Health performance management in complex adaptive systems

How do we reframe health performance management within complex adaptive systems?

Reda SadkiGlobal health, Learning, Research

We need a conceptual framework that situates health performance management within complex adaptive systems. This is a summary of an important paper by Tom Newton-Lewis et al. It describes such a conceptual framework that identifies the factors that determine the appropriate balance between directive and enabling approaches to performance management in a given context. Existing performance management approaches in many low- and middle-income country health systems are largely directive, aiming to control behaviour using targets, performance monitoring, incentives, and answerability to hierarchies. Health systems are complex and adaptive: performance outcomes arise from interactions between many interconnected system actors and their ability to adapt to pressures for change. In my view, this important paper mends an important broken link in theories of change that try to consider learning beyond training. The complex, dynamic, multilevel nature of health systems makes outcomes difficult to control, so directive approaches to performance management need to …

What is a rubric and why you should use it in global health education-small

What is a “rubric” and why use rubrics in global health education?

Reda SadkiGlobal health, Learning, Learning design, Theory

Rubrics are well-established, evidence-based tools in education, but largely unknown in global health. At the Geneva Learning Foundation (TGLF), the rubric is a key tool that we use – as part of a comprehensive package of interventions – to transform high-cost, low-volume training dependent on the limited availability of global experts into scalable peer learning to improve access, quality, and outcomes. The more prosaic definition of the rubric – reduced from any pedagogical questioning – is “a type of scoring guide that assesses and articulates specific components and expectations for an assignment” (Source). The rubric is a practical solution to a number of complex issues that prevent effective teaching and learning in global health. Developing a rubric provides a practical method for turning complex content and expertise into a learning process in which learners will learn primarily from each other. Hence, making sense of a rubric requires recognizing and appreciating the value …

Epidemic preparedness through connected transnational digital networks of local actors-small

Pandemic preparedness through connected transnational digital networks of local actors

Reda SadkiGlobal health, Learning strategy

In the Geneva Learning Foundation’s approach to effective humanitarian learning, knowledge acquisition and competency development are both necessary but insufficient. This is why, in July 2019, we built the first Impact Accelerator, to support local practitioners beyond learning outcomes all the way to achieving actual health outcomes. What we now call the Full Learning Cycle has become a mature package of interventions that covers the full spectrum from knowledge acquisition to implementation and continuous improvement. This package has produced the same effects in every area of work where we have been able to test it: self-motivated groups manifesting remarkable, emergent leadership, connected laterally to each other in each country and between countries, with a remarkable ability to quickly learn and adapt in the face of the unknown. In 2020, we got to test this package during the COVID-19 pandemic, co-creating the COVID-19 Peer Hub with over 6,000 frontline health professionals, …

Reinventing the path from knowledge to action in global health

Reda SadkiGlobal health, Learning strategy, The Geneva Learning Foundation

At the Geneva Learning Foundation (TGLF), we have just begun to share a publication like no other. It is titled Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers. You can access the full report here in French and in English. Short summaries are also available in three special issues of The Double Loop, the Foundation’s free Insights newsletter, now available in both English and French. The report, prefaced by Heidi Larson who leads the Vaccine Confidence Project, includes DOI to facilitate citation in academic research. (The Foundation uses a repository established and maintained by the Geneva-based CERN for this purpose.) However, knowing that academic papers have (arguably) an average of three readers, we have a different aspiration for dissemination. As a global community, we recognize the significance of local action to achieve the global goals. The report documents vaccine confidence practices just …

Mindjourney-online learning network-abstract-colorful

Which is better for global health: online, blended, or face-to-face learning?

Reda SadkiLearning, Research, Theory

Question 1. Does supplementing face-to-face instruction with online instruction enhance learning? No. Positive effects associated with blended learning should not be attributed to the media, per se. (It is more likely that positive effects are due to people doing more work in blended learning, once online and then again in a physical space.) This is the conclusion of the U.S. Department of Education’s “Evaluation of evidence-based practices in online learning: a meta-analysis and review of online learning studies” in September 2010. You can find the full document here. Question 2. Is the final academic performance of students in distance learning programs better than that of those enrolled in traditional FTF programs, in the last twenty-year period? Yes. Distance learning results in increasingly better learning outcomes since 1991 – when learning technologies to support distance learning were far more rudimentary than they are now. This is the meta-analysis done by Mickey …

Digital challenge-based learning in the COVID-19 Peer Hub

Reda SadkiGlobal health, Learning, Writing

A digital human knowledge and action network of health workers: Challenging established notions of learning in global health When Prof Rupert Wegerif introduced DEFI in his blog post, he argued that recent technologies will transform the notions and practice of education. The Geneva Learning Foundation (TGLF) is demonstrating this concept in the field of global health, specifically immunization, through the ongoing engagement of thousands of health workers in digital peer learning. As images of ambulance queues across Europe filled TV screens in 2020, another discussion was starting: how would COVID-19 affect countries with weaker health systems but more experience in facing epidemic outbreaks? In the global immunization community, there were early signs that ongoing efforts to protect children from vaccine preventable diseases – measles, polio, diphtheria – would suffer. On the ground, there were early reports of health workers being afraid to work, being excluded by communities, or having key supplies disrupted. The …

Learning for knowledge creation WHO Scholar programme

Learning for Knowledge Creation: The WHO Scholar Program

Reda SadkiGlobal health, Learning strategy, Scholar Approach

Excerpted from: Victoria J. Marsick, Rachel Fichter, Karen E. Watkins, 2022. From Work-based Learning to Learning-based Work: Exploring the Changing Relationship between Learning and Work, in: The SAGE Handbook of Learning and Work. SAGE Publications. Reda Sadki of The Geneva Learning Foundation (TGLF), working with Jhilmil Bahl from the World Health Organization (WHO) and funding from the Bill and Melinda Gates Foundation, developed an extraordinary approach to blending work and learning. The program started as a series of digitally offered courses for immunization personnel working in various countries, connecting in-country central planners, frontline workers, and global actors. The program was designed to address five common problems in training (Sadki, 2018): the inability to scale up to reach large audiences; the difficulty in transferring what is learned; the inability to accommodate different learners’ starting places; the need to teach learners to solve complex problems; and the inability to develop sufficient expertise …

Arve Henriksen – Groundswell

What is the value of strategy in the middle of a global crisis?

Reda SadkiGlobal health, Learning strategy

A new global vision and strategy titled ‘Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030)’ was endorsed by the World Health Assembly less than a year before the World Health Organization declared COVID-19 a Public Health Emergency of International Concern. Today, the cumulative tension of both urgent and longstanding challenges is stretching people who deliver vaccines. Challenges include immunization service recovery, COVID-19 vaccine introduction, and the persistence of epidemic outbreaks of diseases that can already be prevented by vaccines. Is this the right time to launch a global strategy – especially one developed before the pandemic – to achieve the immunization goals? Yes, immunization staff the world over – and the societies we live in – are still reeling from the shock of the COVID-19 pandemic. Nevertheless, in times of crisis, thinking and acting strategically can help each of us stay focused on the global immunization goals, keeping us on the path to equitable …

Defoe in the Pillory

Accountability in learning

Reda SadkiLearning strategy

What if you were the key internal resource person with learning expertise? What if you advocated, recommended, and prescribed low-volume, high-cost face-to-face training? What if your advocacy was so successful that global partners invested hundreds of millions of dollars in what you prescribed – even in the absence of any standard to determine the return on that investment? What if your recommended approach resulted in zero measurable impact? What if partners nevertheless kept spending on training, entrenching perverse incentives like per diem to substitute for motivation, evidence, and results? What if you ignored and then dismissed, for as long as you possibly could, the relevance and potential of digital networks to support learning? What if you then managed to replicate the worst, least effective kinds of training through sterile digital formats of slides with voiceovers and a quiz at the end? What if you kept badgering managers to get their …

Time travel

What lies beyond the event horizon of the ‘webinar’?

Reda SadkiLearning design, Learning strategy, Thinking aloud

It is very hard to convey to learners and newcomers to digital learning alike that asynchronous modes of learning are proven to be far more effective. There is an immediacy to a sage-on-the-stage lecture – whether it is plodding or enthralling – or to being connected simultaneously with others to do group work. Asynchronous goes against the way our brains work, driven by prompts, events, and immediacy. But people get the benefit of “time-shifting” their TV shows and “on demand” is the norm for media consumption now. Most webinars still require you to show up at a specific time. With live streaming of the Foundation’s events, we are observing growing appreciation for asynchronous “I’ll watch it when I want to” availability of recorded events. The behavior seems different from the intention of viewing a recorded webinar, which almost never happens. (This is, in part, the motivation question: does anyone watch …