A bunch of hot air

Rising together: promoting inclusivity and collaboration in global health 

Reda Sadki Global health

The ways of knowing of health professionals who work on the front lines is distinct because no one else is there every day. Yet they are typically absent from the global table, even though the significance of local knowledge and action is increasingly recognized. In the quest to achieve global health goals, what value should professionals within global health agencies ascribe to local experience? How do we cultivate a more inclusive and collaborative environment? And why should we bother?

A recent roundtable discussion, attended by technical officers and senior leaders, provided an occasion to present and explain how the Geneva Learning Foundation’s Immunization Agenda 2030 (IA2030) platform and network could be used to support “consultative engagement” between global and local leaders. This platform and network is reaching over 50,000 health professionals, helping them build connections with each other – defying boundaries of geography and health system levels – to transform learning into action. 

One global observer expressed concern that all this learning, sharing, and action might be “a bunch of hot air”. This can, at best, be interpreted as doubt towards the value of lived experience, and, at worst, as a brutal dismissal of the will and commitment expressed by thousands of health professionals working, more often than not, in difficult circumstances.

How should we understand and respond to such skepticism?

Between March and September 2022, 10,000 health professionals working on the frontlines of immunization made a personal, moral commitment to making a difference in their communities, above and beyond their professional roles. Together, they decided to make their country’s commitment to IA2030 a personal and professional commitment – because they wanted to. This cannot be insignificant.

In the first year of our IA2030 programme, we observed remarkable gains from such peer learning in the confidence and self-esteem of participants. It has already led to a year of intense sharing of experience, leading to over one thousand health professions taking corrective actions to tackle the root causes of their local challenges, using their own local resources and capacities, and sharing challenges, successes, and lessons learned. Such higher-order learning in the affective domain has already been shown to support deepening competencies needed to tackle complex problems.

To overcome current immunization challenges, it may be useful to first recognize the value of diverse perspectives, acknowledging that each individual’s lived experience can provide unique insights and knowledge. Building meaningful, respectful connections to those on the frontlines creates new possibilities for how this can be combined with the world’s collective knowledge: the norms, standards, and other guidelines that global agencies produce. By doing so, we can create a more inclusive culture, ensuring not only that every voice is heard and valued, but that these voices combine to figure out the “how” of solving global health challenges that play out at the local level.

Moreover, we must avoid perpetuating self-fulfilling prophecies that could undermine the motivation and participation. Heat generated by the voices and collective commitment of thousands of local health workers mobilizing and learning together to take action will evaporate into thin air if the global community fails to listen, respond and support them. A less cynical, more inclusive approach might help us raise the upswell of support in favor of immunization. It is essential that we encourage active involvement and recognize the dedication of those who strive to make a difference in the communities they serve. By fostering a supportive environment when we sit at a global roundtable, we can help dispel skepticism and promote the engagement of health professionals at all levels.

Lastly, it is important to challenge any biases or preconceived notions that may hinder our ability to appreciate the knowledge held by others. As we continue to advocate for local action and recognize the significance of local actors, we must be mindful of potential biases that could inadvertently devalue the contributions of those we seek to support. By being aware of these biases, we can work towards a more equitable global health community where everyone’s knowledge and experience are valued.

Promoting inclusivity and collaboration in global health agencies is critical to achieving our shared objectives. By recognizing the value of local perspectives, challenging biases, and promoting active engagement, we can create a more supportive environment for health professionals around the world and ensure that their collective efforts are recognized and supported.

It is important to consider such rejection in the context of the growing emphasis on local action and the recognition of local actors within the global community. As we work towards a more inclusive and collaborative environment, we must ensure that we genuinely appreciate and support local efforts.

Credible knowers

Credible knowers

Reda Sadki Global health, The Geneva Learning Foundation, Thinking aloud

“Some individuals are acknowledged as credible knowers within global health, while the knowledge held by others may be given less credibility.” – (Himani Bhakuni and Seye Abimbola in The Lancet, 2021)

Immunization Agenda 2030” or “IA2030” is a strategy that was unanimously adopted at the World Health Assembly in 2020. The global community that funds and supports vaccination globally is now exploring what it needs to do differently to transform the Agenda’s goal of saving 50 million lives by the end of the decade into reality. Last year, over 10,000 national and sub-national health staff from 99 countries pledged to achieve this goal when they joined the Geneva Learning Foundation’s first IA2030 learning and action research programme. Discover what we learned in Year 1Learn more about the Foundation’s platform and network

In global health, personal experience is assumed to be anecdotal, the lowest form of evidence. We are learning, as one of many organizations contributing to Immunization Agenda 2030 (IA2030), to reconsider this assumption.

An ongoing ‘consultative engagement’ in which a group of global experts has been listening and learning with health professionals working in districts and facilities provides a practical example that changing how we know can lead to significant change in what we do – and what results and outcomes may come of it.

On 12 December 2022, the Geneva Learning Foundation (TGLF) hosted a special event with the Immunization Agenda 2030 Working Group on Immunization for Primary Healthcare and Universal Health Coverage, which includes representatives from leading global agencies that support immunization efforts worldwide. 

Over 4,000 people participated. Most were health workers from districts and health facilities in Asia, Africa, and Latin America. In the run-up to the event, they shared 139 context-specific experiences about their daily work – challenges, lessons learned, and successes – in integrating immunization as part of primary health care practices. The live event opened with such stories and then transitioned into a formal presentation of the framework. This helped everyone make sense of both the “why” and the “how” of the new framework.

However, this was not the first time that the global group was in listening mode. In fact, the new framework was the capstone in a year-long ‘consultative engagement’ that had begun at Teach to Reach 4 on 10 December 2021, attended by 5,906 health professionals who deliver vaccines in districts and facilities. (Teach to Reach is the Foundation’s networking event series, during which participants meet to share experience and global experts listen and learn. You can view the sessions on primary health care here and here.)

Global health organizations often issue new frameworks and guidance, sometimes accompanied by funding for capacity development. However, dissemination often relies upon conventional high-cost, low-volume approaches, such as face-to-face training or information transmission through digital channels, even though fairly definitive evidence suggests severe limitations to their effectiveness.

To address these challenges, the Geneva Learning Foundation and its partners are launching the IA2030 Movement Knowledge to Action Hub, a platform for sharing local expertise and experience across geographical and health system level boundaries. The goal is to research and implement new ways to convert this knowledge into action, results and, ultimately, impact.

The Double Loop, a monthly insights newsletter edited by Ian Steed and Charlotte Mbuh, is one component of this Hub. The newsletter asked questions to all 4,000 participants of the December 2022 event, 30 days and 90 days later, to gather feedback on the new framework.

Here are the questions we asked three months on:

  1. Since you discovered the Framework for Action: Immunization for Primary Health Care, have you referred to this framework at least once? If you have not used it, can you tell us why? How could this Framework be improved to be more useful to you?
  2. If you have referred to this Framework, tell us what did you do with the information in the Framework? How did your colleagues respond to the Framework?
  3. How did this Framework make a difference in solving a real-world problem you are facing? How did things turn out? Explain what you are doing differently to integrate health services, empower people and communities, and lead multisectoral policy and action.

Within days, we received hundreds of answers:

  • Some health professionals apologized, often citing field work, emergency response, and other pressing priorities. This can help better understand the strengths and weaknesses of learning culture (the capacity for change), which the Foundation’s Insights Unit has been researching in the field of immunization since 2020.  
  • Others praised the framework in generic terms (“It’s a great framework”), but did not share any specific examples of actual review, use, or application. Some speak to sometimes peculiar practices of accountability in immunization, where top-down hierarchies remain the norm and provide incentive to always provide positive accounts and responses, whatever the reality may be.
  • A few respondents candidly explained that the Framework does not fit their local needs, as it was primarily designed for national planners. This begs the question of how such local adaptation and tailoring might happen.
  • Finally, we discovered credible, specific narratives of actual use, including adaptation at the local levels. These provide fascinating examples of how a global guidance, developed through a year-long consultative engagement, is actually being translated into practice.

Our Insights Unit is analyzing these narratives, as this exercise is helping us learn how to scale the IA2030 Movement Knowledge to Action Hub to involve the more than 10,000 health professionals who joined the Movement in its first year.

The Double Loop regularly shares feedback from its readers as “insights on sights”. You can already read a sample of responses about the framework.

On 31 March 2023, our team will meet with the IA2030 Working Group to share and discuss the insights gathered through this process.

The Working Group has also changed through this process. In January 2023, it invited its first sub-national member, Dr. María Monzón from Argentina, who brings her own professional experience and expertise from running a primary health care center. She will also serve as the voice of over 10,000 Movement Leaders, immunization staff from 99 countries and all levels of the health system, who met and have been intensively collaborating for over a year in the Foundation’s IA2030 programme. 

Surprisingly, one global immunization technical expert shared his concern that thousands of professionals learning from each other to strengthen their resolve and action might amount to “just a bunch of hot air”. This will only be the case if the global immunization community fails to respond and support, even as it proclaims a genuine willingness to recognize local voices as credible knowers. In another blog post, I’ll share some thoughts on what it might take to rise together.

Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers

What works in practice to build vaccine confidence?

Reda Sadki Global public health

This is the content of a poster presented today by The Geneva Learning Foundation (LinkedIn | YouTube | Podcast | Twitter)  at the International Social and Behavior Change Communication Summit 2022 (#SBCCSummit) held 5-9 December 2022 in Marrakech, Morocco. What is the Geneva Learning Foundation? Get the full reportRead the preface by Heidi Larson

From responding to the initial shock of the pandemic to preparing COVID-19 vaccine introduction

Over 6,000 health professionals joined the COVID-19 Peer Hub in July 2022, part of the Geneva Learning Foundation’s (TGLF) global immunization learning-to-action platform.

  • From August to October, they focused on developing and implementing recovery plans.
  • In November 2020, members of the COVID-19 Peer Hub decided to launch a reflective exercise to prepare COVID-19 vaccine introduction, after three months on early recovery implementation.
  • The exercise took place between 9 November and 18 December 2020.

We asked a simple question: Can you think of a time when you helped an individual or group overcome their initial reluctance, hesitancy, or fear about vaccination?

  • Each participant developed a case study to describe and analyze such a situation.
  • They then peer reviewed each other’s case studies, giving and receiving feedback to learn from each other.

Who participated?

Local practitioners from 86 countries:

  • 81% (n=591) in West and Central Africa
  • 11% (n=80) in Eastern and Southern Africa
  • 6% (n=43) in South Asia

Health system levels:

  • 18% (n=131) national
  • 29% (n=213) sub-national
  • 29% (n=214) district
  • 20% (n=144) facility

So what?

What was the significance of the experience for participants?

Transformation: “I can tell you this experience changed my life. It has changed my practice and made me think differently about the way I work, considering things I did not think about before.”

Defying boundaries: “It was a opportunity like I have never had before… I have studied with peer from my country. Having a lot of people from other countries sharing their experience was something else.”

What we learned from local practice

  1. Vaccine hesitancy is a complex problem that blanket recommendations or prescriptive guidelines are unlikely to solve.
  2. Instead, we should strive to recognize that solutions must be local to be effective, leveraging the ability of local staff to adapt to their context in order to foster confidence and acceptance of vaccines.
  3. Supporting health workers, already recognized as trusted advisors to communities, requires new ways of listening and learning.
  4. It also requires new ways of fostering, recognizing, and supporting the leadership of immunization staff who work at the local level under often difficult conditions.

4 targeted intervention approaches that worked

  1. targeted individual counselling at the individual or household level;
  2. community outreach for larger groups;
  3. formal meetings (usually for community and religious leaders); and
  4. organized training sessions in which particular subgroups were involved (e.g., training for religious teachers, health workers, youth groups, women’s groups).

2 key determinants that changed minds and behaviors

  1. The tone and delivery of the interventions were as critical to the success of the immunization as the activities themselves.
  2. The positive effect of using multiple approaches: high degree of understanding and compassion; navigating sensitive dynamics, grieving families, and issues related to vulnerable communities affected by displacement or war.

Anthrologica performed the qualitative analysis of the case studies and developed the report for the Geneva Learning Foundation.

Heidi Larson: “So much remains determined by the capacity of people on the frontlines to explain, advocate, and respond in ways that are almost entirely dictated by context”

Reda Sadki Global public health

This is the preface by Heidi Larson for the report “Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers”. This report is presented today by The Geneva Learning Foundation (LinkedIn | YouTube | Podcast | Twitter) at the International Social and Behavior Change Communication Summit 2022 (#SBCCSummit) held 5-9 December 2022 in Marrakech, Morocco. What is the Geneva Learning Foundation? Get the full reportRead the preface by Heidi Larson

My own consciousness of the fragile equilibrium sustaining vaccine confidence came from working with immunization programmes and local health workers to defuse rumors that threatened to derail vaccination initiatives. Twenty years ago, this meant traveling to countries to meet, build relationships with, and work side-by-side with frontliners.

Since that time, the corpus of research on the topic has grown tremendously. Elaborate behavioral science frameworks, supported by robust monitoring and evaluation, are now available to guide policy makers, donors, and other decision makers, for those who have the time and resources to implement them. 

Nevertheless, there remains a gap in our understanding of how the complex dynamics of change actually happen, especially at the most local levels. For this we need to listen to the local experiences and voices of those at the front lines who can tell the real-life stories of how these complex dynamics are navigated.

I found the idea of this report fascinating: 734 health professionals from all levels of the health system took time out from their demanding daily duties to reflect on their practice, describing and then analyzing a situation in which they successfully helped an individual or a group accept or gain confidence that taking vaccines would protect them from disease. Furthermore, they did this during four weeks of remote collaboration at a very crucial historical moment, months before the first doses of COVID-19 vaccine were to arrive in Ghana and Côte d’Ivoire.

Reading this report, I experienced a sense of discovery. The stories shared reminded me of my early work with colleagues working at the local levels, and gave me renewed appreciation of   these health professionals who faced even greater challenges in the face of a deadly pandemic. I could feel how hard it is to remain that ‘most trusted adviser’ to communities, and how so much remains determined by the capacity of people on the frontlines to explain, advocate, and respond in ways that are almost entirely dictated by context, in this case a highly uncertain and evolving pandemic.

I could also feel the tensions due to the imperfection of a participatory methodology that did not neatly fit the conventions and norms of expert-led research. Conventional research has seldom been able to access such local narratives, and even less so with such a large and diverse sample. Furthermore, the peer learning methodology used by the Geneva Learning Foundation meant that there was an immediate benefit for participants who learned from each other. Rather than research subjects or native informants, case study authors were citizen scientists supporting each other in the face of a common challenge. The scale, geographic scope, and diversity of contexts, job roles, and experiences are also strengths of this work. 

Supporting health workers, already recognized as trusted advisors to communities, requires new ways of listening, new ways of supporting, new ways of measuring, documenting and learning.

It also requires new ways of recognizing the leadership of immunization staff who work at local levels under often difficult conditions. 

In some cases, it may actually be the lack of prescriptive guidelines that enabled local health staff to draw on their own creativity and problem-solving capabilities to respond to community needs.

Rather than generalizations, we should therefore strive to recognize that solutions must be local to be effective, recognizing the ability of local staff to adapt to their context in order to foster confidence and acceptance of vaccines, and do all we can to support – letting them be the guide for future efforts.

Heidi Larson, PhD
Professor of Anthropology, Risk and Decision Science and
Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine

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 Sadki Global 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 of peer learning.

This may be difficult to understand for those working in global health, due to a legacy of scientifically and morally wrong norms for learning and teaching primarily through face-to-face training. The first norm is that global experts teach staff in countries who are presumed to not know. The second is that the expert who knows (their subject) also necessarily knows how to teach, discounting or dismissing the science of pedagogy. Experts consistently believe that they can just “wing it” because they have the requisite technical knowledge. This ingrained belief also rests on the third mistaken assumption: that teaching is the job of transmitting information to those who lack it. (Paradoxically, the proliferation of online information modules and webinars has strengthened this norm, rather than weakened it).

Indeed, although almost everyone agrees in principle that peer learning is “great”, there remains deep skepticism about its value. Unfortunately, learner preferences do not correlate with outcomes. Given the choice, learners prefer sitting passively to listen to a great lecture from a globally-renowned figure, rather than the drudgery of working in a group of peers whose level of expertise is unknown and who may or may not be engaged in the activities. (Yet, when assessed formally, the group that works together will out-perform the group that was lectured.) For subject matter experts, there can even be an existential question: if peers can learn without me, the expert, then am I still needed? What is my value to learners? What is my role?

Developing a rubric provides a way to resolve such tensions and augment rather than diminish the significance of expertise. This requires, for the subject matter expert, a willingness to rethink and reframe their role from sage on the stage to guide on the side.

Rubric development requires:

  1. expert input and review to think through what set of instructions and considerations will guide learners in developing useful knowledge they can use; and
  2. expertise to select the specific resources (such as guidance documents, case studies, etc.) that will help the learner as they develop this new knowledge.

In this approach, an information module, a webinar, a guidance document, or any other piece of knowledge becomes a potential resource for learning that can be referenced into a rubric, with specific indications to when and how it may be used to support learning.

In a peer learning context, a rubric is also a tool for reflection, stirring metacognition (thinking about thinking) that helps build critical thinking “muscles”.

Our rubrics combine didactic instructions (“do this, do that”), reflective and exploratory questions, and as many considerations as necessary to guide the development of high-quality knowledge. These instructions are organized into versatile, specific criterion that can be as simple as “Calculate sample size” (where there will be only one correct answer), focus on practicalities (“Formulate your three top recommendations to your national manager”), or allow for exploration (“Reflect on the strategic value of your vaccination coverage survey for your country’s national immunization programme”).

Yes, we use a scoring guide on a 0-4 scale, where the 4 out of 4 for each criterion summarizes what excellent work looks like. This often initially confuses both learners and subject matter experts, who assume that peers (whose prior expertise has not been evaluated) are being asked to grade each other. It turns out that, with a well-designed rubric, a neophyte can provide useful, constructive feedback to a seasoned expert – and vice versa. Both are using the same quality standard, so they are not sharing their personal opinion but applying that standard by using their critical thinking capabilities to do so.

Before using the rubric to review the work of peers, each learner has had to use it to develop their own work. This ensures a kind of parity between peers: whatever the differences in experience and expertise, countries, or specializations, everyone has first practiced using the rubric for their own needs.

In such a context, the key is not the rating, but the explanation that the peer reviewer will provide to explain it, with the requirements that she provides constructive, practical suggestions for how the author can improve their work.

In some cases, learners are surprised to receive contradictory feedback: two reviewers give opposite ratings – one very high, and the other very low – together with conflicting explanations for these ratings. In such cases, it is an opportunity for learners to review the rubric, again, while critically examining the feedbacks received, in order to adjudicate between them. Ultimately, rubric-based feedback allows for significantly more learner agency in making the determination of what to do with the feedback received – as the next task is to translate this feedback into practical revisions to improve their work. This is, in and of itself, conducive to significant learning.

Learn more about rubrics as part of effective teaching and learning from Bill Cope and Mary Kalantzis, two education pioneers who taught me to use them.

Image: Mondrian’s classroom. The Geneva Learning Foundation Collection.

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

Pandemic preparedness through connected transnational digital networks of local actors

Reda Sadki Global 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, and building together the Ideas Engine to rapidly share ideas and practices to problem-solve and take action quickly in the face of dramatic consequences of the new virus on immunization services (largely due to fear, risk, and misinformation). By January 2021, over a third of Peer Hub members had successfully implemented their immunization service recovery project, far faster than colleagues who faced the same problems but worked alone, without a global support network. Once connected to each other, these country teams then organized inter-country peer learning to help them figure out “what works” for COVID-19 vaccine introduction and scale-up.

Such a holistic approach is about mobilizing and connecting country-based impact networks that reach and involve practitioners at the local levels, as well as national MoH leaders and planners – quite different from conventional approaches (whether online or face-to-face) to building capacity and preparedness.

TGLF’s global health network and platform reach significant numbers of practitioners at all levels of the health system. It is not only the number of people who participate (47,000 as I write this) but also the depth of engagement and diversity of contexts that they work in. Globally, 21.2% face armed conflict; 24.5% work with refugees or internally-displaced populations; 61.6% work in remote rural; 47% with the urban poor; 35.7% support the needs of nomadic/migrant populations. This is across 110 countries, with over 70 percent in “high burden” countries. Many have deep experience in responding to epidemic outbreaks of all kinds. Health professionals who join come from all levels of the health system, but most are (logically) from health facilities and districts, the bottom of the health pyramid.

Through the network and platform, they build lateral connections, forging bonds not only of knowledge but also of trust. They do this not because they are from the same profession, but primarily (we believe) because they face similar challenges and see the benefit of sharing their experience in support of each other. Engagement is voluntary (ie people opt in and contribute because they want to), with no per diem or other extrinsic incentives offered. 

Individuals develop and implement corrective actions to tackle the root causes of the challenges they are taking on, drawing on both peer learning and the best available global guidelines. For the IA2030 Movement, our largest initiative so far, participants are simultaneously implementing 1,024 projects in 99 countries, learning from each other what works, sharing successes, lessons learned, and challenges. Here are four examples of what collective action through digital networks looks like :

  • In Ghana, TGLF’s alumni (including national and regional MoH EPI directors) decided to organize online sessions country-wide to share the latest information about COVID-19 with local staff, starting in April 2020. They had learned how to use digital tools to find the best available global knowledge and to combine it with their local expertise and experience to inform collective action.
  • In Burkina Faso, the national EPI manager entrusted the first “masked” vaccination campaign to the TGLF alumni team, which has organized itself country-wide, with over half of alumni working in conflict-affected areas. He told me no one else had the network and the capacity for change to figure out quickly how to get this right.
  • In the Democratic Republic of Congo, the TGLF alumni team is increasingly being asked by national EPI to contribute to various activities, due to their effectiveness in connecting and coordinating. The alumni network is country-wide and includes many from very remote areas. When Monkeypox was reported in Europe and North America, we were already seeing a steady stream of information through the DRC and other country networks.

We believe that this continuous learning and action is actually the definition of preparedness. Trying to imagine preparedness and response to new pandemics using old, failed methods of training and capacity building – whether face-to-face or online – is both dangerous and irrational.

Image: Remote villages illuminated by rays of light, with mountains beyond mountains in the background. The Geneva Learning Foundation Collection.

Reinventing the path from knowledge to action in global health

Reda Sadki Global 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 weeks before the introduction of COVID-19 vaccines. It is grounded in the experience of 734 practitioners from local communities, districts, regions, and national teams, who developed case studies documenting a situation in which they were able to successfully lead individuals and groups toward better understanding and acceptance of the benefits of vaccines and vaccination.

Immunization staff from all levels of the health system became citizen scientists, active knowledge-makers drawing on their personal experience of a situation in which they successfully overcame the barriers to vaccine acceptance in the community.

Experiential learning offers a unique opportunity to discover unfiltered experiences and insights from thousands of people whose daily lives revolve around delivering immunization services. But what happens once experience has been shared? What is to be done with what we learn?

Sharing this report, we have found, has triggered remarkable dialogue and led to the co-creation of a steadily growing collection of new practices actually used to build vaccine confidence (as opposed to the many theoretical frameworks on the topic), submitted through our new Insights system. New stories and their analysis are being shared back with local practitioners and with TGLF’s Insights partners, fostering continuous learning that is an action imperative of a strong learning culture. (For Insights, we work with Bridges to Development, the Centre for Change and Complexity in Learning (C3L), and the International Vaccine Access Center at Johns Hopkins.)

In the coming weeks, we will be inviting 10,000 leaders of the Movement for Immunization Agenda 2030 to share this report to their colleagues, teams, and organizations (in both ministries of health and civil society organizations). They will be sharing back their own insights on how the findings can be used to improve demand for vaccines – and colleagues who listen to their presentation of the report will also be able to share back what they learn, connecting with each other through our Insights system.

Then, the Foundation’s Impact Accelerator will track if and how insights from this report are linked to reported positive outcomes, and we should be able to document this, at least in some cases. This will not only foster double-loop learning but also explicitly link learning to implementation and results.

In this way, local practitioners will be putting to use global knowledge grounded in their local experiences, for their own needs. We believe that this provides a complementary, more organic mechanism than current top-down processes for developing normative guidance driven by global assumptions and priorities.

As Kate O’Brien, WHO’s Director of Immunization, said during a recent Insights Live session: “The global role on immunization is actually to bring together everything that is known by people at the grassroots level. That’s where the action is. Global guidance is basically one means to share knowledge and expertise that’s coming from the grassroots level around the world with others who may not have had that experience yet.”

What we are doing with this report is part of a larger initiative to build the IA2030 Movement Knowledge to Action Hub. New knowledge produced by local practitioners will be available as both static and living documents that local and global practitioners can add their inputs to, at any time. This Hub will be launched at Teach to Reach 7 on 14 October 2022, with over 13,000 local practitioners registered for this event.

Image: Many paths to moving mountains. The Geneva Learning Foundation Collection.

Mindjourney-online learning network-abstract-colorful

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

Reda Sadki Learning, 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 Shachar and Yoram Nuemann reviewing twenty years of research on the academic performance differences between traditional and distance learning: summative meta-analysis and trend examination in the Merlot Journal of Online Learning and Teaching. Vol 6, No. 2, June 2010.

A long time ago, I asked Bill Cope what the evidence says about the superiority of online learning over blended and face-to-face. My experience had already consistently been that you could achieve so much more with the confines and constraints of physical space removed.

Of course, it is complicated. But Bill pointed me to the two meta-analyses published in 2010 that provided fair and definitive evidence to answer two questions. Yet, in the field of global health, the underlying assumption of funders and technical partners remains that there is no better way to learn than by flying bodies and materials at high cost. This is scientifically and morally wrong, does not scale, and has created a per diem economy of perverse incentives. It is wrong even if it is easy to understand why international trainers and trainees both express a preference for the least effective, low volume, high cost approach to learning.

Image: Online learning networks. Personal collection generated by Mindjourney.

How we make sense of complexity, together, at the Geneva Learning Foundation

Reda Sadki The Geneva Learning Foundation

Unique learning experiences generate not just data points but complex stories about what it takes to make change actually happenBy connecting the dots between ideas and implementation, we can zero in on the highest-value insights. 

Our Insights Unit uses the latest advances in learning analytics to map how ideas and practices shared between countries and system levels make a difference. 

The Unit facilitates international partners to work hand-in-hand with local practitioners. 

In addition to thousands of local practitioners contributing and using insights to drive shared learning and action, our Insights Unit’s work is being used by leading global agencies. Examples include: 

  • Effective strategies to overcome vaccine hesitancy in districts and health facilities (BMGF) 
  • Motivation of local health professionals for COVID-19 vaccination (Gavi, the Vaccine Alliance) 
  • Learning culture as a key driver of frontline health worker performance (Wellcome Trust) 
  • Gender barriers, vaccine confidence, and other immunization challenges (WellcomeTrust) 
  • Analysis of implementation of recovery plans in TGLF’s COVID-19 peer support programme (WHO and USAID Momentum) 

We are exploring affordable, practical ways to extract meaning from large data sets 

To learn more about the Geneva Learning Foundation (TGLF), download our brochure, listen to our podcast, view our latest livestreams, subscribe to our insights, and follow us on Instagram, LinkedIn, Facebook, Twitter, and YouTube. Or introduce yourself to our Partnerships team.

Teach to Reach: peer learning at scale

Reda Sadki The Geneva Learning Foundation

Teach to Reach are fast-paced, dynamic digital events connecting local and global practitioners to each other in a new, potentially transformative shared dialogue. 

Teach to Reach and other TGLF special events rally thousands, serving as powerful moments of inspiration, providing the amazing sensation of being connected with thousands of fellow, like-minded people and the impetus to transform this feeling into shared purpose and action. 

Meet, network, and learn with colleagues from all over the world 

Successive editions of TGLF’s flagship event series, “Teach to Reach: Connect”, enabled a cumulative total of 27,000 health professionals to share experiences, test approaches, and identify solutions with international experts listening and learning with them. 

To learn more about the Geneva Learning Foundation (TGLF), download our brochure, listen to our podcast, view our latest livestreams, subscribe to our insights, and follow us on Instagram, LinkedIn, Facebook, Twitter, and YouTube. Or introduce yourself to our Partnerships team.