Learn health, but beware of the behaviorist trap

Reda SadkiGlobal health, Theory

The global health community has long grappled with the challenge of providing effective, scalable training to health workers, particularly in resource-constrained settings.

In recent years, digital learning platforms have emerged as a potential solution, promising to deliver accessible, engaging, and impactful training at scale.

Imagine a digital platform intended to train health workers at scale.

Their theory of change rests on a few key assumptions:

  1. Offering simplified, mobile-friendly courses will make training more accessible to health workers.
  2. Incorporating videos and case studies will keep learners engaged.
  3. Quizzes and knowledge checks will ensure learning happens.
  4. Certificates, continuing education credits, and small incentives will motivate course completion.
  5. Growing the user base through marketing and partnerships is the path to impact.

On the surface, this seems sensible.

Mobile optimization recognizes health workers’ technological realities.

Multimedia content seems more engaging than pure text.

Assessments appear to verify learning.

Incentives promise to drive uptake.

Scale feels synonymous with success.

While well-intentioned, such a platform risks falling into the trap of a behaviorist learning agenda.

This is an approach that, despite its prevalence, is a pedagogical dead-end with limited potential for driving meaningful, sustained improvements in health worker performance and health outcomes.

It is a paradigm that views learners as passive recipients of information, where exposure equals knowledge acquisition.

It is a model that privileges standardization over personalization, content consumption over knowledge creation, and extrinsic rewards over intrinsic motivation.

It fails to account for the rich diversity of prior experiences, contexts, and challenges that health workers bring to their learning.

Most critically, it neglects the higher-order skills – the critical thinking, the adaptive expertise, the self-directed learning capacity – that are most predictive of real-world performance.

Clicking through screens of information about neonatal care, for example, is not the same as developing the situational judgment to adapt guidelines to a complex clinical scenario, nor the reflective practice to continuously improve.

Moreover, the metrics typically prioritized by behaviorist platforms – user registrations, course completions, assessment scores – are often vanity metrics.

They create an illusion of progress while obscuring the metrics that truly matter: behavior change, performance improvement, and health outcomes.

A health worker may complete a generic course on neonatal care, for example, but this does not necessarily translate into the situational judgment to adapt guidelines to complex clinical scenarios, nor the reflective practice to continuously improve.

The behaviorist paradigm’s emphasis on information transmission and standardized content may stem from an implicit assumption that health workers at the community level do not require higher-order critical thinking skills – that they simply need a predetermined set of knowledge and procedures.

This view is not only paternalistic and insulting, but it is also fundamentally misguided.

A robust body of scientific evidence on learning culture and performance demonstrates that the most effective organizations are those that foster continuous learning, critical reflection, and adaptive problem-solving at all levels.

Health workers at the frontlines face complex, unpredictable challenges that demand situational judgment, creative thinking, and the ability to learn from experience.

Failing to cultivate these capacities not only underestimates the potential of these health workers, but it also constrains the performance and resilience of health systems as a whole.

Even if such a platform achieves its growth targets, it is unlikely to realize its impact goals.

Health workers may dutifully click through courses, but genuine transformative learning remains elusive.

The alternative lies in a learning agenda grounded in advances of the last three decades learning science.

These advances remain largely unknown or ignored in global health.

This approach positions health workers as active, knowledgeable agents, rich in experience and expertise.

It designs learning experiences not merely to transmit information, but to foster critical reflection, dialogue, and problem-solving.

It replaces generic content with authentic, context-specific challenges, and isolated study with collaborative sense-making in peer networks.

It recognizes intrinsic motivation – the desire to grow, to serve, to make a difference – as the most potent driver of learning.

Here, success is measured not in superficial metrics, but in meaningful outcomes: capacity to lead change in facilities and communities that leads to tangible improvements in the quality of care.

Global health leaders faces a choice: to settle for the illusion of progress, or to invest in the deep, difficult work of authentic learning and systemic change, commensurate with the complexity and urgency of the task at hand.

Image: The Geneva Learning Foundation Collection © 2024