Ancient Mayan port city of Tulum, Yucatán Peninsula. Personal collection.

Community health into the scalable, networked future of learning

Reda SadkiWriting

Preface to the IFRC Global Health Team’s Training Guidelines (2013) by Reda Sadki

“At the heart of a strong National Society” explains Strategy 2020, “is its nationwide network of locally organized branches or units with members and volunteers who have agreed to abide by the Fundamental Principles and the statutes of their National Society.” To achieve this aim, National Societies share a deeply-rooted culture of face-to-face (FTF) learning through training. This local, community-based Red Cross Red Crescent culture of learning is profoundly social: by attending a “training” at their local branch, a newcomer meets other like-minded people who share their thirst for learning to make a better future. It is also peer education: trainers and other educators are often volunteers themselves, living in the same communities as their trainees.

Although some National Societies have been early adopters of educational technology to deliver distance learning since the early 1990s – and IFRC’s Learning network has scaled up global educational opportunities since 2009 –, such initiatives do not appear to have changed the local, community-based, face-to-face training processes that start in the branch-as-classroom.

Quality in the history of Red Cross Red Crescent learning, education and training (LET) has been based on this combination of practical knowledge you can use, building social ties through face-to-face contact, and leveraging the power of peer education to learn by doing. No other humanitarian organization has ‘brick-and-mortar’ structures on a massive scale to embed public health education in each and every community.

The global volume of health training delivered by the Red Cross Red Crescent is indeed massive. For example, every year, 17 million trainees learn first aid skills face-to-face programs run by National Societies. These trainees then use their first aid skills to provide assistance to 46 million people.

In 2011, IFRC’s research into the social and economic value of its more than 13 million global volunteer workforce concluded that, while many volunteers work across multiple fields, the most volunteers – and the greatest proportion of value – are related to health promotion (IFRC 2011:7). Although the Red Cross and Red Crescent is “known mostly for its role in disasters”, this study highlighted that “the area in which most volunteers are engaged is health.” (IFRC 2011:8)

The social value of the health services delivered by Red Cross Red Crescent volunteers is particularly poignant in the context of a global, critical health workforce shortage. However, the recognition of our unique volunteer workforce is premised on our continued ability to ensure that they continually improve skills, knowledge and competencies to contribute to strengthening health systems.

In 2012, IFRC’s secretariat spent 18,485,821 CHF on a budget line titled “workshops and training”, roughly equivalent to 360,000 hours of in-person training – nearly a thousand hours per day. Every subject matter expert in IFRC’s Global Health Team includes the delivery of face-to-face training in his or her work plan, and many also develop training materials in the form of printed manuals or, more recently, online courses for IFRC’s Learning platform.

With the publication of these guidelines, the Global Health Team aims to recognize the significance of the pedagogical dimension of these training activities as the key determinant of quality in training. Indeed, it is only with a clear framework for how we teach and how we learn that we may know how to measure the learning outcomes, impact and effectiveness of such activities.

These Guidelines for face-to-face training provide detailed instructions first in how to assess learning needs to determine whether these can be addressed by face-to-face training. Only once this is established should training be developed using a rigorous methodology based on available evidence of how adult volunteers learn in Red Cross Red Crescent contexts. Last but not least, training activities should be evaluated not only with respect to improved knowledge and skills, but also improved performance for both the individual and the organization.

By adopting an approach based on needs analysis, these guidelines also highlight the potential for innovative approaches to training that leverage the amazing economy of effort achieved by appropriate use of educational technology and broadened approaches that synergize learning and education with training. A paradigm change is needed for training if it is to remain relevant to delivery science, primarily because of the changing nature of knowledge in an increasingly volatile, uncertain, complex and ambiguous world.

In 1986, according to research by Robert Kelly of Carnegie-Mellon University, 75% of the knowledge needed to do your job was stored in your brain. By 2006, Kelly’s research found that this percentage had dropped to 10%. 90% of the knowledge we use depends on our connections with others. This is in part why, more than ever before, most of what people do in their jobs is currently acquired through experience, regardless of the amount of formal training received. If learning is less and less about recalling information, what then should training focus on?

This dilemma is compounded by the diminishing half-life of knowledge. As learning theorist George Siemens explains, “courses are fairly static, container-views of knowledge. Knowledge is dynamic—changing hourly, daily. [This] requires an understanding of the nature of the half-life of knowledge in [a field, to select] the right tools to keep content current for the learners.” (Siemens 2006:55). How do we train when knowledge flows too fast for processing or interpreting?

If improving performance of health workers in a rapidly-changing world rested solely on more structured, better-designed curricula, this would primarily reveal the underlying assumption or notion that the world has not really changed. Attempting to do more of what has been done in the past is not the answer. We need to do new things in new ways.

As acknowledged in IFRC’s Framework for building strong National Societies (2011), “in a world of changing needs, expectations and opportunities, our knowledge, skills, and competences must keep up to date to meet new demands. We need to address familiar problems by being more proficient in applying what works as well as by using the innovations and insights from new research and technologies that have the potential to bring better results.”

Traditional approaches are unlikely to be scalable. With 13.6 million Red Cross Red Crescent volunteers, no classroom is large enough. No individual is smart enough to tame the knowledge flows, no intervention is complete enough, no training program lasts long enough, and no solution is global enough.

The skills and processes that will make us health workers of tomorrow are not yet embedded in our educational structures. We do know, however, much of what is needed: The capacity to know more is more critical than what is currently known. The ability to see connections between fields, ideas, and concepts is a core skill.

These guidelines recognize the value of existing local knowledge, practices and understanding, and that incorporating them into the learning experience is a key challenge. Our local branches form a vast, global network of brick-and-mortar structures which can be used to anchor public health activities, but they currently reside at the bottom of each National Society’s top-down vertical pyramid. They are rarely linked to each other.

Strategy 2020 calls for IFRC to “draw inspiration from our shared history and tradition” while committing to finding creative, sustainable solutions to a changing world. Meeting the challenge in the future – to reinvent Red Cross Red Crescent health education in order to strengthen National Societies – may well depend on connecting branches to each other to extend our learning culture’s social, peer-based learning to form a vast, global knowledge community. In the 21st Century, such connections may no longer be a ‘nice-to-have’, and may well prove indispensable for anyone working for change at the community level, most obviously on global public health issues with local impact and consequences.

Branches connected to each other could support new forms of community-based public health practice in which local volunteers are linked to international delegates and public health and medical expertise in fluid, real-time, two-way knowledge conversations. Such networks will open new possibilities for a new learning system where community and global health workers create together, giving each other feedback (and even feedback on feedback), sharing their inspirations and discoveries. Within their knowledge communities, they will work at their own pace, according to their own interests and capabilities. They will use digital storytelling to explore and implement solutions, embracing complexity and adapting to volatility and uncertainty in ways that rapid health assessments, operational plans, and other current tools simply cannot. We will be lifelong learners, teaching each other practical skills and refining not only the methods but also the conduits for teaching and learning through constant practice.

These collaborative, flexible, motivating, participatory and supportive approaches are neither wishful thinking nor simply a nicer, kinder and gentler form of learning. Their pedagogical patterns closely emulate core competencies of twenty-first century humanitarian workers, who are expected to be able to manage complex crisscrossing knowledge flows, to work in networked configurations (rather than command-and-control structures), and to use participatory methodologies to partner with beneficiaries.

By asking questions about why we do training, by exploring why and how training can improve performance, these Guidelines represent a milestone on the road to the reinvention of the Red Cross Red Crescent delivery science that underpins how we service the health needs of vulnerable people.

Preface to the IFRC Global Health Team’s Training Guidelines (2013) by Reda Sadki

Image: Ancient Mayan port city of Tulum, Yucatán Peninsula. Personal collection.