Renaissance for global health

Renaissance

Reda Sadki Education business models, Global health

For decades, learning in global health has depended on a conventional model premised on the scarcity of available knowledge and an emphasis on establishing mechanisms to transmit that knowledge from the center (capital city, headquarters) to the periphery (field, village, training room).

With the Internet, scarcity disappeared. But the economy of high-cost, low-volume training has persisted, with little or no accountability. Worse, transmissive training – replicating the least-effective practices from physical spaces – began to proliferate online in video-based training and webinars.

That economy need to be rebuilt in a digital-first age. It requires a new, long-term infrastructure.

The platforms that could do this are the ones that deeply care about the people they reach, with teams who understand that trust in boundless digital spaces must be earned. It has to come from the heart.

The quality of content also matters, but it is not sufficient.

The quality of conversation in the network – as well as the quality of the ‘pipes’ that connect those in it – matter more.

So does the quality of the relationships, both between the team and its members, but – perhaps even more so – between its members. 

There are a number of digital platforms that are trying to connect health workers. In aggregate, it is going to work. 

The fledgling efforts have been about how to reach people. The next phase is going to be about rebuilding the knowledge and learning engine that can drive not just performance and results, but also renew meaning and purpose.

This rebuilding will be based on trust. And on transferring ownership from those who initiated these platforms to those who need them.

Trust does not happen because a platform is easy to use. It does not happen because great content is being offered. It is not about getting the “user” to click the “register here” or “join now” calls to action. 

We have seen what happens when social media customers are advertisers rather than content creators. 

What is the business model for digital health education?

Competition in digital health education can foster a Renaissance for global public health.

We need platforms to succeed if we do not want to remain in the Dark Ages.

Leaders among us

Listening for leadership

Reda Sadki Leadership

On 30 May 2021, Convenors Karen Watkins and Reda Sadki were joined by eight Key Contributors: Nancy Dixon, Bryan Hopkins, Barbara Moser-Mercer, Renee Rogers, Catherine Russ, Esther Wojcicki, Laura Bierema, and Emanuele Capobianco.

This was the third Dialogue convened by The Geneva Learning Foundation for learning, leadership, and impact.

Each Key Contributor has a fascinating, singular leadership journey. This trajectory may have a collective dimension, of movements, of belonging, or of affiliation that have and continue to shape it. Even when this is so, it is also profoundly personal and individual. It is also a process of accretion – although we tend to recall quantum leaps in significant learning. For some, there may be discomfort with calling oneself a ‘leader’, given the conflation between leadership and authority, leadership and management, leadership and perceived value in society.

Then, there is the moment of coming to consciousness, about the significance of leadership.

So we started there, by asking:

  • How do you define the notion of leadership in this Digital Age? How is it different from notions of leadership in the past?
  • When and how did you realize the significance of the leadership question in your work and life? Who or what helped you come to consciousness?
  • What difference did it make to have this new consciousness about the importance of leadership?
    What is your own leadership practice now?
  • How do you define your leadership in relationship to learning? Are you a ‘learning leader’ and, if so, what does that mean?

We are privileged to have a number of Key Contributors who have dedicated their life’s work to the study of leadership and learning. We are interested in their leadership journeys, of course, but we will also turn to them to ask:

  • What do you hear, as you listen to these stories?
  • What can you share from your work on leadership to better understand the journeys being shared?

And, really, we want to know: How do you listen to people sharing their experience of leadership? What should we be listening for in order to unravel what goes into – and can come out of – leadership?

You can listen to the Dialogue here.

blue skies and rainbow

A round table for Immunization Agenda 2030: The leap from “bottom-up” consultation to multidimensional dialogue

Reda Sadki Global health

They connected from health facilities, districts, and national teams all over the world. 4,769 immunization professionals from the largest network of immunization managers in the world joined this week’s Special Event for Immunization Agenda 2030 (IA2030), the new strategy for immunization, with 59 global and regional partners who accepted the invitation to listen, learn, and share their feedback. (The Special Event is now being re-run every four hours, and you can join the next session here.)

“My ‘Eureka moment’ was when the presenter emphasized that many outbreaks are happening throughout the globe and it is the people in the room who can steer things in a better direction”, shared a participant. “This gave me motivation and confidence that by unifying on a platform and by discussing the challenges, we can reach a solution.”

Two of the top global people accountable for executing this new strategy, WHO’s Ann Lindstrand and UNICEF’s Robin Nandy, were in attendance. “With such commitment”, said Robin Nandy, “I am confident that we can achieve the goals of IA2030. Let us be mindful of the importance of convenient and high quality services delivered by a well informed workforce, which you all embody.”

Hearing “invaluable insights”, Ann Lindstrand recalled that “IA2030 was developed with thousands of immunization stakeholders like you. It reflects exactly what you are telling today. I am encouraged to hear your analyses and ideas to face our common challenges.”

Indeed, in developing Immunization Agenda 2030 intended to be “adaptive and flexible”, global partners employed a “bottom-up co-creation process”, described as “close engagement of countries to ensure that the vision, strategic priorities and goals are aligned with country needs.”

There is, however, a risk of confirmation bias. Staff from countries do their best to carry out what they have been asked to do. In the conventional top-down hierarchical system, global recommendations are adopted by ministries of health that then command staff to execute them. If the system remains overly rigid, staff who want to keep their jobs are likely to confirm and comfort the assumptions of the higher-ups whose vision they have been tasked to implement, no matter the depth of the chasm between these assumptions and reality.

During the Teach to Reach Accelerator conference in January 2021, Kate O’Brien, the director of WHO’s Immunization Department, pointed out that the term “bottom-up initiative” does not call into question existing hierarchies: “I don’t like the sort of hierarchy, about this is the bottom and this is the top, it has a certain sort of power element to me. […] I think leadership is about sitting around a table with a group of people, and drawing the best ideas from everybody who’s sitting around that table, wherever they come from.”

Of course, immunization programmes have a strong technical dimension that require standardization. There are critical elements required for safe and effective vaccination. For example, WHO now organizes weekly didactic Q&A webinars (with Project ECHO, a fascinating organization of doctors exploring new ways to learn, and TechNet-21, a pioneering digital platform for immunization) that do the job of transmitting information to people involved in COVID-19 vaccine introduction. However, we know that information is necessary but insufficient to lead to the effective localization and application of standards. 

As Kate O’Brien explained, “we need people to feel like they have the authority and are empowered to lead change in their community, in their programme, at the most local level, understanding what the goal is and what the targets are, taking those critical things that really cannot be compromised and adapting all around that.”

The IA2030 framework is, according to its global custodians, “designed to be tailored by countries to their local context, and to be revised throughout the decade as new needs and challenges emerge.” In line with this vision, global partners are hoping to foster a “groundswell of support” or even a “social movement”, to ensure that immunization remains high on global and regional health agendas in support of countries.

Alicia Juarrero, whose research focuses upon complex systems’ models of neural processes involved in proto-moral, moral and ethical cognition, emotions and behaviors, has made the compelling point that requires us to restructure what she calls the “space of possibility”. Continuous dialogue enabled by digital technologies can cut across hierarchies and borders to help create such a space. This represents a logical and constructive shift from “bottom-up” toward what Ian Steed has called multidimensional dialogue.

Such a dialogue is likely to be different from what global partner staff are used to. It may be interesting, yet feel somehow illegitimate, if only because challenging the status quo may not be in their job description. Some may question its relevance. “This is just not how we do things in immunization,” is how one partner rebuked us in private. Others may even feel threatened, choosing to ignore or dismiss it, even if their organization’s mission is to support countries and people who deliver vaccines. Certainly, what is emergent is far from perfect and requires continued improvement to be truly inclusive of all voices and stakeholders needed to achieve the immunization goals. Nevertheless, participants in this week’s global round table collectively expressed the feeling of empowerment that stems from being connected in a global community for action. Combined with active presence and strong support of organizational leaders, it is moments like these that can spark new consciousness and could foster the birth of a movement.

Image: Rainbow above the clouds. Personal collection.

Arve Henriksen – Groundswell

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

Reda Sadki Global public 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 immunization coverage for everyone. In fact, my conviction is that it is this focus that could make the difference between short-term Pyrrhic recovery and building back better.

Immunization was already recognized as a success story, saving millions of lives every year. The incredibly rapid development of vaccines to protect from the coronavirus has brought the significance of immunization to the entire world’s attention. Is it exaggerated to claim that vaccines – and the people who deliver them – are now saving the world?

Global partners accountable for Immunization Agenda 2030 are hoping to generate a “groundswell of support” or even a “social movement” to ensure that immunization remains high on global and regional health agendas in support of countries.

One good starting point is for global partners to take time to listen to the people who carry out the daily work of vaccination – and for immunization staff from countries to be empowered to share their challenges, lessons learned, and successes with each other. For such listening to be more than a quaint or condescending exercise requires a strategic focus and commitment to respond to these challenges. That, again, is how Immunization Agenda 2030 may be read and applied – if it is interpreted not as a prescriptive guideline-from-above but as a call and openness to new and flexible forms of action.

Image: Towards Language, by Arve Henriksen – Groundswell.

Defoe in the Pillory

Accountability in learning

Reda Sadki Learning 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 people to stop work in order to learn?

What if you responded to the disconnect between learning and work with convoluted competency frameworks and elaborate performance management “solutions” that changed nothing?

What if you used your internal position as gatekeeper to stifle innovation, to ridicule and undermine those advocating new approaches?

What if you then felt threatened when these new approaches began to show results that you have never been able to achieve?

What if you were held accountable for any or all of the above?

Image: Defoe in the Pillory (Wikipedia Commons).

Dialogue for learning, leadership, and impact

Now is not everything

Reda Sadki Leadership, Writing

“Everything is now. Knowledge flows in real time. Global conversations are no longer restricted by physical space. The world has become immediate.” – George Siemens in Knowing Knowledge (2006)

Twenty Key Contributors have now joined the Geneva Learning Foundation’s monthly Dialogue on learning, leadership, and impact. They include: Laura Bierema, Emanuele Copabianco, Nancy Dixon, Katiuscia Fara, Bill Gardner, Keith Hampson, Bryan Hopkins, Iris Isip-Tan, Barbara Moser-Mercer, Aliki Nicolaides, Renee Rogers, Alan Todd, Bill Wiggenhorn, Esther Wojcicki, and Chizoba Wonodi. If you are curious, a few quick Google searches should make obvious two points: First, each one is a singular thinker and leader. Second, with a few exceptions, they might otherwise never meet.

Why do we need such a dialogue? Who is it for? And what do we aim to accomplish?

By learning, we mean the process by which humans come to know, organized into the discipline of education. The science of education, Bill Cope and Mary Kalantzis have asserted, “develops knowledge about the processes of coming to know”, making education “privileged to be the science of sciences.”

Our mission at the Foundation is to discover new ways to tackle the threats to our societies. Our conviction is that education as a philosophy for change provides uniquely fertile ground in the Digital Age for exploration, once disciplinary guardrails and institutional blinders are removed.

“What if”, ponders Aliki Nicolaides, whose work explores learning-within-ambiguity, “learning was the way of an ethical life where the interdependence between individual and societal evolution was embraced and structures reflected an ethic of mutual care, human, non-human, and nature?”

It is easy to get lost in our complex world. The immediacy of the world only heightens the need for reflective practice.

For Renee Rogers, whose coaching practice seeks to “create positive change around challenging issues”, we need a dialogue on “healing collective trauma” to “foster human evolution”.

This dialogue does not have to be abstract, convoluted, or complicated. As Esther Wojcicki, a remarkable Silicon Valley high school teacher, journalist, and author of both Moonshots in Education and How to Raise Successful People, says “simple lessons” can lead to “radical results.”

Why does the Foundation consider leadership to be central in relation to learning?

Leadership is about sense-making to navigate both the known and the unknown. “Leadership is as much of an art”, argued Robert G. Lord and Jessica E. Dinh in 2014, “as it is a role that has significant impact on individuals, groups, organizations, and societies.”

I realized the significance of leadership through engagement with the profound research and writing of Catherine Russ on humanitarian leadership and the professionalization of humanitarian work. This coming to consciousness about the significance of leadership is, in my view, indispensable to transforming theories of change into effective practice.

Can we answer the question of “how to lead” – the prevailing obsession of thousands of business books – before we comprehend how we know what we know about leadership? (Of course, if we do not yet recognize the significance of leadership or reduce it to a “soft skill”, we do not even realize how much both of these questions matter.)

In our inaugural Dialogue on 28 March 2021, my co-founder Karen E. Watkins explained her “belief that, if you create a certain openness in an organizational culture, people are much more likely to see themselves as leaders”. That belief is grounded in a lifetime of visionary dedication to the study of learning culture, leadership, and change.

Alan Todd is a pioneer of digital learning for multinational corporations. There, “change” means, at the very least, a restructuring every seven months. Eight years ago, he wrote that “as leadership talent – and talent in general – become the predominant asset of business, value shifts to the firm’s know-how.”

By impact, we are primarily interested in the creation of value in global development, health, and humanitarian response. It could be said to be shorthand for radical results. (Value and results may mean different things in profit-driven industries – but they all depend on the peculiar industry dedicated to ensuring that there remains a world where we can buy and sell things.)

Against the present and future threats that loom over our societies, we start with those of concern to the Dialogue’s known circle conveners and contributors. Then – and this is where we positively deviate from the norm of expert panels – we intersect these concerns with the challenges, insights, and successes shared by participants who may, initially, be complete strangers to us and to each other.

Our focus on impact saves the Dialogue from descending into the rabbit hole of purely abstract discussion. 

For example, education as social structure has proven incredibly resistant to change. This is a significant threat, as the gap grows between the needs of our societies and what schools and universities are able to provide. Our exploration will certainly be both broad and deep here, spanning from new economic models for education to new ways of thinking and doing for learning practitioners. 

Higher education analyst Keith Hampson has submitted this question for the Dialogue: “To what extent will alternative education providers (i.e. not colleges and universities) establish legitimacy? Will the soft monopoly held by colleges and universities inhibit the development of new forms of digital education and new digital education providers?”

Bill Gardner, a seasoned executive leadership coach, wonders: “How do we as learning facilitators speed up time-to-capability without sacrificing quality and effectiveness?”

What if you do not fit into any of the historical categories of teacher, professor, coach, trainer, or instructional designer? Key to the Dialogue is the recognition that the lens of education needs to expand to include other professions that increasingly recognize the centrality of how we come to know.

Image: Detail of a sculpture found in the H.R. Giger Museum in Gruyère, Switzerland. Personal collection.

On learning, leadership, and impact: a new kind of dialogue to tackle the challenges that threaten our societies

Reda Sadki Writing

The Geneva Learning Foundation’s new Dialogue is an invitation-only global conversation exploring learning, leadership, and impact. Our aim is to explore new ways to connect individuals who are tackling the challenges that threaten our societies.

In the past, one observation has been that conversations around learning and leadership tend to happen between nearly-identical peers.

One of the bets we are making is that to progress our understanding on leadership, diversity is a necessary condition.

And, indeed, I am struck by the radical diversity of the Dialogue’s participants so far.

My conviction is that such improbable connections could create new possibilities for facilitated dialogue to surface new insights into the nature of leadership in the Digital Age.

Below are three examples, connecting a disease control student from Ghana, an engineer working on a water pipeline in Libya, and an NGO worker from New Zealand.

Time travel

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

Reda Sadki Learning 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 recordings of webinars without being forced to?)

It is wonderful that the big video platforms immediately make the recording available, at the same URL, after a livestreamed event. Right now, this is better than Zoom, which does not (yet) offer a simple, automated way to share the recording with everyone who missed a live session, nor a mechanism for post-event viewers to contribute comments or questions.

Image: Time travel (Wikipedia Commons).

Two false dichotomies: quality vs. quantity and peer vs. global expertise

Reda Sadki Global health, Global public health

The national EPI manager of the Expanded Programme for Immunization (EPI) of the Democratic Republic of the Congo (DRC), just addressed the COVID-19 Peer Hub Teams from DRC and Ivory Coast, saluting both teams for their effort to prepare and strengthen COVID-19 vaccine introduction. I am honored to have been invited and pleased to see how this initiative is not only country-led but truly owned and led by its participants.

She has joined the Inter-Country Peer Exchange (reserved for COVID-19 Peer Hub Members) organized by the Peer Hub’s DRC Team to share rapid learning from COVID-19 vaccine introduction.

In the room are immunization professionals, primarily those working for the Ministries of Health, directly involved in vaccine introduction from both countries and from all levels of the health system.

Other COVID-19 Peer Hub country teams are organizing similar inter-country exchanges, in response to their own needs, building on what they have learned as Scholars about the value of digital networks to strengthen and accelerate their response to the pandemic, from recovery to vaccine introduction.

Today’s exchange is reserved for COVID-19 Peer Hub Members from the two countries, following a public meeting on 27 March 2021. (Short recaps in French and in English are available below. The full recording of the inaugural 27 March 2021 exchange is available on The Geneva Learning Foundation’s social media channels.)

The Inter-Country Peer Exchange is only possible because, in response to the pandemic in 2020, we co-designed the Peer Hub and rapidly doubled the size of what was already the largest platform for immunization managers. We combined the best of both worlds: the best available global technical expertise with the field-based expertise of thousands of participants.

In this way, we do not need to choose between false dichotomies that seek to oppose quality to quantity or peer versus global expertise.

COVID-19 vaccine introduction: Recaps below in English and French about the first COVID-19 Peer Hub Inter-Country Peer Exchange between the Peer Hub teams from the Democratic Republic of the Congo (DRC) and Ivory Coast

Walled garden

Can the transformation of global health education for impact rely on input-based accreditation?

Reda Sadki Education business models, Global health, Learning strategy

Burck Smith wrote in 2012 what remains one of the clearest summaries of how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and serves to create an “iron triangle” to maintain high prices, keep out new entrants, and resist change.

It is worth quoting Smith at length (see this link) as we think through the proposal that the transformation of global health education for impact should rely on accredited institutions. Global health efforts are focused on outcomes and aim to achieve impact. Of necessity, this requires rethinking a broad swath of fairly fundamental issues, from how to construct education to what philosophy should underpin what we design and develop. And the focus on results makes the prevailing input-based accreditation criteria unlikely to be the most useful ones to help achieve global health goals.

The call for a “revolution” in education for public health is unlikely to be answered by institutions that form a protected monopoly. The most exciting and promising innovations in education are happening on the fringes of the education landscape, in bootcamps, edtech startups, and other non-traditional organizations that are catalyzing change. Such change remains primarily seen as a threat by established institutions that, in a protected market buttressed by accreditation, are seeking to preserve gross margins that hover at around sixty percent in some countries.

Of course, there is a very real problem with the proliferation of degree mills and other shady profit-first organizations that sell the promise of career development and opportunities but cannot deliver them. Unfortunately, many such outfits are, it turns out, accredited ones. This explains why, alongside accreditation, a parallel industry of quality labels and certifications is supposed to help potential “customers” make better purchasing decision.

Instead, we should rethink what determines the value of a credential. Moving toward competency-based degrees is one necessary but insufficient step that has already been explored. But could we invent a “lifelong credential” that would increase in value over time, as its holder applies what was learned in order to progress and ultimately achieve measurable impact? The tools (blockchain, AI, etc.) to support this already exist. A reductive obsession with legitimacy based on accreditation and the prestige and rankings it supposedly confers will only serve to hinder those of us who are working toward new forms of credentialing, grounded in the needs of people working in countries and guided by what will actually save lives and improve health.

Image: Walled garden, New College (Oxford). Photo by Elaine Heathcote on Flickr.