“If health workers do not share their challenges and solutions, we are bound to fail.” This declaration from a participant in the Teach to Reach initiative facilitated by The Geneva Learning Foundation (TGLF) cuts to the heart of a crisis that has long plagued global health technical assistance: the persistent gap between what external experts provide and what practitioners actually need.
At the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), TGLF’s Reda Sadki presented evidence of a quiet revolution taking place in how global health organizations approach capacity building and technical assistance. His research and practice demonstrate that digitally-enabled peer learning can overcome fundamental limitations that have constrained traditional models for decades. The implications challenge not just how we train health workers, but the entire infrastructure of expert-driven technical assistance that dominates global health.
Why we resist learning from screens
To understand why this revolution has been so long in coming, Sadki traced our resistance to digital learning back to philosophical roots that run deeper than most global health practitioners realize. The skepticism, he argued, stems from a fundamental assumption about how real learning occurs — an assumption that shapes everything from how we design training programs to how we structure technical assistance.
“Plato initiated our traditional negative view of the written word,” Sadki explained, describing how the ancient philosopher believed that writing “detaches the message from its author and transforms it into a dead thing, a text.” For Plato, authentic learning required direct interaction between teacher and student. Anything mediated — whether by writing or, by extension, digital technology — was considered a pale imitation of real knowledge transfer.
This ancient skepticism persists in modern global health, where the dominant assumption is that learning means recalling information and teaching means transmitting that information through direct instruction. Face-to-face workshops and expert-led training sessions are considered “real” technical assistance, while digital alternatives are viewed as convenient but inferior substitutes.
“It is a false dichotomy to distinguish between, to oppose our lived reality to the digital one,” Sadki argued. “The digital one is lived also. It is also reality.” Yet this dichotomy continues to shape technical assistance models that prioritize flying experts around the world to deliver content in person, even when evidence suggests digital approaches may be more effective.
Indeed, the evidence is striking. Two major meta-analyses comparing learning modalities found that “distance learning results have been consistently better” than traditional face-to-face approaches, “and that has been the case since 1991.” Yet global health technical assistance remains largely wedded to what Bill Cope and Mary Kalantzis call a “didactic learning architecture” — the familiar setup where external experts deliver content to passive recipients arranged “in rows, they do not speak to each other, the teacher sits at the front.”
When information transmission fails
The inadequacy of information transmission models becomes clear when considering the nature of challenges that health workers actually face. Most global health training assumes that the problem is a lack of information — that if practitioners simply knew more facts or protocols, they would perform better. This assumption drives technical assistance focused on delivering standardized content through lectures, presentations, and workshops.
But research in learning science reveals a more complex reality. “When knowledge is a river, not a reservoir, process, not a product,” expert-led information transmission breaks down, Sadki observed. Modern knowledge workers have “around 10 percent” of the knowledge they need “right there in your brain,” with “90 percent of what you need to know going to come from other humans, or increasingly from machines.”
This insight challenges the foundation of traditional technical assistance. If practitioners need to access knowledge through connections rather than storage, then the goal should not be filling their heads with information but connecting them to networks where knowledge flows. Yet most capacity building programs continue to focus on what Sadki called “content-driven learning” rather than connection-driven learning.
The shift required is profound. Rather than positioning external experts as the primary source of knowledge, effective technical assistance must create what Connell Foley described as “a fundamental shift from being an expert who provides answers, to being a facilitator who, through critical thought, can develop questions that prompt others to analyze and develop strategies to address their own needs.”
Digital technologies as technical assistance disruptors
The breakthrough comes when digital technologies “enable you to defy distance and boundaries in order to connect with others and learn from them.” This represents more than technological innovation — it challenges the basic economics and power structures of traditional technical assistance.
Consider the conventional model: international organizations identify capacity gaps, hire external experts, and deploy them to deliver training. This approach assumes that valid knowledge flows primarily from international experts to local practitioners. It requires significant funding for travel, venues, and expert fees, limiting both reach and frequency of interaction.
Digitally-enabled peer learning turns this model on its head. “Peer learning has always been there,” Sadki noted. “Learning from others, learning from people who are like yourself has always been important, but it has been limited to those within your physical space.” Digital technologies remove that spatial limitation, enabling practitioners facing similar challenges across different contexts to learn directly from each other.
Cristina Guerrero, an emergency health doctor who leads a helicopter rescue team in Cadiz, Spain, experienced this transformation through the foundation’s #Ambulance! programme with the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC). “I thought I already knew how to face violence,” she reflected. “Then I heard how they do things in other parts of the world. I learned how I can do my work differently. I became mindful in new ways.”
Her experience illustrates what traditional technical assistance models struggle to achieve: not just information transfer, but genuine transformation of practice. Sadki noted that peer learning produced “changes in mindfulness” — higher-order learning that most would consider “impossible to achieve by digital means.” Yet “digital combined with social and peer learning made it possible.”
Evidence of a new technical assistance model
TGLF’s collaboration with the World Health Organization, implementing 46 cohorts of peer learning initiatives focused on immunization and other technical areas, provided rigorous evidence that peer learning can replace traditional expert-led technical assistance. The first impact evaluation of this collaboration in January 2019 found that “these are more than just courses. These are interventions designed to foster and improve practice at every level.”
This approach represents what researcher Alexandra Nastase and colleagues would recognize as a fourth model of technical assistance, beyond their three categories of capacity substitution, supplementation, and development. This model challenges fundamental assumptions about who holds valid knowledge and how capacity building should occur.
The most dramatic validation came through TGLF’s Impact Accelerator mechanism. When 644 alumni signed a pledge to achieve impact in July 2019, something remarkable happened. “‘We are together’ became a slogan for the individuals involved,” Sadki observed. The measurable results were astonishing: participants who engaged in peer learning showed seven times higher rates of project implementation compared to a control group that did not engage in peer learning activities to support and learn from each other.
The scale of subsequent initiatives has been even more striking. The Movement for Immunization Agenda 2030, launched in March 2022, grew to 6,185 participants in its first two weeks. In the first four months, more than 1,000 developed action plans, and over 4,000 joined a new Impact Accelerator. Within this period, 30 percent of participants reported successful implementation of their local projects — implementation rates that far exceed what traditional technical assistance typically achieves.
Beyond the expert monopoly
Perhaps most significantly, the Geneva Learning Foundation’s model has enabled practitioners to transcend traditional power structures and drive their own capacity building agendas. Rather than waiting for external technical assistance, practitioners began forming organic learning networks that generate solutions from the ground up.
- A collective of women who deliver vaccines formed naturally and began leading discussions on making HPV vaccination work for women and girls at successive Teach to Reach peer learning events facilitated by TGLF.
- More than 1,300 health practitioners co-authored a manifesto for global health “with no international agencies or international consultants involved.”
- When the foundation surveyed 1,234 health professionals about climate change threats to the health of their communities, nearly half identified it as the highest threat level — and began making connections to learn from and support each other.
These examples illustrate a fundamental shift in the locus of knowledge creation. Traditional technical assistance assumes that solutions flow from international experts to local implementers. The foundation’s model demonstrates that practitioners facing similar challenges often hold the keys to solutions, and that the role of technical assistance should be creating conditions for them to learn from each other.
Transforming the technical assistance paradigm
The evidence points toward what Sadki called “an opportunity for transformation that may be much harder to achieve [than what we already know how to do], but with a far greater return on the investment.” The transformation involves “empowering health professionals to drive improvement from the ground up, connecting them to their peers, and linking to global guidance.”
This requires fundamentally different approaches to capacity building. Instead of the traditional model where external experts deliver knowledge to passive recipients, effective peer learning creates what Sadki described as “circular, interactive configurations” where practitioners engage directly with each other’s experiences. The facilitation may be digital, but the knowledge exchange is profoundly collaborative.
By systematically applying insights from social learning, networked learning, and digital learning, the foundation has created what amounts to “a human knowledge network” that “unites practitioners and those who support them in a shared pledge to turn knowledge into action.”
The fact that these “recent advances in learning science remain largely unknown in global health, at least in some quarters” remains a challenge.
The future of technical assistance
As global health faces increasingly complex challenges — from climate change to pandemic preparedness to health system resilience — the ability to harness collective intelligence through peer learning may prove essential. The evidence suggests that effective solutions emerge not from more sophisticated expert-driven interventions, but from better systems for enabling practitioners to learn from each other.
The implications extend beyond individual capacity building to systemic change. When health workers share challenges and solutions across contexts, they create what Sadki called “a river of knowledge” that practitioners can dip into when they need to solve a problem. This enables rapid adaptation and innovation at scales that traditional technical assistance cannot achieve.
The revolution in global health technical assistance may ultimately be less about technology and more about recognition — acknowledging that expertise is distributed rather than concentrated, and that the future lies not in perfecting systems for delivering knowledge from experts to practitioners, but in creating conditions for practitioners to take action by combining what they know because they are there every day with the best available global knowledge – reshaping global knowledge in the process.
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