Search
351 results for “redasadki”
-
RT @DigitalScholarX: 📅 Today on #WorldNTDDay, join #TeachToReach to
listen to health workers share their direct experiences in the fight ag… -
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.
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
https://redasadki.me/2024/06/30/why-asking-learners-what-they-want-is-a-recipe-for-confusion/
#globalHealth #learningMethods #learningStrategy #learningStyles
-
RT @DigitalScholarX: Adaptive change propagates learning. #ComplexLearning
-
RT @DigitalScholarX: Creating order from chaos is the art of learning. #ComplexLearning
-
RT @DigitalScholarX: Noise is the curriculum. #ComplexLearning
-
RT @DigitalScholarX: Beyond cognitive/situative - learning emerges from bio-psycho-social systems. #ComplexLearning
-
RT @DigitalScholarX: The edge of chaos is where knowledge thrives. #ComplexLearning
-
RT @DigitalScholarX: Context is the missing variable. #ComplexLearning
-
RT @DigitalScholarX: Learn the whole, not just the parts. #ComplexLearning
-
RT @DigitalScholarX: Assessment staticizes dynamic learning. Grades can't contain emergent insight. #ComplexLearning
-
RT @DigitalScholarX: Deep learning intertwines cognition and emotion. #ComplexLearning
-
In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance:
- Capacity substitution: Technical advisers perform government functions due to urgent needs or lack of in-house expertise. This can fill gaps but has “clear limitations in building state capability.”
- Capacity supplementation: Technical advisers provide specific expertise to complement government efforts in challenging areas. This can “fill essential gaps at critical moments” but has limitations for building sustainable capacity.
- Capacity development: Technical advisers play a facilitator role focused on enabling change and strengthening government capacity over the long term. This takes time but “there is a higher chance that these [results] will be sustainable.”
Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.”
Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and builds sustainable capacity. Considerations that need to be highlighted include balancing short-term needs with long-term capacity building and shifting power to local experts.
However, this requires reframing technical assistance as a policy option through transparent dialogue between government and funders.
What key assumptions about technical assistance does this challenge?
The article challenges some key assumptions and orthodox views about technical assistance in global health:
- It frames technical assistance not as aid provided by donors, but as a policy option and domestic choice that governments make to meet their objectives. This contrasts with the common donor-centric view.
- It critiques the assumption that all technical assistance inherently builds sustainable government capacity and questions this expected linear relationship. The article argues different types of technical assistance have fundamentally different aims – gap-filling versus long-term capacity building.
- The article challenges the idealistic principles often promoted for technical assistance, like localization, government ownership, and adaptability. It suggests the evidence is lacking on if these principles effectively lead to better development outcomes on the ground.
- The article argues that technical assistance decisions involve real dilemmas, tradeoffs and tensions in practice rather than being clear cut. It challenges the notion of win-win solutions and highlights risks like unintended consequences.
- By outlining limitations of different technical assistance approaches, the article pushes back against a one-size-fits-all mindset. The appropriate approach depends on contextual factors and clarity of purpose.
- The article questions typical measures of success for technical assistance based on fast results and output delivery. It advocates for greater focus on processes that enable long-term capacity development even if slower.
How does The Geneva Learning Foundation’s work fit into such a model?
At The Geneva Learning Foundation (TGLF), we realized that our own model to support locally-led leadership to drive change could be described as a new type of technical assistance that does not fit into any of the existing three categories, because:
- TGLF’s model is grounded in principles of localization and decolonization that shift power dynamics by empowering government health workers from all levels of the health system – not only the national authorities – to recognize what change is needed, to lead this change where they work. We have observed that, even in fragile contexts, this accelerates progress toward country goals, and strengthens or can help rebuild civil society fabric.
- It focuses on nurturing intrinsic motivation and peer accountability rather than imposing top-down directives or extrinsic incentives.
- It utilizes lateral feedback loops and informal, self-organized networks that cut across hierarchies and geographic boundaries.
- It emphasizes flexibility, adaptation to local contexts, and problem-driven iteration rather than pre-defined solutions.
- It builds sustainable capacity and self-organized learning cultures that reduce dependency on external support.
Reference: Nastase, A., Rajan, A., French, B., Bhattacharya, D., 2020. Towards reimagined technical assistance: the current policy options and opportunities for change. Gates Open Res 4, 180. https://doi.org/10.12688/gatesopenres.13204.1
Illustration: The Geneva Learning Foundation Collection © 2024
#capacityBuilding #DAC #decolonization #globalHealth #policy #rethinkingAid #technicalAssistance
-
Here is a summary of the key points from the article “Nobody ever gets credit for fixing problems that never happened: creating and sustaining process improvement”.
Overview
- Many companies invest heavily in process improvement programs, yet few efforts actually produce significant results. This is called the “improvement paradox”.
- The problem lies not with the specific tools, but rather how the introduction of new programs interacts with existing organizational structures and dynamics.
- Using system dynamics modeling, the authors studied implementation challenges in depth through over a dozen case studies. Their models reveal insights into why improvement programs often fail.
Core causal loops
- The “Work Harder” loop – managers pressure people to spend more time working to immediately boost throughput and close performance gaps. But this is only temporary.
- The “Work Smarter” loop – managers encourage improvement activities which enhance process capability over time for more enduring gains, but there is a delay before benefits are seen.
- The “Reinvestment” reinforcing loop – successfully improving capability frees up more time for further improvement. But the reverse vicious cycle often dominates instead.
- The “Shortcuts” loop – facing pressure, people cut corners on improvement activities which temporarily frees up more time for work. But this gradually erodes capability.
The capability trap
- Short-term “Work Harder” and “Shortcuts” decisions eventually hurt capability and require heroic work efforts to maintain performance, creating a downward spiral.
- However, because capability erodes slowly, managers fail to connect problems to past decisions and blame poor worker motivation instead, leading to a self-confirming cycle.
- Even improvement programs just increase pressure and drive more shortcuts, making stereotypes and conflicts worse. This “capability trap” causes programs to fail.
The “capability trap” refers to the downward spiral organizations can get caught in, where attempting to boost performance by pressuring people to “work harder” actually erodes process capability over time. This trap works through a few key mechanisms:
- Facing pressure, people cut corners and reduce time spent on improvement activities in order to free up more time for immediate work. This temporarily boosts throughput.
- However, this comes at a cost of gradually declining process capability, as less time is invested in maintenance, training, and problem solving.
- Capability erosion then reduces performance, widening the gap versus desired performance levels.
- Managers falsely attribute this to poor motivation or effort from the workforce. They lack awareness of the capability trap dynamics, and the delays between pressing people to “work harder” and the capability declines that eventually ensue.
- Management increases pressure further, demanding heroic work efforts, which causes workers to cut even more corners. This spirals capability downward while confirming management’s incorrect attribution even more.
Key takeaway for learning leaders
Learning leaders must understand the systemic traps identified in the article that underly failed improvement initiatives and facilitate mental model shifts. This help build sustainable, effective learning programs to be realized through productive capability-enhancing cycles.
Key takeaway for immunization leaders
It’s reasonable to hypothesize that poor health worker performance is a symptom rather than the cause of poor immunization programme performance. Short-term decisions, often responding to top-down targets and donor requirements, hurt capability and require, as the authors say, “heroic work efforts to maintain performance, creating a downward spiral.” Managers then incorrectly diagnose this as a performance problem due to motivation.
How to escape the capability trap
The key to avoiding or escaping this trap is therefore shifting the mental models that reinforce the incorrect attributions about motivation. Some ways to do this include:
- Educating managers on the systemic structures causing the capability trap through methods like system dynamics modeling
- Allowing time for capability-enhancing improvements to take effect before judging performance
- Incentivizing quality and sustainability of throughput rather than just short-term volume alone
- Seeking input from workers on the barriers to improvement they face
With awareness of the structural causes and delays, managers can avoid erroneously attributing blame. Patience and a systems perspective are critical for companies to invest their way out of the capability trap.
- Shift mental models to recognize system structures leading to the capability trap, rather than blaming people. Then improvement tools can work.
- A useful example could be system dynamics workshops that achieved this shift and enabled successful programs, dramatically enhancing performance.
Reference: Repenning, N.P., Sterman, J.D., 2001. Nobody ever gets credit for fixing problems that never happened: creating and sustaining process improvement. California management review 43, 64–88.
Illustration: The Geneva Learning Foundation Collection © 2024
#capabilityDevelopment #HR #processImprovement #TotalQualityManagement
-
🎭 Oh no, #AI is making fake #poverty #porn now? 🖼️ Quick, someone grab a digital extinguisher! 🚒 Because nothing says "solving global issues" like a committee of moral hand-wringing and LinkedIn posts. 🙄
https://redasadki.me/2025/10/23/how-do-we-stop-ai-generated-poverty-porn-fake-images/ #DigitalEthics #MoralResponsibility #SocialMediaCritique #HackerNews #ngated -
-
RT @DrFloGabriel: 📢 My colleagues and I are delighted to announce the launch of our new academic journal, Learning Letters.
Discover our inaugural issue and details on submitting proposals by visiting our website: https://t.co/h4P8CIoDX7
#EducationInnovation
#LearningSciences #AIED #learning https://t.co/jb26iWicU3 -
Climate change and health: what the Lancet Countdown says about the value and significance of local knowledge and action
Here is everything that the new Lancet Countdown says about the value and significance of indigenous and other forms of local knowledge, as well as their value for community-led action to respond to the impacts of climate change on health.
Why does this matter? Read our article: How the Lancet Countdown illuminates a new path to climate-resilient health systems
On the value of community-led action and the significance of local knowledge
Defining community-led action by its local context and empowerment
“Community-led actions are those spearheaded by self-organised individuals within a community, working together for a common goal. Rooted in local societal, cultural, and economic contexts, they can promote equity, empower local actors, and strengthen climate resilience.”
Community-led action as a driver of meaningful progress
“Individual, community-led, and civil society actions can drive meaningful progress with substantial health benefits.”
Grassroots activities growing into formal organizations
“These grassroots activities can grow into formal organisations with national or international influence.”
The dependence of community-led initiatives on local actors
“Despite their capacity to enact change, community-led initiatives depend on the willingness and possibilities of local actors.”
The advantages of community-led actions over top-down interventions
“Tailored to local needs, community-led actions are more likely than top-down interventions to maximise health benefits, bypass the limitations of implementing top-down solutions, and can help avoid unintended harms such as gentrification or increased inequalities.”
The co-benefits of community-led action on mental health and awareness
“Community-led actions can also foster agency, increase attachment to the local environment, and promote social interactions, all of which help reduce the mental health impacts of climate change and increase awareness.”
Recommendation for individuals and civil society: Engage in community-led action
“Engaging in community-led action on health and climate change, supporting equitable inclusion of marginalised communities.”
Recommendation for individuals and civil society: Create community platforms for collective resilience
“Creating community platforms on climate change and health, including citizen groups, to safely exchange ideas and concerns, build collective resilience and adaptive capacity, and enable engagement with decision makers.”
Value of local knowledge: We need more examples of community-led action
Example of local community and indigenous peoples’ forest management
“In Nepal, community forests user groups have grown into a state-sponsored and legally mandated initiative, under which local communities, including Indigenous Peoples, manage 37-7% of national forests—augmenting carbon sinks, enhancing food access, and improving livelihoods.”
Example of farmer-led interventions improving health outcomes
“Across the Sahel, farmers have implemented Farmer Managed Natural Regeneration… These farmer-led interventions resulted in increased tree coverage, crop yields, drought resistance, and access to traditional medicines, contributing to improved health outcome and poverty reduction.”
Environmental defenders need protection
The disproportionate killing of indigenous and minoritized environmental defenders
“A Global Witness report found that 196 activists were killed in 2023 (57% in Latin America), with minoritised and Indigenous groups disproportionately affected.”
Protecting environmental defenders to enable community-led interventions
“Protecting environmental defenders in line with international conventions is critical to enabling community-led interventions, and providing a fertile ground for grassroots initiatives to deliver life-saving progress on health and climate change.”
On the need for community-led action amid waning political engagement
The role of health framing in driving community-led action
“This [health framings of climate change] can be a crucial driver for individual-led and community-led action, especially amid waning engagement from political leaders.”
Community and individual action as essential when national engagement wanes
“When national government engagement wanes (indicator 5.4.1), action by subnational governments, corporations, civil society organisations, communities, and individuals can contribute to keeping the planet within inhabitable limits.”
Recommendation for funders on the significance of local knowledge:
Recommendation for funders: Support community initiatives to scale action
“…supporting governmental bodies, civil society organisations, and community initiatives to scale-up health-promoting and inclusive climate change action.”
On the value of indigenous knowledge
Respecting indigenous knowledge in global health action
“To support global health, these actions need to be delivered in ways that are gender-responsive, reduce health inequities, respect and promote the rights and knowledge of Indigenous People, and account for the protection of vulnerable and underserved communities.”
Recommendation for national governments: Integrate community and indigenous perspectives in policy design
“Including community perspectives in the design of climate and health policies, with particular focus on the most vulnerable communities and Indigenous people.”
Recommendation for city governments: Prioritize indigenous knowledge and community-led initiatives
“Reducing inequities and avoiding unintended harms by integrating community perspectives in all climate change actions and supporting community-led initiatives, with particular focus on vulnerable communities and the priorities and knowledge of Indigenous people.”
On the need to refocus the apparatus of science on the most vulnerable people and communities
Scientific evidence generation is concentrated in high-HDI countries, not where impacts are highest
“Scientific evidence generation is still concentrated in higher HDI countries rather than those most exposed to the health impacts of climate change.”
Data gaps obscuring the impacts on indigenous people
“This lack of disaggregated data makes it difficult to capture the disproportionate impacts of climate change on Indigenous people, such as those living in the circumpolar region, which is heating nearly four times faster than the global average.”
Conflict analysis must be shaped by local dynamics
“This relationship [between climate change and conflict] is now widely recognised as a complex, multicausal phenomenon shaped by local social and cultural dynamics, economic fluctuations, and geopolitical forces at both the domestic and international levels.”
On ensuring the relevance of science to support local action
Harnessing local knowledge for regional stakeholders
“…harnessing local knowledge and translating findings to meet the needs of local stakeholders.”
Advancing the local generation of evidence
“…to advance the local generation of evidence to inform action in one of the world’s most vulnerable regions.”
Informing action at the local level
“…make their findings available to inform action at the national and local levels.”
References
- Romanello, M., et al., 2025. The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
- Sadki, R., 2024. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
Image: The Geneva Learning Foundation Collection © 2025
#communityResilience #communityLedAction #IndigenousKnowledge #LancetCountdown #localKnowledge #MarinaRomanello #The2025ReportOfTheLancetCountdownOnHealthAndClimateChange
-
Climate change and health: what the Lancet Countdown says about the value and significance of local knowledge and action
Here is everything that the new Lancet Countdown says about the value and significance of indigenous and other forms of local knowledge, as well as their value for community-led action to respond to the impacts of climate change on health.
Why does this matter? Read our article: How the Lancet Countdown illuminates a new path to climate-resilient health systems
On the value of community-led action and the significance of local knowledge
Defining community-led action by its local context and empowerment
“Community-led actions are those spearheaded by self-organised individuals within a community, working together for a common goal. Rooted in local societal, cultural, and economic contexts, they can promote equity, empower local actors, and strengthen climate resilience.”
Community-led action as a driver of meaningful progress
“Individual, community-led, and civil society actions can drive meaningful progress with substantial health benefits.”
Grassroots activities growing into formal organizations
“These grassroots activities can grow into formal organisations with national or international influence.”
The dependence of community-led initiatives on local actors
“Despite their capacity to enact change, community-led initiatives depend on the willingness and possibilities of local actors.”
The advantages of community-led actions over top-down interventions
“Tailored to local needs, community-led actions are more likely than top-down interventions to maximise health benefits, bypass the limitations of implementing top-down solutions, and can help avoid unintended harms such as gentrification or increased inequalities.”
The co-benefits of community-led action on mental health and awareness
“Community-led actions can also foster agency, increase attachment to the local environment, and promote social interactions, all of which help reduce the mental health impacts of climate change and increase awareness.”
Recommendation for individuals and civil society: Engage in community-led action
“Engaging in community-led action on health and climate change, supporting equitable inclusion of marginalised communities.”
Recommendation for individuals and civil society: Create community platforms for collective resilience
“Creating community platforms on climate change and health, including citizen groups, to safely exchange ideas and concerns, build collective resilience and adaptive capacity, and enable engagement with decision makers.”
Value of local knowledge: We need more examples of community-led action
Example of local community and indigenous peoples’ forest management
“In Nepal, community forests user groups have grown into a state-sponsored and legally mandated initiative, under which local communities, including Indigenous Peoples, manage 37-7% of national forests—augmenting carbon sinks, enhancing food access, and improving livelihoods.”
Example of farmer-led interventions improving health outcomes
“Across the Sahel, farmers have implemented Farmer Managed Natural Regeneration… These farmer-led interventions resulted in increased tree coverage, crop yields, drought resistance, and access to traditional medicines, contributing to improved health outcome and poverty reduction.”
Environmental defenders need protection
The disproportionate killing of indigenous and minoritized environmental defenders
“A Global Witness report found that 196 activists were killed in 2023 (57% in Latin America), with minoritised and Indigenous groups disproportionately affected.”
Protecting environmental defenders to enable community-led interventions
“Protecting environmental defenders in line with international conventions is critical to enabling community-led interventions, and providing a fertile ground for grassroots initiatives to deliver life-saving progress on health and climate change.”
On the need for community-led action amid waning political engagement
The role of health framing in driving community-led action
“This [health framings of climate change] can be a crucial driver for individual-led and community-led action, especially amid waning engagement from political leaders.”
Community and individual action as essential when national engagement wanes
“When national government engagement wanes (indicator 5.4.1), action by subnational governments, corporations, civil society organisations, communities, and individuals can contribute to keeping the planet within inhabitable limits.”
Recommendation for funders on the significance of local knowledge:
Recommendation for funders: Support community initiatives to scale action
“…supporting governmental bodies, civil society organisations, and community initiatives to scale-up health-promoting and inclusive climate change action.”
On the value of indigenous knowledge
Respecting indigenous knowledge in global health action
“To support global health, these actions need to be delivered in ways that are gender-responsive, reduce health inequities, respect and promote the rights and knowledge of Indigenous People, and account for the protection of vulnerable and underserved communities.”
Recommendation for national governments: Integrate community and indigenous perspectives in policy design
“Including community perspectives in the design of climate and health policies, with particular focus on the most vulnerable communities and Indigenous people.”
Recommendation for city governments: Prioritize indigenous knowledge and community-led initiatives
“Reducing inequities and avoiding unintended harms by integrating community perspectives in all climate change actions and supporting community-led initiatives, with particular focus on vulnerable communities and the priorities and knowledge of Indigenous people.”
On the need to refocus the apparatus of science on the most vulnerable people and communities
Scientific evidence generation is concentrated in high-HDI countries, not where impacts are highest
“Scientific evidence generation is still concentrated in higher HDI countries rather than those most exposed to the health impacts of climate change.”
Data gaps obscuring the impacts on indigenous people
“This lack of disaggregated data makes it difficult to capture the disproportionate impacts of climate change on Indigenous people, such as those living in the circumpolar region, which is heating nearly four times faster than the global average.”
Conflict analysis must be shaped by local dynamics
“This relationship [between climate change and conflict] is now widely recognised as a complex, multicausal phenomenon shaped by local social and cultural dynamics, economic fluctuations, and geopolitical forces at both the domestic and international levels.”
On ensuring the relevance of science to support local action
Harnessing local knowledge for regional stakeholders
“…harnessing local knowledge and translating findings to meet the needs of local stakeholders.”
Advancing the local generation of evidence
“…to advance the local generation of evidence to inform action in one of the world’s most vulnerable regions.”
Informing action at the local level
“…make their findings available to inform action at the national and local levels.”
References
- Romanello, M., et al., 2025. The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
- Sadki, R., 2024. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
Image: The Geneva Learning Foundation Collection © 2025
#communityResilience #communityLedAction #IndigenousKnowledge #LancetCountdown #localKnowledge #MarinaRomanello #The2025ReportOfTheLancetCountdownOnHealthAndClimateChange
-
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
-
Critical evidence gaps in the Lancet Countdown on health and climate change
The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”.
Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing.
The fundamental tension appears right at the start.
The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.”
This framing privileges standardized, quantifiable data over other forms of knowledge.
Yet paradoxically, the report recognizes that “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.”
This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.
Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.
When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.
Can we afford to wait?
As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?
Explore the value of health workers’ experiential knowledge: 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
Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.
This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”
The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.
The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.
A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”
More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”
However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”
This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.
A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”
This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.
Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.
This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.
Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.
It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.
For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.
The seeds of this transformation are present in the 2024 report.
Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.
References
- Romanello, M., et al., 2024. 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
- 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
- Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
- Sadki, R., 2025. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
- Sadki, R., 2024. Knowing-in-action: Bridging the theory-practice divide in global health. https://doi.org/10.59350/4evj5-vm802
- Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
- Sadki, R., 2024. World Health Summit: to rebuild trust in global health, invest in health workers as community leaders. https://doi.org/10.59350/343na-80712
- Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
- Sanchez, J.J. et al. (2025) ‘The climate crisis and human health: identifying grand challenges through participatory research’, The Lancet Global Health, p. S2214109X25000038. Available at: https://doi.org/10.1016/S2214-109X(25)00003-8.
Image: The Geneva Learning Foundation Collection © 2024
#climateAndHealth #COP29 #CriticalEvidenceGapsInTheLancetCountdownOnHealthAndClimateChange #epistemology #experientialKnowledge #IndigenousKnowledge #localKnowledge #quantitativeData
-
Critical evidence gaps in the Lancet Countdown on health and climate change
The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”.
Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing.
The fundamental tension appears right at the start.
The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.”
This framing privileges standardized, quantifiable data over other forms of knowledge.
Yet paradoxically, the report recognizes that “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.”
This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.
Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.
When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.
Can we afford to wait?
As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?
Explore the value of health workers’ experiential knowledge: 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
Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.
This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”
The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.
The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.
A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”
More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”
However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”
This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.
A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”
This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.
Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.
This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.
Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.
It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.
For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.
The seeds of this transformation are present in the 2024 report.
Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.
References
- Romanello, M., et al., 2024. 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
- 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
- Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
- Sadki, R., 2025. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
- Sadki, R., 2024. Knowing-in-action: Bridging the theory-practice divide in global health. https://doi.org/10.59350/4evj5-vm802
- Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
- Sadki, R., 2024. World Health Summit: to rebuild trust in global health, invest in health workers as community leaders. https://doi.org/10.59350/343na-80712
- Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
- Sanchez, J.J. et al. (2025) ‘The climate crisis and human health: identifying grand challenges through participatory research’, The Lancet Global Health, p. S2214109X25000038. Available at: https://doi.org/10.1016/S2214-109X(25)00003-8.
Image: The Geneva Learning Foundation Collection © 2024
#climateAndHealth #COP29 #CriticalEvidenceGapsInTheLancetCountdownOnHealthAndClimateChange #epistemology #experientialKnowledge #IndigenousKnowledge #localKnowledge #quantitativeData
-
RT @DigitalScholarX: Ghanaian Nurse Saves Patient Using Geneva Learning Skills
#GenevaLearningFoundation #SuccessStory #GlobalHealth #Healt… -
@DigitalScholarX 4/ We engage workers around their own local challenges that they identify. These challenges are the ones that matter to the people they serve. Their expertise and insights drive the learning. #participatory
-
RT @DigitalScholarX: Chidinma Ozoh, Community health worker, FCT, Nigeria #IWD2024 #women #globalhealth
“To pursue a career in health or h…
-
Listening to and learning from the experience being shared by a #RedCross volunteer who helped others after receiving help herself, in the context of the humanitarian crisis in Ukraine #EU4Health #PeerLearning #PowerOfHumanity #psychosocialsupport @ifrc @Xcastel @BirgitteEbbesen… https://t.co/aE19bnkwss https://t.co/ciuaCM6n1Z
-
The ongoing war in Ukraine has taken a severe toll on the population’s mental health and psychosocial wellbeing. A new interdisciplinary review from the ARQ National Psychotrauma Centre and VU Amsterdam provides an in-depth analysis of the mental health impacts, cultural and historical factors shaping coping and help-seeking, the evolving humanitarian response, and recommendations for strengthening mental health and psychosocial support (MHPSS) in Ukraine.
The report is an interdisciplinary literature review supplemented by key informant interviews. It synthesizes academic publications, gray literature, media reports and policy documents in English, Ukrainian and Russian. The review team included Ukrainian practitioners and regional experts to identify additional Ukrainian-language sources.
The review found that the war has led to high levels of acute psychological distress, increased risk of the development of future mental health problems, exacerbation of chronic mental health conditions, psychosocial problems, and an increase in substance use. Exposure to war-related trauma and violence, coupled with the loss of social support systems, poses lifelong risks for a range of mental health issues. Internally displaced persons (IDPs) are particularly vulnerable, with previous research showing that “32% of IDPs in Ukraine experienced post-traumatic stress disorder (PTSD) and 22% had depression.”
Children’s mental health is a critical concern, with “three out of four parents report[ing] signs of psychological trauma in their children” such as “impaired memory, inattention, and learning difficulties.” Over 1.2 million children are internally displaced, with approximately 91,000 separated from family care. These are “the most vulnerable children […] living outside their families, residential institutions for children without parental care or boarding schools, unaccompanied and separated children, and children with disabilities.” Displacement disrupts education, social networks and routines. Adolescents struggle most to adapt and connect with new peers. Older children are taking on caregiver roles for younger siblings. The review identifies a lack of policies and programs specifically targeting child and adolescent mental health as a key gap.
Ukraine’s complex history has shaped current attitudes and practices around mental health. The review notes that “Ukraine’s historical memory is fragmented, with evaluations of events varying significantly among different population groups,” compounded by “Russia’s historic and contemporary efforts to rewrite Ukrainian history.” Soviet-era legacies of stigma, institutionalization, and the misuse of psychiatry have bred mistrust of formal mental health services, according to the review. Instead, “help seeking behaviour tends to be directed toward spiritual leaders (clergy) and practices.” Religious beliefs and leaders play an important role in mental health coping and support.
High levels of societal stigma toward mental illness persist, rooted in cultural norms that view psychological distress as a personal weakness or moral failing. Many Ukrainians hide their struggles and avoid seeking professional help due to fears of being perceived as ‘weak,’ receiving a diagnosis that could jeopardize employment, or being involuntarily hospitalized. “Ukrainians still perceive psychiatrists as being highly likely to disclose information about mental health and psychosocial disorders with employers, and therefore, even a single visit to a psychiatric hospital may destroy the future […] There is a particular tendency to hide suicidal thoughts due to high levels of fear of involuntary hospitalisation”, says the report.
Since 2014, conflict-affected areas in Eastern Ukraine have seen an influx of MHPSS services through humanitarian efforts, while recent national reforms have aimed to decentralize and deinstitutionalize mental healthcare. However, the current crisis has disrupted these reform efforts while dramatically increasing MHPSS needs. This presents both challenges and opportunities to “build on available resources” and integrate “successes of the emergency response into building more sustainable mental health care systems.”
The review highlights the stark regional disparities in MHPSS needs and capacities due to variations in conflict exposure, displacement patterns, infrastructure damage, and pre-existing resources. Areas affected by armed conflict face acute challenges, including widespread mine contamination, community distrust, and decimated health services. Meanwhile, safer areas in Western Ukraine are straining to meet the needs of large displaced populations. However, they also have more MHPSS responders and opportunities for longer-term interventions.
To address these complex challenges, the authors stress the importance of cross-sectoral coordination, building on local capacities and cultural resources, and strengthening partnerships between government, civil society, and faith-based organizations. Rigorous research on MHPSS interventions in conflict-affected Ukraine can inform evidence-based responses in the country and globally.
The review provides a roadmap for strengthening Ukraine’s MHPSS response through a focus on sustainable, locally-grounded, and trauma-informed approaches. While the needs are vast, there are also opportunities to transform mental healthcare and build resilience.
Reference: Iryna Frankova, Megan Leigh Bahmad, Ganna Goloktionova, Orest Suvalo, Kateryna Khyzhniak, 2024. Mental Health and Psychosocial Support in Ukraine: Coping, Help-seeking and Health Systems Strengthening in Times of War. ARQ National Psychotrauma Centre and VU Amsterdam, Amsterdam, Netherlands.
Image: The Geneva Learning Foundation Collection © 2024
#armedConflict #coping #mentalHealth #MHPSS #psychosocialSupport #Ukraine #war
-
RT @DigitalScholarX: Unveiling Malaria's Impact: Voices from the Community
#MalariaAwareness #CommunityVoices #HealthImpact #NeglectedTropi… -
RT @DigitalScholarX: Climate Change's Impact on Health: Observations from Global Health Workers
#ClimateChangeImpacts #GlobalHealthWorkers…