Green skills and artificial intelligence

The future of work: remarks at the 9th 1M1B Impact Summit held at the United Nations in Geneva

Reda SadkiArtificial intelligence, Global health

On November 7, 2025, Reda Sadki, Executive Director of The Geneva Learning Foundation, joined the panel “The Future of Work: AI and Green Skills” at the 9th 1M1B Impact Summit held at the United Nations in Geneva. Moderated by Elizabeth Saunders, the discussion explored the rapid redefinition of the workforce by artificial intelligence and the green transition. The following is an edited transcript of Mr. Sadki’s remarks.

Living with artificial intelligence

Moderator: You have just seen some of these really incredible changemaker ideas and so what skills and mindsets stood out to you and how do you think those can be scaled to build a workforce that is living with AI and not competing with it?

That is a wonderful question.

I would answer that the key skill is learning to work with artificial intelligence.

It is likely that your generation will be the first one learning to work side-by-side with AI as a partner or a co-worker, in the same way my generation learned to navigate the Internet.

This requires three things.

First, being ambitious.

Second, being bold.

And third, being courageous.

Things are going to change dramatically in the next three to six years.

There is a convergence of belief among those building these systems—what some call the “San Francisco Consensus”—that within this short timeframe, AI will fundamentally transform every aspect of human activity.

We are facing the arrival of a new, non-human intelligence that is likely to have better reasoning skills than humans.

This is not just about new tools.

We are already seeing AI automate the routine tasks that make up the first rungs of a professional career.

Some may tell you AI is not coming for your job, but I struggle to see that as anything other than misleading at best.

In our programmes at The Geneva Learning Foundation, we have already used AI to replace key functions previously performed by humans.

So, the sooner we are thinking, learning, and getting ready to navigate those changes, the better.

The challenge is not to compete with AI in knowledge transmission.

The risk is what some call “metacognitive laziness”, outsourcing our critical thinking to the machine.

What is left for humans, and what we must cultivate, is facilitation, interpretation, and uniquely human-centric skills.

These include creativity, curiosity, critical thinking, collective care, and consciousness.

We must cultivate judgment, contextual wisdom, and ethical reasoning.

We are navigating the unknown, and learning to do so together – by strengthening the connections between us, by asking what it means to be connected as humans – will be critical to our survival.

Peer learning and democratizing access

Moderator: I have a question for you about your foundation, because you have pioneered peer learning networks that have reached thousands globally. So what can we learn from this model about how to democratize access to AI and green skills, and make lifelong learning more inclusive and action-driven?

The Geneva Learning Foundation’s mission, since 2016, has been to research, develop, and implement new ways to learn and lead.

Our initial premise was that our traditional education systems are broken.

They often rely on a top-down, “transmission model” of learning, where knowledge flows from experts to practitioners.

This model is too slow, too expensive, and often fails to reach the people and communities that are facing extinction-level threats, whether that is climate change or artificial intelligence.

In today’s world, these broken systems create significant risks when it comes to the critical threats upon our societies, including climate change and artificial intelligence.

In the last three years, we have made key breakthroughs in solving four problems:

  • The problem of scale: how do we simultaneously connect tens of thousands of people in a single initiative, rather than one classroom at a time?
  • The problem of speed: how do we share knowledge at the speed problems emerge?
  • The problem of cost: how do we make this affordable?
  • And the problem of sustainability: how do we create systems people will continue to use because they are relevant?

We have developed a model that we have tested in over 137 countries, working with international partners as well as ministries of health and, most importantly, with people on the ground in local communities.

The first lesson learned is that in today’s complex, hyper-connected world, where there is an abundance of knowledge, simply knowing things is necessary, but not sufficient.

The second lesson is recognizing the significance of what people know because they are there every day.

We operate within knowledge systems that tend to devalue this “experiential knowledge”, often dismissing it as “anecdotal”.

This is a form of “epistemic injustice”.

We believe we must value what the health worker knows, what the mother or grandmother knows, and what the youth know, in order to solve the challenges before us.

The third lesson is the power of digital networks to enable connections.

In the past, learning from experience was constrained by our local environment.

With digital networks, you can make connections with people from all over the world.

This led us to the central piece of our innovation: peer learning mediated through digital networks.

This could be so much more than the informal chatter and negative feedback loops of social media.

It is a structured process where participants develop concrete projects addressing real challenges, review each other’s work, and engage in facilitated dialogue to share insights.

Knowledge flows horizontally, from peer to peer, rather than just vertically.

This model solves our four problems.

It gives us scale.

There is no upper limit.

It gives us speed.

It turns out to be incredibly cheap.

And it is sustainable, because people keep doing it because it is actually helping them solve their needs.

To give a specific example, in July 2023 we launched our program on climate change and health.

We started by listening to the voices of thousands of health workers from all over the world, who painted a very scary picture of the impacts of climate change on the health of those they serve.

But we also found that health workers were being incredibly creative with very limited resources.

They had already begun to solve the problems they were facing in their communities, but unfortunately, very often with no one helping or supporting them.

That led us to calculate that if we are able to connect one million health workers to each other to be learning from and supporting each other by 2030, that group of health workers could use the power of those connections to save seven million lives.

And for the “bean counters” in the room, this would be at a cost of less than two dollars per life saved, which is actually cheaper than vaccination, one of the most effective interventions we have in health today.

This is such an incredible equation that some of our partners say it sounds too good to be true.

There is an incredible opportunity to link up health workers with other segments of society, including youth.

We see the potential from building these coalitions and networks.

This brings us back to AI.

We really see peer learning as key to our survival as human beings.

We may end up working with machines that already exceed our cognitive capacities, and will almost certainly do so definitively in pretty much every area of work within the next three to six years.

We are going to have to respond to that by strengthening the connections we have as human beings.

AI systems are trained on global data, but humans possess deep “contextual intelligence”.

Peer learning is the bridge.

It is how we learn together how to adapt AI’s powerful analytics to our local realities, cultural contexts, trust networks, and resource constraints.

We have to think about what it means to be human in the Age of AI, and learning from each other will be very critical, very key to that survival.

Image: The Geneva Learning Foundation Collection © 2025. Suspended between earth and ether, Cathedral of Circuits and Roots evokes a world where technology and nature, thought and matter, coalesce in fragile harmony. Its oxidized cubes, hues of turquoise, gold, and quiet rust, resemble relics of a civilization both ancient and yet to come. The sculpture’s floating architecture suggests a digital forest, each metallic block a leaf of knowledge, each connection a pulse of shared intelligence. It speaks to the dual call of our age: to grow roots deep in human wisdom, even as we build circuits reaching toward artificial minds. In this shimmering equilibrium, the work asks: can progress be both luminous and humane — and can learning itself become an act of restoration?

References

Bill Gates

Development is adaptation: Bill Gates’s shift is actually about linking climate change and health

Reda SadkiGlobal health

Bill Gates’ latest public memo marks a significant shift in how the world’s most influential philanthropist frames the challenge of climate change. He sees a future in which responding to climate threats and promoting well-being become two sides of the same mission, declaring, “development is adaptation.”

Gates argues that the principal metric for climate action should not be global temperature or near-term emission reductions alone, but measured improvement in the lives of the world’s most vulnerable populations.

He argues that the focus of climate action should be on the “greatest possible impact for the most vulnerable people.”

The suffering of poor communities must take priority, since, in his view, “climate change, disease, and poverty are all major problems. We should deal with them in proportion to the suffering they cause.”

Climate change is about the health of the most vulnerable

This position resonates with a core message that has emerged across global health over the past several years: climate change is about health.

New data from the 2025 Lancet Countdown draw a stark picture:

  • Heat-related mortality has risen 63 percent since the 1990s.
  • Deaths from wildfire smoke and air pollution caused by fossil fuels continue to climb.
  • Food insecurity, driven by erratic weather, is destabilizing health and economies at once.
  • Thirteen out of twenty key health indicators linked to climate impacts now signal urgent action is needed.

Health professionals, policy coalitions, scientists, and patient advocates have succeeded in bringing this nexus between climate and health squarely to the global agenda, culminating in recent summits where health finally shared the main stage with energy and economics.

Yet just as the science and advocacy align, political attention risks fragmenting.

Despite sweeping reports, evidence, and high-level declarations, momentum can ebb.

There is now a risk that the transformative potential embedded in the climate-health linkage may not be fully realized.

Here, Gates’s pivot could actually be the inflection point that the field needs.

The case for health workforce-centered adaptation

For nearly a decade, The Geneva Learning Foundation (TGLF) has been advocating and demonstrating that meeting complex humanitarian, health, and development challenges requires strengthening not just technical capacities or disease programs, but the underlying connective tissue of the health system: its workforce.

TGLF’s digital peer-learning platform now connects over 70,000 health workers across more than 130 countries.

These practitioners – mostly in government service, often in low-resource or crisis-affected settings – are the first to observe, and often the first to respond to, the local impacts of climate change on health.

Their reports show that health impacts are immediate and multi-faceted: rising malnutrition from crop failures, increases in waterborne diseases following floods, new burdens from air pollution and heat, and psychological distress from repeated disasters.

What sets this approach apart is its systemic focus.

Climate change is not a threat that can be “verticalized”.

It demands responses that are adaptive, distributed, and coordinated across all levels of the health system.

TGLF’s innovation lies in harnessing a distributed network to surface and scale locally-grounded solutions:

Data from these initiatives demonstrate that such networked learning delivers results at scale, often with return on investment superior to parallel vertical programs, and increases system resilience and flexibility.

Development is adaptation: the need for human capital investment

The urgency and logic of these approaches are reinforced by ongoing policy developments ahead of COP30:

  • WHO’s Global Action Plan on Climate Change and Health, adopted at the World Health Assembly in May 2025, recognizes that without context-sensitive system strengthening, existing approaches are insufficient, and positions knowledge and workforce mobilization as strategic imperatives.
  • The COP30 Belem Health Action Plan establishes adaptation of the health sector to climate change as an international priority, calling for holistic, cross-sectoral strategies, and “community engagement and participation as foundational to implementation.”

Without empowered and connected health workers, no global action plan will reach those most at risk or maintain public trust.

A strategic investment imperative: why the next breakthrough must be human-centered

The philanthropic search for cost-effective, scalable, and measurable impact has built immense legacies in reducing child mortality and combating infectious disease.

Gates’ own approach of pioneering “vertical” innovations, optimizing delivery through metrics, and prioritizing technical solutions has been transformative, especially at the intersection of science and delivery.

However, emerging science show the limits of technical “magic bullets” absent robust, interconnected local systems.

Trust, legitimacy, and action flow from the relationships health workers build in – and with – their communities.

If development is adaptation, what does this mean for the next phase in climate-health philanthropy?

If the measure of climate action’s value is the scale and speed at which lives are improved and disasters averted, investing in the human infrastructure of the health system is the most evidence-based, cost-effective, and legacy-ensuring play available.

  1. Investing in the health workforce is itself a breakthrough technology: It increases the absorptive capacity of low-resource health systems, making innovations stick and catalyzing uptake well beyond single-disease silos or narrow infrastructure projects.
  2. Long-term, system-wide resilience is built by equipping health workers – not simply with technology or training from above, but with platforms for peer learning, rapid response, and locally-driven adaptation coordinated through agile networks.
  3. The network effect is real: A million motivated and networked health practitioners is likely to surface, refine, and implement interventions at a scale and pace that outstrips most top-down models. Digitally-enabled peer learning, tested by TGLF, could link to AI systems to provide distributed AI-human intelligence that supports effective action.

Without these bridges, even the best technology or policies will fail to gain a durable footprint at community level, especially as climate impacts deepen.

Health is where climate change action matters most

The world is waking to the reality that technical solutions alone cannot future-proof health against climate risks.

We need to focus on the highest-value levers.

This starts with a distributed, networked workforce at the coalface of the crisis, empowered to adapt, share, and lead.

In a world of accelerating climate shocks and retreating political will, the boldest, most rational bet for sustained global impact is to go “horizontal” – to invest in the people and the systems that connect them.

By helping build adaptive, digitally connected networks of health professionals, philanthropy can reinforce the foundation upon which all high-impact innovation rests.

This is not a departure from the pursuit of technology-driven change, but rather the necessary evolution to ensure every breakthrough finds its mark – and that trust in science and public health stays strong under pressure.

If ever there was a time for rigorous, data-driven engagement that bridges technology, health, and community resilience, this is it.

Every indicator – scientific, economic, social – suggests that communities will confront more climate disruptions in the coming years.

Investing in the people who translate science into health, who stand with their communities in crisis, is the most robust, scalable, and sustainable bet that any philanthropist or society can make.

By focusing on these vital human connections, the world can ensure that innovation works where it matters most – and that the next chapter of climate action measures true success by the health, security, and opportunity it delivers for all.

History will honor those whose support creates not only tools and policies, but the living networks of trust and craft upon which community resilience depends.

That is the climate breakthrough waiting to happen.

References

  1. COP30 Belém Action Plan. (2025). The Belém Health Action Plan for the Adaptation of the Health Sector to Climate Change. https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/advocacy-partnerships/talks/health-at-cop30
  2. Ebi, K.L., et al. (2025). The attribution of human health outcomes to climate change: transdisciplinary practical guidance. Climatic Change, 178, 143. https://doi.org/10.1007/s10584-025-03976-7
  3. Ebi, K.L., Haines, A. (2019). The imperative for climate action to protect health. The New England Journal of Medicine, 380, 263–273. https://doi.org/10.1056/NEJMra1807873
  4. Jacobson, J., Brooks, A., Mbuh, C., Sadki, R. (2023). Learning from frontline health workers in the climate change era. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7316466
  5. Jones, I., Mbuh, C., Sadki, R., Steed, I. (2024). Climate change and health: Health workers on climate, community, and the urgent need for action (Version 1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
  6. 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
  7. Sadki, R. (2024). Health at COP29: Workforce crisis meets climate crisis. The Geneva Learning Foundation. https://doi.org/10.59350/sdmgt-ptt98
  8. Sadki, R. (2024). Strengthening primary health care in a changing climate. The Geneva Learning Foundation. https://doi.org/10.59350/5s2zf-s6879
  9. Sadki, R. (2024). The cost of inaction: Quantifying the impact of climate change on health. The Geneva Learning Foundation. https://doi.org/10.59350/gn95w-jpt34
  10. Sanchez, J.J., et al. (2025). The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(25)00003-8
  11. Storeng, K. T. (2014). The GAVI Alliance and the Gates approach to health system strengthening. Global Public Health, 9(8), 865–879. https://doi.org/10.1080/17441692.2014.940362
  12. World Health Organization. (2025). Draft Global Action Plan on Climate Change and Health. Seventy-eighth World Health Assembly. https://apps.who.int/gb/ebwha/pdf_files/WHA78/A78_4Add2-en.pdf
20251029.CLIMATE Lancet Countdown 2025.005.1600

How the Lancet Countdown illuminates a new path to climate-resilient health systems

Reda SadkiGlobal health

The 2025 Lancet Countdown report has begun to acknowledge a critical, often-overlooked source of intelligence to build climate-resilient health systems: the health worker. By including testimonials from health workers alongside formal quantitative evidence, the Lancet cracks open a door, hinting at a world beyond globally standardized datasets. This is a necessary first step. However, the report’s framework for action remains a traditional, top-down model. It primarily frames the health workforce as passive recipients of knowledge—a group that must be “educated and trained” because they are “unprepared”, rather than build on existing evidence that points to health workers as leaders for climate-health resilience.

The 2025 report confirms that climate change’s assault on human health has reached alarming new levels.

  • Thirteen of 20 indicators tracking health threats are flashing red at record highs.
  • Heat-related mortality, now estimated at 546,000 deaths annually in the 2012-21 period, has climbed 63% since the 1990s.
  • Deaths linked to wildfire smoke pollution hit a new peak in 2024, while fossil fuel combustion overall remained responsible for 2.52 million deaths in 2022 alone.
  • Extreme weather increasingly drives food insecurity.
  • This accelerating health crisis unfolds against a backdrop of faltering political will.
  • The report documents governmental retreats from climate commitments.

Yet, within this sobering assessment lies a quiet but potentially pivotal shift.

For the first time, the Countdown’s country profiles integrate direct testimonials from frontline health workers, explicitly acknowledging their “lived experiences as valuable evidence”.

It is a crucial opening, recognizing that globally standardized data alone cannot capture the full picture or tell the story.

The Countdown’s inclusion of health worker voices in its country profiles is laudable.

It hints at bridging what philosopher Donald Schön called the divide between the “high, hard ground” of research-based theory and the “swampy lowlands” of messy, real-world practice.

Schön argued that the problems of greatest human concern often lie in that swamp, requiring practitioners to rely on experience and intuition – what he termed “knowing-in-action”.

This promising step creates new possibilities.

When the reference global report on climate change and health sees the frontline, this illuminates the path to recognize those working there as agents and leaders capable of forging solutions.

However, the report’s dominant framework still positions the health workforce primarily on the receiving end of knowledge transfer.

Indicator 2.2.5 meticulously documents gaps in climate and health education, concluding that professionals are left “unprepared”.

The resulting recommendation?

Health systems must “[e]ducat[e] and train[…] the health workforce”.

This framing, while highlighting a genuine need, implicitly casts health workers as passive vessels needing to be filled, rather than as active knowers and problem-solvers.

This perspective misses an important dimension, one vividly apparent from our direct work at The Geneva Learning Foundation with tens of thousands of health practitioners globally.

Frontline health workers are already responding – adapting vaccination schedules during heatwaves, managing cholera outbreaks after floods, counseling communities on new health risks – because they must.

Their daily observations is distinct from “lived experience”, because of their formal health education. 

The patterns that emerge could form a vital, real-time early warning system, detecting subtle shifts in disease patterns or community vulnerabilities even before formal surveillance systems register them.

To dismiss this deep experiential knowledge as merely “anecdotal” is to ignore critical intelligence in a rapidly escalating crisis.

Worse, it reflects an “epistemological injustice” where practical wisdom is systematically devalued.

Here lies the crucial disconnect.

The Lancet Countdown rightly presents evidence for “community-led action,” showcasing powerful examples in Panel 6 where farmers or local groups have driven substantial environmental and health gains.

Yet, it fails to connect this potential explicitly to the health workers embedded within those very communities.

What does empowering the health workforce truly mean?

It cannot be limited to providing didactic training, such as webinar lectures about climate science.

Drawing on our research and practice, it involves concrete actions:

  1. Recognizing health professionals as knowledge creators: Systematically capturing, validating, and integrating their “knowing-in-action” into the evidence base.
  2. Connecting them through peer learning networks: Enabling practitioners facing similar “swampy” problems across diverse contexts to share hyperlocal solutions and build collective intelligence.
  3. Supporting locally-led implementation: Equipping them to design and execute adaptation projects tailored to community needs, often leveraging existing local resources, as demonstrated in TGLF initiatives where the vast majority of participants reported sustaining action without external funding.
  4. Creating feedback loops to policy: Establishing mechanisms for this ground-level knowledge to flow upwards, informing district, national, and even global strategies.

This approach offers concrete pathways for the academic research community.

These networks function as distributed, real-world laboratories.

They generate rich qualitative and quantitative data on context-specific climate impacts, the practicalities of implementing adaptation strategies, barriers encountered, and observed outcomes.

They offer fertile ground for implementation science, participatory action research, and validating citizen science methodologies at scale.

Rigorous study of these networks themselves – how knowledge flows, how solutions spread, how collective capacity builds – can advance our understanding of learning and adaptation in complex systems.

This vision of an empowered, networked health workforce directly supports emerging global policy.

WHO’s Global Plan of Action on Climate Change and Health, and the Belém Health Action Plan (BHAP) under development for COP30, both stress social participation, capacity building, and the integration of local knowledge.

Peer learning networks provide a practical, field-tested engine to translate these principles into action, connecting the ambitions of Belém with the realities faced by a nurse in Bangladesh, a community health worker in Kenya, or a community health doctor in India.

Furthermore, this approach may represent one of the most effective investments available.

Preliminary analysis by The Geneva Learning Foundation suggests that supporting local action health workers through networked peer learning could yield substantial health gains.

With a critical mass of one million health workers connected to learn from and support each other, the potential is to save seven million lives, at a cost lower than that of immunization.

This is not just about doing good.

It is about smart investment in resilience.

The 2025 Lancet Countdown acknowledges the view from the ground.

The challenge now is to fully integrate that perspective into research and policy, by supporting and amplifying existing, community-led local action.

We must move beyond framing health workers as recipients of knowledge or vulnerable populations needing protection, and recognize their indispensable role as knowledgeable, capable leaders.

Harnessing their “knowing-in-action” through structured, networked peer support is not merely an alternative approach. 

It is essential for building the adaptive, equitable, and effective health responses this escalating climate crisis demands.

The wisdom needed to navigate the swamp often resides within it.

References

  1. Romanello M, Walawender M, Hsu S-C, et al. The 2025 report of the Lancet Countdown on health and climate change. Lancet 2025; published online Oct 29. https://doi.org/10.1016/S0140-6736(25)01919-1.
  2. Sadki, R., 2025a. 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
  3. Sadki, R., 2025b. 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
  4. Sadki, R., 2024a. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
  5. Sadki, R., 2024b. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
  6. Sadki, R., 2024c. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
  7. Sadki, R., 2024d. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
  8. Sadki, R., 2024e. Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems. https://redasadki.me/2024/11/26/why-guidelines-fail-on-consequences-of-the-false-dichotomy-between-global-and-local-knowledge-in-health-systems/
  9. Sadki, R., 2024f. Anecdote or lived experience: reimagining knowledge for climate-resilient health systems. https://redasadki.me/2024/11/11/anecdote-or-lived-experience-reimagining-knowledge-for-climate-resilient-health-systems/
  10. Sadki, R., 2024g. Knowing-in-action: Bridging the theory-practice divide in global health. https://redasadki.me/2024/12/14/knowing-in-action-bridging-the-theory-practice-divide-in-global-health/
  11. Sadki, R., 2023a. Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline. https://doi.org/10.59350/3kkfc-9rb27
  12. Sadki, R., 2023b. Climate change is a threat to the health of the communities we serve: health workers speak out at COP28. https://redasadki.me/2023/12/11/climate-and-health-health-workers-trust/
  13. Sanchez, J.J., Gitau, E., Sadki, R., Mbuh, C., Silver, K., Berry, P., Bhutta, Z., Bogard, K., Collman, G., Dey, S., Dinku, T., Dwipayanti, N.M.U., Ebi, K., Felts La Roca Soares, M., Gudoshava, M., Hashizume, M., Lichtveld, M., Lowe, R., Mateen, B., Muchangi, M., Ndiaye, O., Omay, P., Pinheiro dos Santos, W., Ruiz-Carrascal, D., Shumake-Guillemot, J., Stewart-Ibarra, A., Tiwari, S., 2025. The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health 13, e199–e200. https://doi.org/10.1016/s2214-109x(25)00003-8
  14. Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673
  15. The Geneva Learning Foundation, 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

Image: The Geneva Learning Foundation Collection © 2025

20251029.CLIMATE Lancet Countdown 2025.008.1600

Climate change and health: what the Lancet Countdown says about the value and significance of local knowledge and action

Reda SadkiGlobal health

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

  1. 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
  2. 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

Old poison in new bottles

How do we stop AI-generated ‘poverty porn’ fake images?

Reda SadkiArtificial intelligence, Global health

There is an important and necessary conversation happening right now about the use of generative artificial intelligence in global health and humanitarian communications.

Researchers like Arsenii Alenichev are correctly identifying a new wave of “poverty porn 2.0,” where artificial intelligence is used to generate stereotypical, racialized images of suffering – the very tropes many of us have worked for decades to banish.

The alarms are valid.

The images are harmful.

But I am deeply concerned that in our rush to condemn the new technology, we are misdiagnosing the cause.

The problem is not the tool.

The problem is the user.

Generative artificial intelligence is not the cause of poverty porn.

The root cause is the deep-seeded racism and colonial mindset that have defined the humanitarian aid and global health sectors since their inception.

This is not a new phenomenon.

It is a long-standing pattern.

In my private conversations with colleagues and researchers like Alenichev, I find we often agree on this point.

Yet, the public-facing writing and research seem to stop short, focusing on the technological symptom rather than the systemic illness.

It is vital we correct this focus before we implement the wrong solutions.

The old poison in a new bottle

Long before Midjourney, large organizations and their communications teams were propagating the worst kinds of caricatures.

I know this.

Many of us know this.

We remember the history of award-winning photographers being sent from the Global North to “find… miserable kids” and stage images to meet the needs of funders. Organizations have always been willing to manufacture narratives that “show… people on the receiving end of aid as victims”.

These working cultures — which demand images of suffering, which view Black and Brown bodies as instruments for fundraising, and which prioritize the “western gaze” — existed decades before artificial intelligence.

Artificial intelligence did not create this impulse.

It just made it cheaper, faster, and easier to execute.

It is an enabler, not an originator.

If an organization’s communications philosophy is rooted in colonial stereotypes, it will produce colonial stereotypes, whether it is using a 1000-dollar-a-day photographer or a 30-dollar-a-month software subscription.

The danger of a misdiagnosis

If we incorrectly identify artificial intelligence as the cause of this problem, our “solution” will be to ban the technology.

This would be a catastrophic mistake.

First, it is a superficial fix.

It allows the very organizations producing this content to performatively cleanse themselves by banning a tool, all while eluding the fundamental, painful work of challenging their own underlying racism and colonial impulses.

The problem will not be solved; it will simply revert to being expressed through traditional (and often staged) photography.

Second, it punishes the wrong people.

For local actors and other small organizations, generative artificial intelligence is not necessarily a tool for creating poverty porn.

It is a tactical advantage in a fight for survival.

Such organizations may lack the resources for a full communication team.

They are then “punished by algorithms” that demand a constant stream of visuals, burying stories of organizations that cannot provide them.

Furthermore, some organizations committed to dignity in representation are also using artificial intelligence to solve other deep ethical problems.

They use it to create dignified portraits for stories without having to navigate the complex and often extractive issues of child protection and consent.

They use it to avoid exploiting real people.

A blanket ban on artificial intelligence in our sector would disarm small, local organizations.

It would silence those of us trying to use the tool ethically, while allowing the large, wealthy organizations to continue their old, harmful practices unchanged.

The real work ahead

This is why I must insist we reframe the debate.

The question is not if we should use artificial intelligence.

The question is, and has always been, how we challenge the racist systems that demand these images in the first place.

My Algerian ancestors fought colonialism.

I cannot separate my work at The Geneva Learning Foundation from the struggle against racism and fighting for the right to tell our own stories.

That philosophy guides how I use any tool, whether it is a word processor or an image generator.

The tool is not the ethic.

We need to demand accountability from organizations like the World Health Organization, Plan International, and even the United Nations.

We must challenge the working cultures that green-light these campaigns.

We should also, as Arsenii rightly points out, support local photographers and artists.

But we must not let organizations off the hook by allowing them to blame a piece of software for their own lack of imagination and their deep, unaddressed colonial legacies.

Artificial intelligence is not the problem.

Our sector’s colonial mindset is.

References

Image: The Geneva Learning Foundation Collection © 2025

State of AI report

What the 2025 State of AI Report means for global health and humanitarian action

Reda SadkiArtificial intelligence, Global health

The 2025 State of AI Report has arrived, painting a picture of an industry being fundamentally reshaped by “The Squeeze.”

This is a critical, intensifying constraint on three key resources: the massive-scale compute (processing power) required for training, the availability of high-quality data, and the specialized human talent to build frontier models.

This squeeze, the report details, is accelerating a consolidation of power.

It favors the “hyperscalers”—the handful of large technology corporations that can afford to build their own power plants to run their data centers.

For leaders in global health and humanitarian action, the report is essential reading.

However, it must be read with a critical eye.

The report’s narrative is, in many ways, the narrative of the hyperscalers.

It focuses on the benchmarks they dominate, the closed models they are building, and the resource problems they face.

This “view from the top” is valuable, but it is not the only reality.

What does this consolidation of power mean for our sector, and where should we be focusing our attention?

The new AI divide: A focus on closed-model dominance

The report documents a clear trend: closed, proprietary models are pulling ahead of open-source alternatives in raw performance benchmarks.

This is a direct result of the compute squeeze.

When training costs become astronomical, only the wealthiest organizations can compete at the frontier.

This focus on state-of-the-art performance, while informative, can be a distraction.

For humanitarian action, the “best” model is not necessarily the one that tops a leaderboard, but the one that is affordable, adaptable, and deployable in low-resource settings.

The true implication for our sector is the emergence of a new “AI divide”.

This divide is not just about access but about capability.

We may face a future where Global North institutions may license “PhD-level” specialized AI agents at cost lower than their human counterparts, while practitioners in the Global South are left with rudimentary or geolocked tools.

This dynamic threatens to reinforce, rather than disrupt, existing knowledge power imbalances and risks a new era of “digital colonialism”, where the sector becomes entirely dependent on a few private companies for its most critical technology.

Opportunities in the State of AI: Breakthroughs in science and health

The most unambiguous good news in the 2025 report is the dramatic acceleration of AI in science and medicine.

AI is no longer just a research assistant; it is demonstrating expert-level accuracy in diagnostics and is actively designing novel therapeutics.

This is a profound opportunity for global health.

Where the report’s perspective is incomplete, however, is on the gap between this capability and its real-world application.

An AI can provide a brilliant medical insight, but it lacks the “contextual intelligence” of a local practitioner.

An AI model may not know that people in a specific district avoid the clinic on Tuesdays because it is market day – unless humans are working side-by-side with the model to share such qualitative and experiential data.

Read more: Why peer learning is critical to survive the Age of Artificial Intelligence

Therefore, the report’s findings on medical AI should not prompt us to simply buy new tools.

It should prompt us to invest in the human infrastructure—like structured peer learning networks —where health workers can collectively learn how to blend AI’s power with their deep understanding of local realities.

The State of AI report’s risks and our own

The 2025 report rightly identifies a shift in risk, moving from passive issues like model bias to active, malicious threats like accelerated cyber capabilities and new “bio-risks.”

These are critical concerns for the health and humanitarian sectors.

But the report misses the most immediate barrier to AI adoption in our field: our own organizational culture.

Many of our institutions operate within “highly punitive accountability systems”.

These systems, which tie performance evaluation directly to funding, create an environment where experimentation carries significant personal and institutional risk.

This leads to a “transparency paradox”.

Health workers and field staff are already experimenting with AI, but they are forced to hide their use.

If they disclose that a report was AI-assisted, they risk having their work subjected to “automatic devaluation,” regardless of its quality.

This punitive culture prevents open discussion and makes collective learning difficult.

State of AI: A strategic response to the squeeze

The 2025 State of AI Report confirms that we cannot compete in the compute squeeze.

Our strategy must therefore be one of smart adaptation and collective action.

For global health and humanitarian leaders, key takeaways include:

  1. Do not be distracted by the “SOTA” race. Our goal is not to have the highest-performing model, but the most applicable and equitable one.
  2. Invest in human networks, not just technology. The greatest gains will come from building the collaborative capacity of our workforce to use AI tools effectively in context.
  3. Fix our internal culture. We must create environments where staff can experiment with AI openly and safely, without fear of reprisal. We cannot adapt to this technology if we are punishing our innovators.
  4. Unite for collective power. The report’s theme of consolidation is a warning. As individual non-governmental organizations, we have no power to negotiate with hyperscalers. We must explore forming a “cooperative” to gain a “seat at the table” and co-shape an AI ecosystem that serves the public interest, not just corporate agendas.

These risks and opportunities are part and parcel of why The Geneva Learning Foundation is offering the AI4Health certificate programme. Learn more here: https://www.learning.foundation/ai.

References

Empower Learners for the Age of AI conference

The great unlearning: notes on the Empower Learners for the Age of AI conference

Reda SadkiArtificial intelligence

Artificial intelligence is forcing a reckoning not just in our schools, but in how we solve the world’s most complex problems. 

When ChatGPT exploded into public consciousness, the immediate fear that rippled through our institutions was singular: the corruption of process.

The specter of students, professionals, and even leaders outsourcing their intellectual labor to a machine seemed to threaten the very foundation of competence and accountability.

In response, a predictable arsenal was deployed: detection software, outright bans, and policies hastily drafted to contain the threat.

Three years later, a more profound and unsettling truth is emerging.

The Empowering Learners AI 2025 global conference (7-10 October 2025) was a fascinating location to observe how academics – albeit mostly white men from the Global North centers that concentrate resources for research – are navigating these troubled waters.

The impacts of AI in education matter because, as the OECD’s Stefan Vincent-Lancrin explained: “performance in education is the learning, whereas in many other businesses, the performance is performing the task that you’re supposed to do.” 

The problem is not that AI will do our work for us.

The problem is that in doing so, it may cause us to forget how to think.

This is not a distant, dystopian fear.

It is happening now.

A landmark study presented by Vincent-Lancrin delivered a startling verdict: students who used a generic, answer-providing chatbot to study for a math exam performed significantly worse than those who used no AI at all.

The tool, designed for efficiency, had become a shortcut around the very cognitive struggle that builds lasting knowledge.

Jason Lodge of the University of Queensland captured the paradox with a simple analogy.

“It’s like an e-bike,” he explained. “An e-bike will help you get to a destination… But if you’re using an e-bike to get fit, then getting the e-bike to do all the work is not going to get you fit. And ultimately our job… is to help our students be fit in their minds”.

This phenomenon, dubbed “cognitive offloading,” is creating what Professor Dragan Gasevic of Monash University calls an epidemic of “metacognitive laziness”.

Metacognition – the ability to think about our own thinking – is the engine of critical inquiry.

Yet, generative AI is masterfully engineered to disarm it.

By producing content that is articulate, confident, and authoritative, it exploits a fundamental human bias known as “processing fluency,” our tendency to be less critical of information that is presented cleanly. 

“Generative AI articulates content… that basically sounds really good, and that can potentially disarm us as the users of such content,” Gasevic warned.

The risk is not merely that a health worker will use AI to draft a report, but that they will trust its conclusions without the rigorous, critical validation that prevents catastrophic errors.

Empower Learners for the Age of AI: the human algorithm

If AI is taking over the work of assembling and synthesizing information, what, then, is left for us to learn and to do?

This question has triggered a profound re-evaluation of our priorities.

The consensus emerging is a radical shift away from what can be automated and toward what makes us uniquely human.

The urgency of this shift is not just philosophical.

It is economic.

Matt Sigelman, president of The Burning Glass Institute, presented sobering data showing that AI is already automating the routine tasks that constitute the first few rungs of a professional career ladder.

“The problem is that if AI overlaps with… those humble tasks… then employers tend to say, well, gee, why am I hiring people at the entry level?” Sigelman explained.

The result is a shrinking number of entry-level jobs, forcing us to cultivate judgment and adaptive skills from day one.

This new reality demands a focus on what machines cannot replicate.

For Pinar Demirdag, an artist and co-founder of the creative AI company Cuebric, this means a focus on the “5 Cs”: Creativity, Curiosity, Critical Thinking, Collective Care, and Consciousness.

She argues that true creativity remains an exclusively human domain. “I don’t believe any machine can ever be creative because it doesn’t lie in their nature,” she asserted.

She believes that AI is confined to recombining what is already in its data, while human creativity stems from presence and a capacity to break patterns.

This sentiment was echoed by Rob English, a creative director who sees AI not as a threat, but as a catalyst for a deeper humanity.

“It creates an opportunity for us to sort of have to amplify the things that make us more human,” he argued.

For English, the future of learning lies in transforming it from a transactional task into a “lifestyle,” a mode of being grounded in identity and personal meaning.

He believes that as the value of simply aggregating information diminishes, what becomes more valuable is our ability “to dissect… to interpret or to infer”.

In this new landscape, the purpose of learning – whether for a student or a seasoned professional – shifts from knowledge transmission to the cultivation of human-centric capabilities.

It is no longer enough to know things.

The premium is on judgment, contextual wisdom, ethical reasoning, and the ability to connect with others – skills forged through the very intellectual and social struggles that generic AI helps us avoid.

Empower Learners for the Age of AI: Collaborate or be colonized

While the pedagogical challenge is profound, the institutional one may be even greater.

For all the talk of disruptive change, the current state in many of our organizations is one of inertia, indecision, and a dangerous passivity.

As George Siemens lamented after investing several years in trying to move the needle at higher education institutions, leadership has been “too passive,” risking a repeat of the era when institutions outsourced online learning to corporations known as “OPMs” (online programme managers) that did not share their values: “I’m worried that we’re going to do the same thing with AI, that we’re just going to sit on our hands, leadership’s going to be too passive… and the end result is we’re going to be reliant down the road on handing off the visioning and the capabilities of AI to external partners.”

The presidents of two of the largest nonprofit universities in the United States, Dr. Mark Milliron of National University and Dr. Lisa Marsh Ryerson, president of Southern New Hampshire University, offered a candid diagnosis of the problem.

Ryerson set the stage: “We don’t see it as a tool. We see it as a true framework redesign for learning for the future.” 

However, before any institution can deploy sophisticated AI, it must first undertake the unglamorous, foundational work of fixing its own data infrastructure.

“A lot of universities aren’t willing to take two steps back before they take three steps forward on this,” Dr. Milliron stated. “They want to jump to the advanced AI… when they actually need to go back and really… get the basics done”.

This failure to fix the “plumbing” leaves organizations vulnerable, unable to build their own strategic capabilities.

Such a dynamic is creating what keynote speaker Howard Brodsky termed a new form of “digital colonialism,” where a handful of powerful tech companies dictate the future of critical public goods like health and education.

His proposed solution is for institutions to form a cooperative, a model that has proven successful for over a billion people globally.

“I don’t believe at the current that universities have a seat at the table,” Brodsky argued. “And the only way you get a seat at the table is scale. And it’s to have a large voice”.

A cooperative would give organizations the collective power to negotiate with tech giants and co-shape an AI ecosystem that serves public interest, not just commercial agendas.

Without such collective action, the fear is that our health systems and educational institutions will become mere consumers of technologies designed without their input, ceding their agency and their future to Silicon Valley.

The choice is stark: either become intentional builders of our own solutions, or become passive subjects of a transformation orchestrated by others.

The engine of equity

Amid these profound challenges, a powerfully optimistic vision for AI’s role is also taking shape.

If harnessed intentionally, AI could become one of the greatest engines for equity in our history.

The key lies in recognizing the invisible advantages that have long propped up success.

As Dr. Mark Milliron explained in a moment of striking clarity: “I actually think AI has the potential to level the playing field… second, third, fourth generation higher ed students have always had AI. They were extended families… who came in and helped them navigate higher education because they had a knowing about it.”

For generations, those from privileged backgrounds have had access to a human support network that functions as a sophisticated guidance system.

First-generation students and professionals in under-resourced settings are often left to fend for themselves.

AI offers the possibility of democratizing that support system.

A personalized AI companion can serve as that navigational guide for everyone, answering logistical questions, reducing administrative friction, and connecting them with the right human support at the right time.

This is not about replacing human mentors.

It is about ensuring that every learner and every practitioner has the foundational scaffolding needed to thrive.

As Dr. Lisa Marsh Ryerson put it, the goal is to use AI to “serve more learners, more equitably, with equitable outcomes, and more humanely”.

This vision recasts AI not as a threat to be managed, but as a moral imperative to be embraced.

It suggests that the technology’s most profound impact may not be in how it changes our interaction with knowledge, but in how it changes our access to opportunity.

Technology as culture

The debates from the conference make one thing clear.

The AI revolution is not, at its core, a technological event.

Read the article: Why learning technologists are obsolete

It is a pedagogical, ethical, and institutional one.

It forces us to ask what we believe the purpose of learning is, what skills are foundational to a flourishing human life, and what kind of world we want to build.

The technology will not provide the answers.

It will only amplify the choices we make.

As we stand at this inflection point, the most critical task is not to integrate AI, but to become more intentional about our own humanity.

The future of our collective ability to solve the world’s most pressing challenges depends on it.

Do you work in health?

As AI capabilities advance rapidly, health leaders need to prepare, learn, and adapt. The Geneva Learning Foundation’s new AI4Health Framework equips you to harness AI’s potential while protecting what matters most—human experience, local leadership, and health equity. Learn more: https://www.learning.foundation/ai.

References

Image: The Geneva Learning Foundation Collection © 2025

Pour retrouver les enfants congolais non vaccinés, il est question des fumoirs à poisson et du dialogue inter-religieux

Reda SadkiGlobal health

Au deuxième jour de leurs travaux en direct, les professionnels de la santé congolais sont passés de la découverte à l’exploration des causes profondes qui laissent des centaines de milliers d’enfants exposés aux maladies évitables par la vaccination. Ils découvrent que les racines du problème sont souvent là où personne ne les attend: dans l’économie de la pêche, le dialogue avec les églises ou la gestion des camps de déplacés.

Lire également: En République démocratique du Congo, la traque des enfants « zéro dose » passe par l’intelligence collective des acteurs de la santé

Les analyses, plus fines, révèlent des leviers d’action insoupçonnés, démontrant la puissance d’une méthode qui transforme les soignants en stratèges.

« La séance d’hier, c’était une séance de découverte, mais aujourd’hui, c’était une séance d’exploration. Explorer, c’est aller en profondeur. Il faut sonder ».

Ces mots de Fidèle Tshibanda Mulangu, un participant congolais, résument la bascule qui s’est opérée ce mercredi 8 octobre.

Après une première journée consacrée au partage des défis, la dynamique a changé.

L’objectif n’était plus seulement d’identifier les problèmes, mais de les disséquer avec une précision accrue.

Dans le cadre de l’initiative menée par La Fondation Apprendre Genève et ses partenaires — le ministère de la Santé de la RDC, l’UNICEF et Gavi — les participants ont été invités à appliquer une deuxième fois la méthode d’analyse des causes profondes.

L’effet a été immédiat.

« La séance d’hier m’a permis de comprendre que ce que je pensais être une cause profonde n’était qu’une cause intermédiaire », a ainsi partagé Hermione Raissa Tientcheu Ngounou, illustrant la sophistication croissante des analyses.

Le dialogue rompu entre la foi et la santé publique

Au cœur du Kasaï, un groupe de travail a de nouveau abordé la question des églises de réveil hostiles à la vaccination.

Mais cette fois, l’analyse a dépassé le constat d’un obstacle religieux. « Les fidèles, lorsqu’ils tombent malades, ne vont pas dans les structures sanitaires, mais ils préfèrent rester dans des centres de prière », a expliqué le rapporteur du groupe, décrivant une rupture de confiance avec le système de santé formel.

En poussant la réflexion, les participants ont conclu que le vrai problème était « l’absence d’un cadre de concertation formel entre le système de santé et les confessions religieuses ».

La cause profonde n’était donc pas la foi, mais une faillite institutionnelle.

Une prise de conscience qui a immédiatement fait émerger des solutions.

« Dans le contexte des églises de réveil, les leaders de ces églises doivent être nos alliés », a insisté un participant, Mwamialumba Fidel.

Vacciner dans le chaos de la guerre

Dans le Nord-Kivu, une autre discussion a porté sur la vaccination des populations déplacées.

Confrontés à une cause première comme la guerre, hors de leur portée, les soignants ont fait preuve d’un pragmatisme remarquable.

L’analyse ne s’est pas enlisée dans un sentiment d’impuissance.

Le groupe a rapidement identifié une faille concrète dans le système.

« Pour les déplacés, le grand problème est que les enfants arrivent sans carnet de vaccination, et on ne sait pas comment les intégrer dans le PEV de routine », a partagé Clémence Mitongo.

La cause racine n’était donc plus le conflit, mais « le manque de stratégie spécifique pour la prise en charge de ces enfants » une fois en sécurité.

Le groupe a ainsi transformé un problème insoluble en un défi organisationnel sur lequel il est possible d’agir.

Au-delà des frontières, une leçon d’économie locale

La richesse des échanges a été amplifiée par la participation de professionnels d’autres pays.

Un des cas les plus édifiants est venu de Madagascar, où 93 enfants d’un village de pêcheurs n’étaient pas vaccinés.

« Les femmes sont obligées d’accompagner les hommes pour la vente du poisson. Et quand elles reviennent, nos équipes sont déjà parties », a expliqué le rapporteur du groupe.

La cause profonde, révélée par l’analyse, n’avait rien de sanitaire.

C’était l’absence d’un fumoir pour conserver le poisson, qui forçait les femmes à s’absenter.

L’impact de cet exemple a été puissant.

« Ce cas du Madagascar est très édifiant et illustre parfaitement la pertinence de l’analyse approfondie », a commenté Alphonse Kitoga.

Une pédagogie de l’action

Ces cas pratiques illustrent la maturation rapide des participants.

La méthode des « cinq pourquoi », introduite la veille, est devenue un outil maîtrisé, un réflexe analytique.

« C’est une nouvelle approche pour nous », a affirmé Baudouin Mbase Bonganga. « Le fait de travailler en groupe, de partager les expériences, ça nous a vraiment enrichis ».

L’exercice ne vise pas à transmettre un savoir, mais à cultiver une compétence: la capacité de chaque professionnel à devenir un fin diagnosticien des problèmes de sa communauté et un architecte de solutions adaptées.

De l’analyse à l’action

Cette journée d’exploration intensive n’est qu’une étape.

Les participants ont jusqu’au vendredi 10 octobre pour soumettre la première version de leur projet de terrain, où ils appliqueront ces analyses à leurs propres communautés.

L’initiative démontre qu’en s’appropriant les bons outils, les acteurs de terrain peuvent rapidement monter en puissance.

Comme l’a brillamment résumé Papa Gorgui Samba Ndiaye: « Cette méthode permet de contextualiser réellement les problèmes, et ce qui est bien, c’est qu’on sort des solutions toutes faites… Ça nous amène à innover ».

Le mouvement est en marche, et il est porté par ceux qui, chaque jour, sont en première ligne.

Image: Peer learning exercise, as seen from The Geneva Learning Foundation’s livestreaming studio.

En République démocratique du Congo, la traque des enfants « zéro dose » passe par l’intelligence collective des acteurs de la santé

En République démocratique du Congo, la traque des enfants « zéro dose » passe par l’intelligence collective des acteurs de la santé

Reda SadkiGlobal health

KINSHASA et LUMUMBASHI, le 7 octobre 2025 (La Fondation Apprendre Genève) – « Ces jeunes filles qui ont des grossesses indésirables, quand elles mettent au monde, elles ont tendance à laisser les enfants livrés à eux-mêmes », explique Marguerite Bosita, coordonnatrice d’une organisation non gouvernementale à Kinshasa.

« Ce manque d’informations sur les questions liées à la vaccination se pose encore plus, car ces enfants grandissent exposés à des difficultés de santé ».

Sa voix, émanant d’une mission de terrain dans la province du Kongo Central, s’est jointe à des centaines d’autres ce 7 octobre 2025.

Il s’agissait de la deuxième journée d’un exercice d’apprentissage par les pairs de 16 jours visant à identifier et à atteindre les enfants dits « zéro dose » en République démocratique du Congo (RDC).

Ce sont ces centaines de milliers de nourrissons qui n’ont reçu aucun vaccin pour les protéger de nombreuses maladies.

Pour les 1 617 professionnels de la santé inscrits à cet exercice, il ne s’agissait pas d’un webinaire de formation classique, mais d’une étape importante d’un mouvement bien plus large.

Organisé par La Fondation Apprendre Genève, cet exercice est une pierre angulaire du Mouvement congolais pour la vaccination à l’horizon 2030 (IA2030).

Il bénéficie du soutien du ministère de la Santé de la RDC à travers son Programme élargi de vaccination (PEV), de l’UNICEF et de Gavi, l’Alliance du Vaccin.

L’initiative renverse le modèle traditionnel de l’aide internationale.

Au lieu de s’appuyer sur des experts extérieurs, elle part d’un postulat aussi simple qu’il est conséquent.

La meilleure expertise pour résoudre les défis de première ligne se trouve chez les travailleurs de la santé eux-mêmes.

La composition de cette cohorte témoigne de la profondeur de l’initiative.

Plus de la moitié des participants proviennent des niveaux périphériques et infranationaux du système de santé, là où la vaccination a lieu.

Un professionnel sur cinq travaille au niveau central, assurant un lien essentiel entre les politiques nationales et les réalités du terrain.

Le profil des participants est tout aussi varié.

Un tiers sont des médecins, 30 % des agents de santé publique, suivis par les agents de santé communautaire (13 %) et les infirmiers (9 %).

Fait marquant, près de la moitié d’entre eux travaillent directement pour le ministère de la Santé à travers le Programme élargi de vaccination (le «PEV»).

Cette forte proportion de personnel gouvernemental, complétée par une représentation significative de la société civile et du secteur privé, ancre fermement l’initiative dans une appropriation nationale.

Le regard du terrain

« Les défis sont tellement grandioses », a déclaré Franck Kabongo, consultant en santé publique à Lubumbashi, dans la province du Haut-Katanga.

En effet, les défis décrits par les participants sont immenses.

Il a souligné deux obstacles majeurs.

D’une part, la difficulté d’atteindre les enfants dans les communautés reculées.

Car les problèmes logistiques représentent un « casse-tête» pour de nombreux acteurs de santé impliqué dans la vaccination.

Pour Mme Bosita à Kinshasa, le problème est profondément social.

Son organisation soutient les enfants vulnérables, y compris les orphelins et ceux qui vivent dans la rue, dont beaucoup sont nés de jeunes mères sans suivi médical.

« Il n’y a pas assez de sensibilisation sur le terrain par rapport à cette notion », a-t-elle déploré, expliquant sa volonté d’intégrer la vaccination dans le travail de son association.

Ces témoignages, partagés dès les premières minutes, ont brossé un tableau saisissant d’un corps de métier dévoué.

Ils luttent contre un enchevêtrement complexe de barrières logistiques, sociales et informationnelles qui laissent les enfants les plus vulnérables sans protection.

À la recherche des causes profondes

Le cœur de l’exercice n’est pas seulement de partager les problèmes, mais de les disséquer.

Grâce à une analyse de groupe structurée, les participants s’exercent à la technique des « cinq pourquoi ».

Cette méthode vise à dépasser les symptômes pour trouver la véritable cause fondamentale d’un problème.

Lors d’une session plénière, Charles Bawande, animateur communautaire dans la zone de santé de Kalamu à Kinshasa, a présenté un dilemme courant.

Une forte concentration d’enfants zéro dose parmi les communautés de rue, très mobiles et souvent peu scolarisées.

Au départ, le problème semblait être un simple manque d’information.

Mais au fur et à mesure que le groupe a creusé, une réalité plus complexe est apparue.

Pourquoi les enfants sont-ils manqués?

Parce que les travailleurs de santé communautaires, les relais communautaires, ne disposent pas des informations nécessaires.

Pourquoi n’ont-ils pas ces informations?

Parce qu’ils n’assistent souvent pas aux séances d’information essentielles.

Pourquoi n’y assistent-ils pas?

Parce qu’ils sont occupés par d’autres activités.

« Ils doivent vivre, ils doivent manger… ils sont locataires, ils doivent payer le loyer », a expliqué M. Bawande.

La dernière question a révélé le cœur du problème.

Pourquoi sont-ils occupés par d’autres choses?

Parce que leur travail de relais communautaire est entièrement bénévole.

Alors qu’on attend d’eux qu’ils agissent comme des volontaires, beaucoup sont des parents et des chefs de famille qui doivent donner la priorité à leur gagne-pain.

Un problème qui semblait être un simple déficit d’information s’est révélé être ancré dans la précarité économique du système de santé bénévole.

Une mosaïque de défis partagés

Lorsque les participants se sont répartis en près de 80 petits groupes, leurs discussions ont révélé un large éventail d’obstacles, chacun profondément lié au contexte local.

Les rapports des groupes ont dressé une carte riche et détaillée des freins à la vaccination à travers le vaste pays.

Près de Goma, dans le Nord-Kivu, le groupe de Clémence Mitongo a identifié l’insécurité due à la guerre comme une barrière principale qui a déplacé les populations et perturbé les services de santé.

Dans la province du Kasaï, le groupe de Yondo Kabonga a mis en lumière l’impact des rumeurs, de la désinformation et des barrières géographiques comme les ravins et les rivières.

Ailleurs, d’autres groupes ont fait état de la résistance issue de convictions religieuses, certaines églises enseignant à leurs fidèles que la foi seule suffit à protéger leurs enfants.

Un autre groupe a discuté du cas des réfugiés revenus d’Angola, où l’ignorance des parents concernant le calendrier vaccinal constitue un obstacle majeur.

Ce diagnostic collectif a démontré la puissance du modèle d’apprentissage par les pairs.

Aucun expert ne pourrait à lui seul posséder une compréhension aussi fine et étendue des défis à l’échelle nationale.

Une nouvelle façon d’apprendre

Cet exercice est fondamentalement différent des programmes de formation traditionnels.

Il s’agit d’un parcours pratique où les participants deviennent des créateurs de connaissances et leaders des actions qui en découlent.

Au cours du programme, chaque participant développera son propre projet de terrain, qu’il partagera avec son équipe, son centre de santé ou son district.

Il s’agit d’un plan concret pour s’attaquer à un défi « zéro dose » dans sa propre communauté.

Après avoir soumis une version préliminaire d’ici le vendredi 10 octobre, ils entreront dans une phase d’évaluation par les pairs.

Chaque participant recevra les retours de trois collègues et, en retour, en fournira à trois autres, contribuant ainsi à renforcer le travail de chacun par l’intelligence collective.

Tracer une voie à suivre

L’étape suivante pour ces milliers de professionnels de la santé est de consolider leurs discussions de groupe et de poursuivre le travail sur leurs projets individuels avant l’échéance de vendredi.

Le parcours se poursuivra avec des phases consacrées à l’évaluation par les pairs, à la révision des projets et, enfin, à une assemblée générale de clôture pour partager les plans améliorés.

Cet exercice intensif est plus qu’un simple événement.

Il est un catalyseur pour le Mouvement congolais pour la vaccination à l’horizon 2030.

L’objectif est de traduire la stratégie mondiale du Programme pour la vaccination à l’horizon 2030 en actions tangibles, menées localement, qui produisent un impact réel.

La solution, comme le suggère ce mouvement, ne se trouve pas dans des lignes directrices venues de Genève, mais dans la sagesse, la créativité et l’engagement combinés de milliers de praticiens congolais, travaillant ensemble à travers tout le pays.

Illustration: The Geneva Learning Foundation Collection © 2025

Colonization, climate change, and indigenous health from Algiers to Acre

Colonization, climate change, and indigenous health: from Algiers to Acre

Reda SadkiGlobal health

I sat in a conference hall in Rio Branco, Acre State, Brazil.

My mind was in a sanatorium of Algiers, Algeria.

This was where my mother was sent as a girl.

They told her she got tuberculosis because she was an “indigène musulman”.

In 1938, the year of my mother’s birth and after over a century of colonization, about 5 out of every 100 Algerian people got infected with tuberculosis each year.

French colonial reports show that Algerians died from tuberculosis at much higher rates than French settlers.

They claimed the disease was endemic due to the supposed inferiority of our people.

And that she was going to die.

Colonialism is a liar.

She survived.

And it took less than eight years for an independent Algeria, free of the scourge of colonialism, to eradicate the scourge of TB.

Listening to the leaders at Brazil’s First National Seminar on Indigenous Health and Climate Change, I heard that same lie being dismantled.

The body of the territory, the body of the people

I listened.

I heard a diagnosis specific to their lands and histories, and recognized a familiar pattern.

The territory is a living body, they said.

When it is sick, we are sick.

Ceiça Pitaguary is an indigenous leader and activist from the Pitaguary people in Brazil.

The crisis, she explained, is a daily reality of “prolonged droughts, devastating floods, intense storms, and the rise in temperatures” that represents “real losses experienced in the body and on the territory”.

This is a wound with many layers.

There are the physical symptoms an epidemiologist would recognize: respiratory illnesses from fire and waterborne diseases from floods.

But the deeper sickness that speakers diagnosed, one after another, is a systemic decay.

I listened as Wallace Apurinã stated that when the floods come, “traditional medicine, which is such an important and fundamental knowledge for our subsistence… this ends”.

It is a crisis that creates what Elisa Pankararu named a “collective sadness”.

“Our people are sad,” she said, because the world is in imbalance.

This is a spiritual wound, like the one Juliana Tupinikim described.

She said the Krenak people lost not just a river to a mining disaster, but “fundamental elements of their spirituality and cultural identity”.

The crisis, Gemina Shanenawá insisted, is not abstract.

“It has a face, a name, and a territory: the face of Indigenous women”.

She gave voice to their struggle: “‘I lost everything, I lost my house, I lost my pigs, my chickens. And now? What am I going to do?’”.

The architecture of failure

There is a pathogen worse than fossil fuel.

It is colonialism.

I recognized its stench in the testimony of the leaders.

It is a system designed to fail its most vulnerable.

Weibe Tapeba, Brazil’s Secretary of Indigenous Health, described the paralysis.

“Today, our Indigenous territories are not understood as federal units,” he said.

This means that they are unable to issue crucial decrees themselves, which severely hinders their ability to prepare for, respond to, and recover from increasingly frequent catastrophic events.

“We do not have the autonomy to issue such a decree ourselves”.

This intentional powerlessness leaves communities exposed.

It creates the chain reaction that researcher Renata Gracie detailed in the Yanomami territory, where illegal mining leads directly to “an enormous increment in the occurrence of malaria, trachoma, measles, tuberculosis, malnutrition”.

The state’s response—culturally inappropriate food baskets were one example I heard—is changing.

It was impressive to see how government, with leadership from Tapeba and others, engages in meaningful, open dialogue by and for indigenous communities.

What you call anecdote, we call ancestral science

An invisible but profound violence of colonization is the dismissal of a people’s way of knowing.

Your science is ’data’.

Ours is ’folklore’.

The entire seminar was a rebellion against this lie.

In my own talk, I spoke about how health workers’ expertise – what they know because they are there every day – is often devalued as mere “anecdote”.

Putira Sacuena provided the most powerful rebuttal.

She spoke of a small frog in the Xingu territory.

“We stopped hearing its sound in the territory”, she explained.

The frog’s silence predicted the rise in respiratory illness and diarrhea.

She said: this is ancestral science.

It is a signal from a highly sophisticated, multi-generational system of environmental monitoring.

Our existing systems do not just miss this data.

They are structurally incapable of recognizing it as data in the first place.

The challenge, then, is to begin the work of unlearning the colonial biases that prevent us from seeing the knowledge that is right in front of us.

It requires us to abandon the “high, hard ground” of our self-referential expertise.

The fight for health here is, more than we realized, a fight for cognitive justice, a demand that such knowledge be seen not as a cultural artifact, but as essential data.

As Ceiça Pitaguary declared, “The fight against the climate crisis will not be won without Indigenous peoples”.

That is not a political slogan.

It is a vital, scientific truth of our time.

It demands that we, in our institutions and our fields of practice, dismantle the systems that are causing this devastation.

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Image: The Geneva Learning Foundation Collection © 2025