The limitations of expert-led fellowships for global health

How to overcome limitations of expert-led fellowships for global health

Global health, Theory

Coaching and mentoring programs sometimes called “fellowships” have been upheld as the gold standard for developing leaders in global health. For example, a fellowship in the field of immunization was recently advertised in the following manner. We will not dwell here on the ‘live engagements’, which are expert-led presentations of technical knowledge. We already know that such ‘webinars’ have very limited learning efficacy, and unlikely impact on outcomes. (This may seem like a harsh statement to global health practitioners who have grown comfortable with webinars, but it is substantiated by decades of evidence from learning science research.) On the surface, the rest of the model sounds highly effective, promising personalized attention and expert guidance. The use of a project-based learning approach is promising, but it is unclear what support is provided once the implementation plan has been crafted. It is when you consider the logistical aspects that the cracks begin …

How does peer learning compare to expert-led coaching fellowships

How does the scalability of peer learning compare to expert-led coaching ‘fellowships’?

Global health, Theory

By connecting practitioners to learn from each other, peer learning facilitates collaborative development. ow does it compare to expert-led coaching and mentoring “fellowships” that are seen as the ‘gold standard’ for professional development in global health? Scalability in global health matters. (See this article for a comparison of other aspects.) Simplified mathematical modeling can compare the scalability of expert coaching (“fellowships”) and peer learning Let N be the total number of learners and M be the number of experts available. Assuming that each expert can coach K learners effectively: For N>>M×KN>>M×K, it is evident that expert coaching is costly and difficult to scale. Expert coaching “fellowships” require the availability of experts, which is often optimistic in highly specialized fields. The number of learners (N) greatly exceeds the product of the number of experts (M) and the capacity per expert (K). Scalability of one-to-one peer learning By comparison, peer learning turns …

Calculating the relative effectiveness of expert coaching, peer learning, and cascade training

Calculating the relative effectiveness of expert coaching, peer learning, and cascade training

Global health, Theory

A formula for calculating learning efficacy, (E), considering the importance of each criterion and the specific ratings for peer learning, is: This abstract formula provides a way to quantify learning efficacy, considering various educational criteria and their relative importance (weights) for effective learning. Variable  Definition Description  S Scalability Ability to accommodate a large number of learners  I Information fidelity Quality and reliability of information  C Cost effectiveness Financial efficiency of the learning method  F Feedback quality Quality of feedback received  U Uniformity Consistency of learning experience  Summary of five variables that contribute to learning efficacy Weights for each variables are derived from empirical data and expert consensus. All values are on a scale of 0-4, with a “4” representing the highest level. Scalability Information fidelity Cost-benefit Feedback quality Uniformity 4.00 3.00 4.00 3.00 1.00 Assigned weights Here is a summary table including all values for each criterion, learning efficacy calculated …

Why does cascade training fail

Why does cascade training fail?

Global health, Theory

Cascade training remains widely used in global health. Cascade training can look great on paper: an expert trains a small group who, in turn, train others, thereby theoretically scaling the knowledge across an organization. It attempts to combine the advantages of expert coaching and peer learning by passing knowledge down a hierarchy. However, despite its promise and persistent use, cascade training is plagued by several factors that often lead to its failure. This is well-documented in the field of learning, but largely unknown (or ignored) in global health. What are the mechanics of this known inefficacy? Here are four factors that contribute to the failure of cascade training 1. Information loss Consider a model where an expert holds a knowledge set K. In each subsequent layer of the cascade, α percentage of the knowledge is lost: 2. Lack of feedback In a cascade model, only the first layer receives feedback …

The capability trap

The capability trap: Nobody ever gets credit for fixing problems that never happened

Leadership, Learning strategy

Here is a summary of the key points from the article “Nobody ever gets credit for fixing problems that never happened: creating and sustaining process improvement”. Overview Core causal loops The capability trap The “capability trap” refers to the downward spiral organizations can get caught in, where attempting to boost performance by pressuring people to “work harder” actually erodes process capability over time. This trap works through a few key mechanisms: Key takeaway for learning leaders Learning leaders must understand the systemic traps identified in the article that underly failed improvement initiatives and facilitate mental model shifts. This help build sustainable, effective learning programs to be realized through productive capability-enhancing cycles. Key takeaway for immunization leaders It is reasonable to hypothesize that poor health worker performance is a symptom rather than the cause of poor immunization programme performance. Short-term decisions, often responding to top-down targets and donor requirements, hurt capability …

Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

Global health

The article “Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030” is, according to the authors, “the first to showcase the positive inclusion of mainstreaming gender in a WHO capacity-building program.” Context: Key findings: This is consistent with the known effectiveness of peer feedback, as the rubric followed by each learner included specific instructions to “describe how your action plan has considered and integrated gender dimensions in immunization.” TGLF’s peer learning model focuses on generating and applying new knowledge. This appears to be conducive to raising awareness of issues like gender barriers to immunization. By giving and receiving feedback, participants build understanding. Whereas only around ten percent of learners participated in expert-led presentations offered about gender and immunization, every learner had to think through and write up gender analysis. And every learner had to give feedback on the gender analyses of three colleagues. The social …

Towards reimagined technical assistance Thinking beyond the current policy options

Towards reimagined technical assistance: thinking beyond the current policy options

Global health, Leadership

In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance: Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.” Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and …

Protect Invest Together

Protect, invest, together: strengthening health workforce through new learning models

Global health

In “Prioritising the health and care workforce shortage: protect, invest, together,” Agyeman-Manu et al. assert that the COVID-19 pandemic aggravated longstanding health workforce deficiencies globally, especially in under-resourced nations.  With projected shortages of 10 million health workers concentrated in Africa and the Middle East by 2030, the authors urgently call for policymakers to commit to retaining and expanding national health workforces.  They propose common-sense solutions: increased, coordinated financing and collaboration across government agencies managing health, finance, economic development, education and labor portfolios. But how can such interconnected, long-term investments be designed for maximum sustainable impact? And what is the role of education? Rethinking health worker learning In a 2021 WHO survey across 159 countries, most health workers reported lacking adequate training to respond effectively to pandemic demands. This exposed systemic weaknesses in how health workforces develop skills at scale. Long before the COVID-19 pandemic, limitations of traditional learning approaches were …

The imperative for climate action to protect health and the role of education

The imperative for climate action to protect health and the role of education

Global health

“The Imperative for Climate Action to Protect Health” is an article that examines the current and projected health impacts of climate change, as well as the potential health benefits of actions to reduce greenhouse gas emissions. The authors state that “climate change is causing injuries, illnesses, and deaths, with the risks projected to increase substantially with additional climate change.”  Specifically, the article notes that approximately “250,000 deaths annually between 2030 and 2050 could be due to climate change–related increases in heat exposure in elderly people, as well as increases in diarrheal disease, malaria, dengue, coastal flooding, and childhood stunting.” The impacts will fall disproportionately on vulnerable populations, and climate change “could force more than 100 million people into extreme poverty by 2030.” The article discusses major exposure pathways that link climate hazards to health outcomes like “heat-related illness and death, illnesses caused by poor air quality, undernutrition from reduced food …

Prioritizing the health and care workforce shortage

Prioritizing the health and care workforce shortage: protect, invest, together

Global health

The severe global shortage of health and care workers poses a dangerous threat to health systems, especially in low- and middle-income countries (LMICs). The authors of the article “Prioritising the health and care workforce shortage: protect, invest, together”, including six health ministers and the WHO Director-General, assert that this workforce crisis requires urgent action and propose “protect, invest, together” to tackle it. Deep protection of the existing workforce, they assert, is needed through improved working conditions, fair compensation, upholding rights, addressing discrimination and violence, closing gender inequities, and implementing the WHO Global Health and Care Worker Compact to ensure dignified working environments. All countries must prioritize retaining workers to build resilient health systems. Significantly increased and strategic long-term investments are imperative in both training new health workers through educational channels and sustaining their employment. Countries should designate workforce development, especially at the primary care level, as crucial human capital investments …