13 June 2022. These sessions brought together between 20 and 400 practitioners per session to discuss and solve real-world immunization challenges.
IA2030 case study 16, by Charlotte Mbuh and François Gasse, offers valuable insights from these experience-sharing session:
- what we learned from the experiences themselves and how it can help practitioners; and
- what we learned about the significance and potential of the peer learning process itself.
Download the full case study: IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation.
For every challenge shared during the experience sharing sessions, there was always at least one member who had encountered or was encountering the same challenge and had carried out measures to resolve it.
These sessions provided a space to share practical stories that are making a difference – and supported participants in considering their relevance to their own situations.
Experience sharing also helped build confidence and motivation.
Members were able to identify with experiences shared, realizing they were not alone in facing similar challenges.
The sessions covered a wide range of critical immunization topics.
For instance, a participant from Nigeria discussed strategies for reaching zero-dose children in Borno state.
Facing the challenge of reaching approximately 600,000 unvaccinated children, the presenter received practical suggestions from peers, including developing a zero-dose reduction operational plan, leveraging new vaccine introductions, and partnering with the private sector for evening vaccination services.
In another session, a subnational Ministry of Health staff member from Côte d’Ivoire presented challenges related to cross-border immunization campaigns.
Peers shared experiences of organizing cross-border meetings to identify unvaccinated children, synchronize efforts, and involve community representatives in the process.
Such context-specific, experience-based advice exemplifies the unique value of peer learning in addressing complex health system challenges.
The case study of 44 sessions highlights how these sessions fostered multiple types of learning simultaneously.
Participants reported learning from each other’s experiences, experiencing the power of solving problems together across distances, feeling a growing sense of belonging to a community, and connecting across country borders and health system levels.
A district-level Ministry of Health staff member from Ghana encapsulated the impact: “I have linked up with expert vaccinators worldwide through experience sharing and twinning. I have become more competent and knowledgeable in the area of immunization, and work confidently.”
This sentiment was echoed by many participants who found value not only in acquiring new knowledge but also in expanding their professional networks and gaining confidence in their problem-solving abilities.
The case study also reveals the adaptability of the approach in responding to unique contexts.
This resilience underscores the potential of digital platforms to democratize access to expertise and foster global collaboration.
However, the study also identifies areas for improvement.
- Participants expressed a desire for more follow-up support and opportunities to continue their peer learning groups beyond the initial sessions.
- Additionally, the need for better integration of community engagement strategies was identified as a key area for future development.
To contextualize these findings, we can turn to a 2022 study by Watkins et al., which evaluated a prototype of these experience-sharing sessions known as Immunization Training Challenge Hackathons (ITCH), conducted in 2020.
The ITCH methodology, developed by The Geneva Learning Foundation (TGLF), informed the design of the 2022 IA2030 Movement sessions.
Watkins et al. found that the ITCH approach fostered four simultaneous types of learning: peer, remote, social, and networked.
- Peer Learning: This involves participants learning directly from each other’s experiences and knowledge. In the context of immunization, imagine a scenario where a vaccination program manager from rural India shares their successful strategy for improving vaccine cold chain management with a colleague facing similar challenges in sub-Saharan Africa. This direct exchange of practical, context-specific knowledge can complement more theoretical training, as it is based on real-world application.
- Remote Learning: This refers to the ability to learn and solve problems collaboratively across geographical distances. For an immunization specialist, this might seem counterintuitive, as many believe that hands-on, in-person training is essential. However, the ITCH sessions demonstrated that meaningful learning can occur remotely. For example, a team in Bangladesh could describe their approach to overcoming vaccine hesitancy, and a team in Nigeria could immediately adapt and apply those strategies to their local context, all without the need for costly and time-consuming travel.
- Social Learning: This concept emphasizes the importance of learning within a network. In the immunization field, professionals often work in isolation, especially at sub-national levels. The ITCH sessions created a sense of belonging to a global network, community, and platform of immunization practitioners. This social aspect can boost motivation, reduce feelings of isolation, and foster a collective approach to problem-solving that transcends individual or even national boundaries.
- Networked Learning: This type of learning emerges from connections made across different levels of health systems and across country borders. For an epidemiologist, this might be analogous to how disease surveillance networks function across borders. In the ITCH context, it means that a district-level immunization officer could learn from and share ideas with national-level policymakers from other countries, fostering a more holistic understanding of immunization challenges and solutions.
These four types of learning operate simultaneously during ITCH sessions, creating a synergistic effect.
For instance, a participant might learn a new cold chain management technique (peer learning) from a colleague in another country (remote learning), feel supported by the global community in implementing this new technique (social learning), and then share their adaptation of this technique with others across various levels of the health system (networked learning).
From an epidemiological perspective, this approach to learning could be compared to how we understand disease transmission and intervention effectiveness.
Just as multiple factors contribute to disease spread and control, these multiple learning types contribute to knowledge dissemination and capacity building in the immunization field.
The value of this approach lies in its potential to rapidly disseminate practical, context-specific knowledge and solutions across a global network of immunization professionals.
This can lead to faster adoption of best practices, more innovative problem-solving, and ultimately, improvements in immunization program performance that could contribute to better disease control outcomes.
While this approach may seem unconventional compared to traditional training methods in the immunization field, the evidence presented by Watkins et al. suggests that it can be a powerful complement to existing capacity-building efforts, particularly in resource-constrained settings where access to formal training opportunities may be limited.
This multifaceted approach allowed participants to not only acquire new knowledge but also to expand their professional networks and gain confidence in their problem-solving abilities—findings that align closely with the outcomes observed in the 2022 IA2030 Movement sessions.
The Watkins study emphasized the importance of building confidence and motivation through peer learning experiences, a theme strongly echoed in the Mbuh case study.
Furthermore, Watkins et al. highlighted the potential of this approach to create a “space of possibility” for innovation and problem-solving, which is evident in the diverse and creative solutions shared during the 2022 sessions.
Both studies underscore the significance of peer-led, digital learning experiences in accelerating progress towards global health goals.
By fostering peer learning and digital collaboration, these approaches empower health workers to turn global strategies into effective local action.
References
Mbuh, C., Gasse, F., Jones, I., Sadki, R., Brooks, A., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7014392
Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4
Image: The Geneva Learning Foundation Collection © 2024
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#CharlotteMbuh #continuousLearning #FrançoisGasse #FullLearningCycle #IA2030 #IA2030CaseStudies #ImmunizationAgenda2030 #ITCH #KarenEWatkins #learningCulture #MovementForImmunizationAgenda2030 #networkedLearning #peerLearning #remoteLearning #TheGenevaLearningFoundation
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Integrating community-based monitoring (CBM) into a comprehensive learning-to-action model
According to Gavi, “community-based monitoring” or “CBM” is a process where service users collect data on various aspects of health service provision to monitor program implementation, identify gaps, and collaboratively develop solutions with providers.
- Community-based monitoring (CBM) has emerged as a promising strategy for enhancing immunization program performance and equity.
- CBM interventions have been implemented across different settings and populations, including remote rural areas, urban poor, fragile/conflict-affected regions, and marginalized groups such as indigenous populations and people living with HIV.
By engaging service users, CBM aims to foster greater accountability and responsiveness to local needs.
- However, realizing CBM’s potential in practice has proven challenging.
- Without a coherent approach, CBM risks becoming just another disconnected tool.
The Geneva Learning Foundation’s innovative learning-to-action model offers a compelling framework within which CBM could be applied to immunization challenges.
The model’s comprehensive design creates an enabling environment for effectively integrating diverse monitoring data sources – and this could include community perspectives.
Health workers as trusted community advisers… and members of the community
A distinctive feature of TGLF’s model is its emphasis on health workers’ role as trusted advisors to the communities they serve.
The model recognizes that local health staff are not merely service providers, but often deeply embedded community members with intimate knowledge of local realities.
For example, in TGLF’s immunization learning initiatives, participating health workers frequently share insights into the social, cultural, and economic factors shaping vaccine hesitancy and uptake in their communities.
- They discuss the everyday barriers families face, from misinformation to transportation challenges, and strategize context-specific outreach approaches.
- This grounding in community realities positions health workers as vital bridges for facilitating community engagement in monitoring.
When local staff are empowered as active agents of learning and change, they can more effectively champion community participation, translating insights into tangible improvements.
Could CBM fit into a more comprehensive system from local monitoring to action?
TGLF’s model supports health workers in this bridging role by providing a comprehensive framework for local monitoring and action.
Through peer learning networks and problem-solving cycles, the model equips health staff to collect, interpret, and act on unconventional monitoring data from their communities.
For instance, in TGLF’s 2022 “Full Learning Cycle” initiative, 6,185 local health workers from 99 countries examined key immunization indicators to inform their analyses of root causes and then map out corrective actions.
- Participants began monitoring their own local health indicators, such as vaccination coverage rates.
- For many, this was the first time they had been prompted to use this data for problem-solving a real-world challenge they face, rather than just reporting up the next level of the health system.
They discussed many factors critical for tailoring immunization strategies.
This transition – from being passive data collectors to active data users – has proven transformative.
It positions health workers not as cogs in a reporting machine, but as empowered analysts and strategists.
By discussing real metrics with peers, participants make data actionable and contextually meaningful.
Guided by expert-designed rubrics and facilitated discussions, health workers translated this localized monitoring data into practical improvement plans.
For an epidemiologist, this represents a significant shift from traditional top-down monitoring paradigms.
By valuing and actioning local knowledge, TGLF’s model demonstrates how community insights can be systematically integrated into immunization decision-making.
However, until now, its actors have been health workers, many of them members of the communities they serve, not service users themselves.
CBM’s focus on monitoring is important – but leaves out key issues around community participation, decision-making autonomy, and strategy.
How could we integrate CBM into a transformative approach?
TGLF’s experiences suggest that CBM could be embedded within comprehensive learning-to-action systems focused on locally-led change.
TGLF’s model is more than a monitoring intervention.
- It combines structured learning, rapid solution sharing, root cause analysis, action planning, and peer accountability to drive measurable improvements.
- These mutually reinforcing components create an enabling environment for health workers to translate insights into impact.
In this framing, community monitoring becomes one critical input within a continuous, collaborative process of problem-solving and adaptation.
Several features of TGLF’s model illustrate how this integration could work in practice:
- Peer accountability structures, where health workers regularly convene to review progress, share challenges, and iterate solutions, create natural entry points for discussing and actioning community feedback.
- Rapid dissemination channels, like TGLF’s “Ideas Engine” for spreading promising practices across contexts, enable local innovations in response to community-identified gaps to be efficiently scaled.
- Emphasis on root cause analysis and systemic thinking equips health workers to interpret community insights within a broader ecosystem lens, connecting localized issues to upstream determinants.
- Cultivation of connected leadership empowers local actors to champion community priorities and navigate complex change processes.
TGLF’s extensive digital network connects health workers across system levels and contexts, enabling them to learn from each other’s experiences with no upper limit to the number of participants.
By contrast, CBM seems to assume that a community is limited to a physical area, which fails to recognize that problem-solving complex challenges requires expanding the range of inputs used.
Within a networked approach that connects both community members and health workers across boundaries of geography, health system level, and roles, CBM could become an integral component of a transformative approach to health system improvement – one that recognizes communities and local health workers as capable architects of context-responsive solutions.
Fundamentally, the TGLF model invites a shift in mindset about whose expertise counts in monitoring and driving system change.
CBM could provide the ‘connective tissue’ for health workers to revise how they listen and learn with the communities they serve.
For immunization programs grappling with persistent inequities, this shift from passive compliance to proactive local problem-solving is critical.
As the COVID-19 crisis has underscored, rapidly evolving public health challenges demand localized action that harnesses the full range of community expertise.
TGLF’s model offers a tested framework for actualizing this vision at scale.
By investing in local health workers’ capacity to learn, adapt, and lead change in partnership with the communities they serve, the model illuminates a promising pathway for integrating CBM into immunization monitoring and beyond.
For epidemiologists and global health practitioners, TGLF’s approach invites a reframing of how we conceptualize and operationalize community engagement in health system monitoring.
It challenges us to move beyond tokenistic participation towards genuine co-design and co-ownership of monitoring processes with local actors.
Realizing this vision will require significant shifts in mindsets, power dynamics, and resource flows.
But as TGLF’s initiatives demonstrate, when we invest in the leadership of those closest to the challenges we seek to solve, transformative possibilities emerge.
Further rigorous research comparing the impacts of different CBM integration models could help accelerate this paradigm shift, surfacing critical lessons for the immunization field and global health more broadly.
TGLF’s model not only offers compelling lessons for reimagining monitoring and improvement in immunization programs, it also provides a pathway for integrating CBM into a system that supports actual change.
CBM practitioners are likely to struggle with how to incorporate it into existing practices.
By investing in frontline health workers as change agents, and surrounding them with an empowering learning ecosystem, the model offers a path to then bring in community monitoring.
Without such leadership from health workers, it is unlikely that communities are able to participate.
The journey to authentic community engagement in health system monitoring is undoubtedly complex.
But if we are to deliver on the promise of equitable immunization for all, it is a journey we must undertake.
TGLF’s model lights one promising path forward – one that positions communities and local health workers as the beating heart of a learning health system.
While Gavi’s evidence brief affirms the promise of CBM for immunization, TGLF’s experience with its own model suggests the full potential of CBM may be realized by embedding it within more comprehensive, digitally-enabled learning systems that activate health workers as agents of change – and do so with both physical and digital communities implementing new forms of peer and community accountability that complement conventional kinds (supervision, administration, donor, etc.).
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#communityBasedMonitoring #continuousLearning #globalHealth #healthWorkers #HRH #HumanResourcesForHealth #immunization #ImmunizationAgenda2030 #learningStrategy #TheGenevaLearningFoundation #zeroDoseChildren #ZeroDoseLearningHubZDLH_
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Why asking learners what they want is a recipe for confusion
A survey of learners on a large, authoritative global health learning platform has me pondering once again the perils of relying too heavily on learner preferences when designing educational experiences.
One survey question intended to ask learners for their preferred learning method.
The list of options provided includes a range of items.
(Some would make the point that the list conflates learning resources and learning methods, but let us leave that aside for now.)
Respondents’ top choices (source) were videos, slides, and downloadable documents.
At first glance, this seems perfectly reasonable.
After all, should we not give learners what they want?
As it happens, the main resources offered by this platform are videos, slides, and other downloadable documents.
(If we asked learners who participate in our peer learning programmes for their preference, they would likely say that they prefer… peer learning.)
Beyond this availability bias, there is a more significant problem with this approach: learner preferences often have little correlation with actual learning outcomes.
And learners are especially bad at self-evaluating what learning methods and resources are most conducive to effective learning.
The scientific literature is quite clear on this point.
Bjork’s 2013 article on self-regulated learning emphatically states that: “learners are often prone to illusions of competence during learning, and these illusions can be remarkably compelling.”
The study by Deslauriers et al. (2019) provides a compelling demonstration that while students express a strong preference for traditional lectures over active learning methods, they actually learn significantly more from the active approaches they claim to dislike.
This disconnect between preference and efficacy is not surprising when we consider how learning actually works.
Effective learning requires effort, struggle, and sometimes discomfort as we grapple with new ideas and challenge our existing mental models.
It is not always an enjoyable process in the moment, even if the long-term results are deeply rewarding.
Furthermore, learners (like all of us) are subject to various cognitive biases that can lead them astray when evaluating their own learning.
The illusion of explanatory depth, for example, can cause us to overestimate how well we understand a topic after passively consuming information about it.
None of this is to say we should ignore learner perspectives entirely.
Motivation and engagement do matter for learning.
But we need to be thoughtful about how we solicit and interpret learner feedback.
Asking about preferences for specific content formats (videos, slides, etc.) tells us very little about the actual learning activities and cognitive processes involved.
A more productive approach might be to focus on understanding learners’ goals, challenges, and contexts.
What are they trying to achieve?
What obstacles do they face?
What constraints shape their learning environment?
With this information, we can design evidence-based learning experiences that truly meet their needs – even if they don’t always match their stated preferences.
As learning professionals, our job is not to give learners what they think they want.
It is to create the conditions for transformative learning experiences that expand their capabilities and perspectives.
This often means pushing learners out of their comfort zones and challenging their assumptions about how learning should look and feel.
References
Bjork, R. A., Dunlosky, J., & Kornell, N. (2013). Self-regulated learning: Beliefs, techniques, and illusions. Annual Review of Psychology, 64, 417-444. https://doi.org/10.1146/annurev-psych-113011-143823
Deslauriers, L., McCarty, L.S., Miller, K., Callaghan, K., Kestin, G., 2019. Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom. Proceedings of the National Academy of Sciences 201821936. https://doi.org/10.1073/pnas.1821936116
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#globalHealth #learningMethods #learningStrategy #learningStyles
-
Why asking learners what they want is a recipe for confusion
A survey of learners on a large, authoritative global health learning platform has me pondering once again the perils of relying too heavily on learner preferences when designing educational experiences.
One survey question intended to ask learners for their preferred learning method.
The list of options provided includes a range of items.
(Some would make the point that the list conflates learning resources and learning methods, but let us leave that aside for now.)
Respondents’ top choices (source) were videos, slides, and downloadable documents.
At first glance, this seems perfectly reasonable.
After all, should we not give learners what they want?
As it happens, the main resources offered by this platform are videos, slides, and other downloadable documents.
(If we asked learners who participate in our peer learning programmes for their preference, they would likely say that they prefer… peer learning.)
Beyond this availability bias, there is a more significant problem with this approach: learner preferences often have little correlation with actual learning outcomes.
And learners are especially bad at self-evaluating what learning methods and resources are most conducive to effective learning.
The scientific literature is quite clear on this point.
Bjork’s 2013 article on self-regulated learning emphatically states that: “learners are often prone to illusions of competence during learning, and these illusions can be remarkably compelling.”
The study by Deslauriers et al. (2019) provides a compelling demonstration that while students express a strong preference for traditional lectures over active learning methods, they actually learn significantly more from the active approaches they claim to dislike.
This disconnect between preference and efficacy is not surprising when we consider how learning actually works.
Effective learning requires effort, struggle, and sometimes discomfort as we grapple with new ideas and challenge our existing mental models.
It is not always an enjoyable process in the moment, even if the long-term results are deeply rewarding.
Furthermore, learners (like all of us) are subject to various cognitive biases that can lead them astray when evaluating their own learning.
The illusion of explanatory depth, for example, can cause us to overestimate how well we understand a topic after passively consuming information about it.
None of this is to say we should ignore learner perspectives entirely.
Motivation and engagement do matter for learning.
But we need to be thoughtful about how we solicit and interpret learner feedback.
Asking about preferences for specific content formats (videos, slides, etc.) tells us very little about the actual learning activities and cognitive processes involved.
A more productive approach might be to focus on understanding learners’ goals, challenges, and contexts.
What are they trying to achieve?
What obstacles do they face?
What constraints shape their learning environment?
With this information, we can design evidence-based learning experiences that truly meet their needs – even if they don’t always match their stated preferences.
As learning professionals, our job is not to give learners what they think they want.
It is to create the conditions for transformative learning experiences that expand their capabilities and perspectives.
This often means pushing learners out of their comfort zones and challenging their assumptions about how learning should look and feel.
References
Bjork, R. A., Dunlosky, J., & Kornell, N. (2013). Self-regulated learning: Beliefs, techniques, and illusions. Annual Review of Psychology, 64, 417-444. https://doi.org/10.1146/annurev-psych-113011-143823
Deslauriers, L., McCarty, L.S., Miller, K., Callaghan, K., Kestin, G., 2019. Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom. Proceedings of the National Academy of Sciences 201821936. https://doi.org/10.1073/pnas.1821936116
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#globalHealth #learningMethods #learningStrategy #learningStyles
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Self-regulated learning: 8 things we know about learning across the lifespan in a complex world
The work by Robert A. Bjork and his colleagues is very helpful to make sense of the limitations of learners’ perceptions. Here are 8 summary points from their paper about self-regulated learning.
- Our complex and rapidly changing world increasingly requires self-initiated, self-managed, and self-regulated learning, not simply during the years associated with formal schooling, but across the lifespan.
- Learning how to learn is, therefore, a critical survival tool, but research on learning, memory, and metacognitive processes has demonstrated that learners are prone to intuitions and beliefs about learning that can impair, rather than enhance, their effectiveness as learners.
- Becoming sophisticated as a learner requires not only acquiring a basic understanding of the encoding and retrieval processes that characterize the storage and subsequent access to the to-be-learned knowledge and procedures, but also knowing what self-regulated learning activities and techniques support long-term retention and transfer.
- Managing one’s ongoing learning effectively requires accurate monitoring of the degree to which learning has been achieved, coupled with appropriate selection and control of one’s learning activities in response to that monitoring.
- Assessing whether learning has been achieved is difficult because conditions that enhance performance during learning can fail to support long-term retention and transfer, whereas other conditions that appear to create difficulties and slow the acquisition process can enhance long-term retention and transfer.
- Learners’ judgments of their own degree of learning are also influenced by subjective indices, such as the sense of fluency in perceiving or recalling to-be-learned information, but such fluency can be a product of low-level priming and other factors that are unrelated to whether learning has been achieved.
- Becoming maximally effective as a learner requires interpreting errors and mistakes as an essential component of effective learning rather than as a reflection of one’s inadequacies as a learner.
- To be maximally effective also requires an appreciation of the incredible capacity humans have to learn and avoiding the mindset that one’s learning abilities are fixed.
Reference:
Bjork, R.A., Dunlosky, J., Kornell, N., 2013. Self-Regulated Learning: Beliefs, Techniques, and Illusions. Annu. Rev. Psychol. 64, 417–444. https://doi.org/10.1146/annurev-psych-113011-143823
#learningStrategy #lifelongLearning #memory #metacognition #retrieval #selfManagedLearning #selfRegulatedLearning #transfer
-
Self-regulated learning: 8 things we know about learning across the lifespan in a complex world
The work by Robert A. Bjork and his colleagues is very helpful to make sense of the limitations of learners’ perceptions. Here are 8 summary points from their paper about self-regulated learning.
- Our complex and rapidly changing world increasingly requires self-initiated, self-managed, and self-regulated learning, not simply during the years associated with formal schooling, but across the lifespan.
- Learning how to learn is, therefore, a critical survival tool, but research on learning, memory, and metacognitive processes has demonstrated that learners are prone to intuitions and beliefs about learning that can impair, rather than enhance, their effectiveness as learners.
- Becoming sophisticated as a learner requires not only acquiring a basic understanding of the encoding and retrieval processes that characterize the storage and subsequent access to the to-be-learned knowledge and procedures, but also knowing what self-regulated learning activities and techniques support long-term retention and transfer.
- Managing one’s ongoing learning effectively requires accurate monitoring of the degree to which learning has been achieved, coupled with appropriate selection and control of one’s learning activities in response to that monitoring.
- Assessing whether learning has been achieved is difficult because conditions that enhance performance during learning can fail to support long-term retention and transfer, whereas other conditions that appear to create difficulties and slow the acquisition process can enhance long-term retention and transfer.
- Learners’ judgments of their own degree of learning are also influenced by subjective indices, such as the sense of fluency in perceiving or recalling to-be-learned information, but such fluency can be a product of low-level priming and other factors that are unrelated to whether learning has been achieved.
- Becoming maximally effective as a learner requires interpreting errors and mistakes as an essential component of effective learning rather than as a reflection of one’s inadequacies as a learner.
- To be maximally effective also requires an appreciation of the incredible capacity humans have to learn and avoiding the mindset that one’s learning abilities are fixed.
Reference:
Bjork, R.A., Dunlosky, J., Kornell, N., 2013. Self-Regulated Learning: Beliefs, Techniques, and Illusions. Annu. Rev. Psychol. 64, 417–444. https://doi.org/10.1146/annurev-psych-113011-143823
#learningStrategy #lifelongLearning #memory #metacognition #retrieval #selfManagedLearning #selfRegulatedLearning #transfer
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Klepac and colleagues‘ scoping review of climate change, malaria and neglected tropical diseases: what about the epistemic significance of health worker knowledge?
By Luchuo E. Bain and Reda Sadki
The scoping review by Klepac et al. provides a comprehensive overview of codified academic knowledge about the complex interplay between climate change and a wide range of infectious diseases, including malaria and 20 neglected tropical diseases (NTDs).
The review synthesized findings from 511 papers published between 2010 and 2023, revealing that the vast majority of studies focused on malaria, dengue, chikungunya, and leishmaniasis, while other NTDs were relatively understudied.
The geographical distribution of studies also varied, with malaria studies concentrated in Africa, Brazil, China, and India, and dengue and chikungunya studies more prevalent in Australia, China, India, Europe, and the USA.
One of the most striking findings of the review is the potential for climate change to have profound and varied effects on the distribution and transmission of malaria and NTDs, with impacts likely to vary by disease, location, and time.
However, the authors also highlight the uncertainty surrounding the overall global impact due to the complexity of the interactions and the limitations of current predictive models.
This underscores the need for more comprehensive, collaborative, and standardized modeling efforts to better understand the direct and indirect effects of climate change on these diseases.
Another significant insight from the review is the relative lack of attention given to climate change mitigation and adaptation strategies in the existing literature.
Only 34% of the included papers considered mitigation strategies, and a mere 5% addressed adaptation strategies.
Could we imagine future mapping to recognize the value of new mechanisms for and actors of knowledge production that do not meet the conventional criteria for what currently counts as valid knowledge?
What might be the return on going at least one step further beyond questioning our own underlying assumptions about ‘how science is done’ to actually supporting and investing in innovative indigenous- and community-led, co-created initiatives?
This gap highlights the urgent need for more research on how to effectively reduce the impact of climate change on malaria and NTDs, particularly in areas with the highest disease burdens and the populations most vulnerable to the impacts of climate change.
While the review emphasizes the need for more research to fill these evidence gaps, this begs the question of the resources and time required to fill them.
This is where there is likely to be value in the experiential data from health workers on the frontlines to provide insights into the mechanisms of climate change impacts on health and effective response strategies.
The upcoming Teach to Reach 10 event (background | registration) , a massive open peer learning platform that brings together health professionals from around the world to network and learn from each other’s experiences, offers a unique opportunity to engage thousands of health workers in a dialogue that can deepen our understanding of how climate change is affecting the health of local communities.
Experiential data has been, historically, dismissed as ‘anecdotal’ evidence at best.
The value and significance of what you know because you are there every day, serving the health of your community, has been ignored.
The expertise and knowledge of frontline health workers are often overlooked or undervalued in global health decision-making processes, despite their critical role in delivering health services and their deep understanding of local contexts and challenges.
Yes, the importance of incorporating the insights and experiences of health workers in the global health discourse cannot be overstated.
As Abimbola and Pai (2020) argue, the decolonization of global health requires a shift towards valuing and amplifying the voices of those who have been historically marginalized and excluded from the dominant narratives.
This concept, known as epistemic justice, recognizes that knowledge is not solely the domain of academic experts but is also held by those with lived experiences and practical expertise (Fricker, 2007).
Epistemic injustice, as defined by Fricker (2007), occurs when an individual is wronged in their capacity as a knower, either through testimonial injustice (when a speaker’s credibility is undervalued due to prejudice) or hermeneutical injustice (when there is a gap in collective understanding that disadvantages certain groups).
In the context of global health, epistemic injustice often manifests in the marginalization of knowledge held by communities and health workers in low- and middle-income countries, as well as the dominance of Western biomedical paradigms over local ways of knowing (Bhakuni & Abimbola, 2021).
By engaging health workers from around the world in peer learning and knowledge sharing, Teach to Reach can help to challenge the epistemic injustice that has long plagued global health research and practice.
By providing a platform for health workers to share their experiences and insights, Teach to Reach – alongside many other initiatives focused on listening to and learning from communities – can contribute to ensuring that the fight against malaria and NTDs in the face of climate change is informed not only by rigorous scientific evidence but also by the practical wisdom of those on the ground.
That is only if global partners are willing to challenge their own assumptions, and take the time to listen and learn.
Moreover, the decolonization of global health requires a shift towards more equitable and inclusive forms of knowledge production and dissemination.
This involves challenging the historical legacies of colonialism and racism that have shaped the global health field, as well as the power imbalances that continue to privilege certain forms of knowledge over others (Büyüm et al., 2020).
By fostering a dialogue between health workers and global partners, Teach to Reach can help to bridge the gap between research and practice, ensuring that the latest scientific findings are effectively translated into actionable strategies that are grounded in local realities and responsive to the needs of those most affected by climate change and infectious diseases.
The value of experiential data from health workers in filling evidence gaps and informing effective response strategies cannot be understated.
As the Klepac review highlights, there is a paucity of research on the impacts of climate change on many NTDs and the effectiveness of mitigation and adaptation strategies.
While more rigorous scientific studies are undoubtedly needed, waiting years or decades for this evidence to accumulate before taking action is not a viable option given the urgency of the climate crisis and its devastating impacts on health.
Health workers’ firsthand observations and experiences can provide valuable insights into the complex mechanisms through which climate change is affecting the distribution and transmission of malaria and NTDs, as well as the effectiveness of different intervention strategies in real-world settings.
This type of contextual knowledge is essential for developing locally tailored solutions that account for the unique social, cultural, and environmental factors that shape disease dynamics in different communities.
Furthermore, engaging health workers as active partners in research and decision-making processes can help to ensure that the solutions developed are not only scientifically sound but also feasible, acceptable, and sustainable in practice.
The involvement of frontline health workers in the co-creation of knowledge and interventions can lead to more effective, equitable, and context-specific solutions that are responsive to the needs and priorities of local communities.
References
- Abimbola, S., & Pai, M. (2020). Will global health survive its decolonisation? The Lancet, 396(10263), 1627-1628. https://doi.org/10.1016/S0140-6736(20)32417-X
- Bhakuni, H., & Abimbola, S. (2021). Epistemic injustice in academic global health. The Lancet Global Health, 9(10), e1465-e1470. https://doi.org/10.1016/S2214-109X(21)00301-6
- Büyüm, A. M., Kenney, C., Koris, A., Mkumba, L., & Raveendran, Y. (2020). Decolonising global health: If not now, when? BMJ Global Health, 5(8), e003394. https://doi.org/10.1136/bmjgh-2020-003394
- Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press.
- Klepac, P., et al., 2024. Climate change, malaria and neglected tropical diseases: a scoping review. Transactions of The Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trae026
#climateAndHealth #climateChange #epistemic #epistemicInjustice #globalHealth #health #learningCulture #luchuoEBain #malaria #neglectedTropicalDiseases #petraKlepac #thokoElphickPooley