The many faces of immunization.10.5281/zenodo.8166653

World Immunization Week: What do you see?

Global health

English version | Version française

This is the preface of the new publication The many faces of immunization. Learn more… Download the collection…

Every day, thousands of health workers, from Afghanistan to Zimbabwe, get up and go to work with a single goal in mind ­ to ensure that vaccines reach those who need them.

To mark World Immunization Week 2023 (24­–30 April 2023) and the launch of the “Big Catch Up” campaign, the Geneva Learning Foundation (TGLF) invited members of the Movement for Immunization Agenda 2030 (IA2030) to share photographs of themselves and their daily work.

More than 1,000 visual stories were shared.

These are not the carefully composed and technically accomplished shots of the professional photographer: rather, they capture a raw and authentic view of what immunization means in practice.

The transport challenges.

The concerned and loving mothers.

The curious onlookers.

The dialogue between practitioners and community members.

The schoolchildren waving their vaccination cards.

The reams of paper-based data.

This is our second annual gallery of photographs shared by members of the Movement. Get the 2022 World Immunization Week photo book It takes people to make #vaccineswork…

Once again, it celebrates their diversity of roles and challenges faced in their daily lives, and their commitment to the IA2030 goal of ensuring that every child, every family, is protected from vaccine-preventable diseases.

If we did it again, it is because we observed that visual storytelling had a profound effect across the Movement.

This effect may be hard to quantify.

On its own, it certainly does not improve vaccination coverage.

And yet, it has everything to do with how health workers perceive themselves, perceive the value of their own work.

Not just knowing but seeing that there are colleagues across the world who are doing the same work, whatever the contexts, is heartening and inspiring.

It can help strengthen or renew resolve and commitment.

It can help make a difference – and sustain it over time.

To achieve their goals, they may be working in health facilities offering immunization services and other forms of primary health care.

Or they may be taking part in outreach or stratégies avancées, delivering vaccines out in the communities where people live.

Alternatively, they may be based in district or regional offices, providing oversight and offering “supportive supervision” ­ constructive feedback and advice to ensure practitioners can do their jobs better.

If they are among the many practitioners engaged in outreach activities, they may face multiple challenges.

They may have to overcome geographical obstacles ­ rivers, flooding, poor roads, or just long distances.

They may have to venture into areas of political instability or conflict.

They may have to make contact with mobile populations whose precise location may be uncertain.

And they may have to enter informal urban settings in a state of permanent flux.

Then, when they reach their destination, they may find that those they engage are not receptive to vaccination.

They may have to spend time with people to help them understand the benefits and safety of vaccines.

Of course, actually vaccinating people is not the only task that needs to be undertaken.

Vaccination programmes rely on a collective of people with a diverse range of roles, such as maintaining essential cold chain equipment, managing data, and working with communities to build support for vaccination.

Community-based volunteers provide a vital link between immunization programmes and local communities.

Effective teamwork is essential.

At the end of a long day, every vaccination practitioner can return home knowing that they have done their bit to make the world a healthier place, and just might have saved a life.

Charlotte Mbuh and Reda Sadki
The Geneva Learning Foundation (TGLF)

Jones, I., Sadki, R., & Mbuh, C. (2024). The many faces of immunization (IA2030 Listening and Learning Report 5) (1.0). Special Event: World Immunization Week. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.8166653

Climate Change and Health Perspectives from Developing Countries

Climate change and health: perspectives from developing countries

Global health

Today, the Geneva Learning Foundation’s Charlotte Mbuh delivered a scientific presentation titled “On the frontline of climate change and health: A health worker eyewitness report” at the University of Hamburg’s Online Expert Seminar on Climate Change and Health: Perspectives from Developing Countries.

Mbuh shared insights from a report based on observations from frontline health workers on the impact of climate change on health in their communities.

Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline

Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

The Geneva Learning Foundation, a Swiss non-profit, facilitated a special event “From community to planet: Health professionals on the frontlines of climate change” on 28 July 2023, engaging 4,700 health practitioners from 68 countries who shared 1,260 observations.

“93% of respondents believed that there was a link between climate change and health, and they reported a direct local experience of a wide range of climatic and environmental impacts,” Mbuh stated.

The most commonly reported impacts were on farming and farmland, the distribution of disease-carrying insects, and urban areas becoming hotter.

Health impacts linked to these climatic and environmental changes included increased malnutrition and/or undernutrition, increased waterborne diseases, and changes to the incidence and distribution of vector-borne diseases.

Mbuh emphasized that these impacts were particularly prevalent in smaller communities or mid-sized towns.

Mbuh highlighted the unique role of frontline health workers as trusted advisors to their communities: “Frontline health workers are trusted advisors of the communities that they serve, and they have unique insights to local realities and are strategically positioned to bring about change,” she said.

The Geneva Learning Foundation aims to leverage its digitally-enabled peer learning network of health workers to drive change across different levels of the health system and geographical boundaries.

Mbuh concluded : “These experiences demonstrate the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate health nexus and building resilience in the face of a changing climate.”

The presentation underscored the urgent need to invest in frontline health workers at the local level to build resilience against the impacts of climate change on health, particularly in vulnerable communities in developing countries.

The event was organized by the International Expert Centre of Climate Change and Health (IECCCH) at the Research and Transfer Centre Sustainable Development and Climate Change Management, Hamburg University of Applied Sciences, in collaboration with the European School of Sustainability Science and Research (ESSSR), the UK Consortium on Sustainability Research (UK-CSR), and the Inter-University Sustainable Development Research Programme (IUSDRP).

Photo: The Geneva Learning Foundation Collection © 2024

Visual storytelling impacts of climate change on health

Making the invisible visible: storytelling the health impacts of climate change

Global health

On March 18, 2024, the Geneva Learning Foundation (TGLF) hosted a workshop bringing together 553 health workers from 55 countries with TGLF’s First Fellow of Photography and award-winning photographer Chris de Bode. Watch the workshop in English and in French. Poor connectivity? Get the audio-only podcast.

The dialogue focused on exploring the power of health workers who are there every day to communicate the impacts of climate change on the health of those they serve. Learn more…

The Geneva Learning Foundation’s exploration of visual storytelling began, two years ago, with a simple yet powerful call to action for World Immunization Week: “Would you like to share a photo of your daily work, the work that you do every day?” Over 1,000 photos were shared within two weeks. “We repeated this in 2023, to show that it is people who make #VaccinesWork”, explains Charlotte Mbuh, the Foundation’s deputy director. Watch the 2022 and 2023 events, as well as the inauguration of the First International Photography Exhibition of the Movement for Immunization Agenda 2030 (IA2030).

In July 2023, over 4,700 health professionals – primarily government workers from 68 low and middle-income countries – responded to the call to share their firsthand observations of the impacts of climate change on health. Watch the special event “From community to planet: Health professionals on the frontlines of climate change“… Get the insights report…

That is when Chris de Bode, who has spent decades documenting global health stories, expressed his excitement to flip the script:

“Over the last two years, we received so many pictures about your daily work. By asking you a new question, a different angle on what you work on, we can go a little bit deeper in what you actually do. Since you are on the front line everywhere in the world, it’s super interesting to create a collection of images to show the world and also show each other within the community.”

What would Taphurother Mutange, a community health worker from Kenya, want to show in the photos she will take?

“What I want to show to people is the floods. In my community where I work, the floods were too much. Water went into a house where there was a 12-year-old girl sleeping. The water carried the girl out, and up to date, as I’m talking, she has never been seen.”

She linked this devastation directly to health, adding, “So climate change goes together with health, because after the rains, the children, pregnant mothers, and even older people get sick, and you might see there’s not enough drugs in the facility. So we might even go on losing some lives.”

Brigitte Meugang, a health professional from Yaoundé, Cameroon, captured the essence of why visual storytelling matters:

“I’m attending this event because I believe that with a picture, you can say a thousand words.

And with a beautiful picture, you can learn a lot.

You can understand a lot.

And you can understand really the story just by looking at a picture, usually.”

Chris guided participants on the psychology and ethics of photography, the power of light, and how to create compelling visual narratives.

He challenged the idea that photos must be candid to be authentic.

“A picture is always subjective.

It’s your position as a photographer who decides which picture you take and what you want to tell with the image.

When I take portraits of people, I stage, and I always stage.”

Participants grappled with this in the context of their health work.

Emmanuel Musa, from Nigeria, highlighted the tension:

“Professionally, we’ve been asked to take pictures, action pictures, but not to have a kind of arranged, organized setting…

Because normally we look at pictures that are actionable, that probably funders can see, probably supervisors can see what’s happening in the field, instead of organizing a group picture, you set as if we’re in a studio.”

Aimée N’genda, a health worker from the Democratic Republic of Congo (DRC), also emphasized the importance of consent and the risk of exploitation, especially in urban settings.

“Based on our experience, you need to ask for a written consent that you should keep, because you’ve got some people that will take advantage of it and think that when you take pictures of their children, they think you make money out of this, without paying them any fees.”

Despite the challenges, Chris affirmed the unique power health workers have as visual storytellers.

“You guys and ladies, you are there on the spot.

You’re there every day.

You have a large, large advantage on us, professional photographers who have to go there.”

Participants left energized to apply what they learned.

François Desiré, for example, declared, “I’m going to share pictures of mobile clinics that integrate immunization and nutrition.”

The dialogue equipped health workers to harness visual storytelling to communicate vital stories of how climate change impacts health in their communities, sparking change through the power of a single image.

The Geneva Learning Foundation (TGLF) is actively seeking a donor or sponsor to support visual storytelling by health professionals.

Version française: Raconter la santé en image: un atelier photo avec Chris de Bode pour Teach to Reach 10

This story was written by generative AI, based on a word-for-word transcript of the workshop.

Image: Screen shot of the chat during the workshop “Visual storytelling for health” on 18 March 2024.

Examples of double-loop learning in global health

Five examples of double-loop learning in global health

Writing

Read this first: What is double-loop learning in global health?

Example 1: Addressing low uptake of a vaccine program

Single–Loop Learning: Improve logistics and supply chain management to ensure consistent vaccine availability at clinics.

Double–Loop Learning: Engage with community leaders to understand cultural beliefs and concerns around vaccination, and co-design a more localized and trustworthy immunization strategy.

What is the difference? Double-loop learning questions the assumption that the primary goal should be to increase uptake at all costs. It considers whether the program design respects community autonomy and addresses their real concerns. It may surface competing values of public health impact vs. community self-determination.

Example 2: Responding to an infectious disease outbreak

Single–Loop Learning: Rapidly mobilize health workers and supplies to affected areas to contain the outbreak following established emergency protocols.

Double–Loop Learning: Critically examine why the health system was vulnerable to this outbreak, and work with communities to redesign surveillance, preparedness and response systems to be more resilient.

What is the difference? Double-loop learning interrogates whether the existing outbreak response system is built on the value of health equity. It asks if the system privileges the needs of some populations over others and perpetuates historical power imbalances. It strives to create a more inclusive, participatory approach to defining outbreak preparedness and response priorities.

Example 3: Implementing a maternal health intervention that shows low adherence

Single–Loop Learning: Retrain health providers to improve their counseling skills and provide better patient education on the intervention.

Double–Loop Learning: Conduct participatory research with women and families to understand their needs, preferences and barriers to care-seeking, and collaborate with them to iteratively adapt the intervention design.

What is the difference? Double-loop learning challenges the implicit assumption that the intervention design is inherently correct and that non-adherence is a ‘user error’. It examines whether the intervention embodies values of respect, humility and co-creation with communities. It seeks to align the intervention with women’s self-articulated reproductive health values and preferences.

Example 4: Evaluating an underperforming community health worker (CHW) program

Single–Loop Learning: Strengthen CHW supervision, increase performance incentives, and optimize the ratio of CHWs to households.

Double–Loop Learning: Facilitate a joint reflection process with CHWs and community representatives to examine program strengths, challenges and equity gaps, and co-create a revised strategy that better aligns with community priorities and integrates CHWs’ insights.

What is the difference? Double-loop learning questions whether the CHW program is driven by the value of empowering communities as agents of their own health vs. treating CHWs as an instrument of technocratic public health aims. It re-centers the program on the value of CHW leadership and community-driven problem definition.

Example 5: Reforming a health financing policy to improve population coverage

Single–Loop Learning: Adjust the premium amounts, enrollment processes and benefit package based on initial uptake data.

Double–Loop Learning: Convene citizen panels and key stakeholders to deliberate on the fundamental goals and values underlying the financing reforms, and recommend redesigning the policy to better advance equity and financial protection.

What is the difference? Double-loop learning interrogates whether the true intent of the policy is to advance equity and financial protection for marginalized groups or simply to expand coverage as an end unto itself. It opens up debate on the core values and theory of change underlying the reforms. It aims to re-anchor the policy in a wholistic vision of equitable universal health coverage.

Why learning culture is the missing link between learning and performance in global health

Learning culture: the missing link in global health between learning and performance

Global health

Read this first: What is double-loop learning in global health?

Learning culture is a critical concept missing from health systems research.

It provides a practical and actionable framework to operationalize the notion of ‘learning health systems’ and drive transformative change.

Watkins and Marsick describe learning culture as the capacity for change. They identify seven key action imperatives or “essential building blocks” that strengthen it: continuous learning opportunities, inquiry and dialogue, collaboration and team learning, systems to capture and share learning, people empowerment, connection to the environment, and strategic leadership for learning (Watkins & O’Neil, 2013).

Crucially, the instrument developed by Watkins and Marsick assesses learning culture by examining perceptions of norms and practices, not just individual behaviors (Watkins & O’Neil, 2013).

This aligns with Seye Abimbola’s assertion that learning in health systems should be “people-centred” and occurs at multiple interconnected levels.

Furthermore, this research demonstrates that certain dimensions of learning culture, like strategic leadership and systems to capture and share knowledge, are key mediators and drivers of performance outcomes (Yang et al., 2004).

This provides compelling evidence that investments in learning can yield tangible improvements in health delivery and population health.

Learn more: Jones, I., Watkins, K. E., Sadki, R., Brooks, A., Gasse, F., Yagnik, A., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Case Study 7. Motivation, learning culture and programme performance (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7004304

As Watkins and Marsick (1996) argue, to develop a strong learning culture, we need to “embed a learning infrastructure”, “cultivate a learning habit in people and the culture”, and “regularly audit the knowledge capital” in our organization or across a network of partners.

While investments in learning can be a challenging sell in resource-constrained global health settings, this evidence establishes that learning culture is in fact an indispensable driver of health system effectiveness, not just a “nice to have” attribute.

Subsequent studies have also linked learning culture to key performance indicators like care quality, patient satisfaction, and innovation.

Why lack of continuous learning is the Achilles heel of immunization

To advance learning health systems, it is important to translate this research in terms that resonate with the worldview of global health practitioners like epidemiologists and to produce further empirical studies that speak to their evidentiary standards.

Ultimately, this will require expanding mental models about what constitutes legitimate and actionable knowledge for health improvement.

The learning culture framework offers an evidence-based approach to guide this transformation.

References

Abimbola, S. The uses of knowledge in global health. BMJ Glob Health 6, e005802 (2021).

Watkins, K. E. & O’Neil, J. The Dimensions of the Learning Organization Questionnaire (the DLOQ): A Nontechnical Manual. Advances in Developing Human Resources 15, 133–147 (2013).

Watkins, K., & Marsick, V. (1996). (Eds.). In action: Creating the learning organization (Vol. 1). Alexandria, VA: ASTD Press.

Yang, B., Watkins, K. E. & Marsick, V. J. The construct of the learning organization: Dimensions, measurement, and validation. Human Resource Development Quarterly 15, 31–55 (2004).

What is double loop learning in global health

What is double-loop learning in global health?

Global health

Argyris (1976) defines double-loop learning as occurring “when errors are corrected by changing the governing values and then the actions.” He contrasts this with single-loop learning, where “errors are corrected without altering the underlying governing values.”

  • Double-loop learning involves questioning “not only the objective facts but also the reasons and motives behind those facts”.
  • It requires becoming aware of one’s own “theories-in-use” – the often tacit beliefs and norms that shape behavior – and subjecting them to critical reflection and change. 

This is challenging because it can threaten one’s sense of competence and self-image.

‘Are we doing things right?’ vs. ‘Are we doing the right things?’

In global health, double-loop learning means not just asking “Are we doing things right?” but also “Are we doing the right things?” It means being willing to challenge long-held assumptions about what works, for whom, and under what conditions.

Epistemological assumptions (“we already know the best way”), methodological orthodoxies (“this is not how we do things”), and apolitical stance (“I do health, not politics”) of epidemiology can predispose practitioners to be dismissive of a concept like double-loop learning. 

Learn more: Five examples of double-loop learning in global health

Seye Abimbola is part of a growing community of researchers who argue that double-loop learning is critical for advancing equity and self-reliance in global health systems, because global health tends to overlook its own assumptions.

Is it reasonable to posit that some global health interventions have been driven by unchecked assumptions – assumptions about what communities need, what they value, and what will work in their context? How often have we relied on a one-size-fits-all approach, implementing ‘best practices’ from afar without fully understanding local realities? How do we know to what extent programs have thereby failed to meet their goals, wasted precious resources, and may have even caused unintended harm?

As Abimbola (2021) notes, “double-loop learning goes further to question and influence frameworks, models and assumptions around problems and their solutions, and can drive deeper shifts in objectives and policies.”

For example, affected communities hold vital expertise to mitigate health risks.

However, fully leveraging this potential requires global health professionals to fundamentally rethink their roles and assumptions.

  • For research to serve the needs of affected communities, it is likely to be useful to reframe these roles and assumptions to see themselves as “subsidiary” partners in service of “primary” community actors (Abimbola, 2021).
  • Institutionalizing double-loop learning requires enabling critical reflection and co-production between health workers, managers and citizens (Sheikh & Abimbola, 2021).
  • It also depends on developing the learning capacities of communities and health workers in areas like participatory governance, team-based learning and innovation management.

The next logical question is ‘how’ to do this.

Learning culture is a critical concept missing from health systems research.

It provides a practical and actionable framework to operationalize the notion of ‘learning health systems’ and drive transformative change.

Learn more: Learning culture: the missing link in global health between learning and performance

Further reading

Learning-based complex work: how to reframe learning and development

What learning science underpins peer learning for Global Health?

How do we reframe health performance management within complex adaptive systems?

References

Abimbola, S. The uses of knowledge in global health. BMJ Glob Health 6, e005802 (2021).

Argyris, C. Single-loop and double-loop models in research on decision making. Administrative science quarterly 363–375 (1976).

Argyris, C. Double-loop learning, teaching, and research. Academy of Management Learning & Education 1, 206–218 (2002).

Kabir Sheikh & Seye Abimbola. Learning Health Systems: Pathways to Progress. (Alliance for Health Policy and Systems Research, 2021).

Image: The Geneva Learning Foundation Collection © 2024

Civil society organisations and global health initiatives Problems of legitimacy

Do Civil Society Organizations (CSOs) actually help global health?

Global health

This summary analyzes two important articles examining the role of civil society organizations (CSOs) in global health: “Civil society organisations and global health initiatives: Problems of legitimacy” by Doyle and Patel (2008), and “Civil society in global health policymaking: a critical review” by Gómez (2018).

While both articles challenge dominant assumptions about CSOs in global health, Doyle and Patel focus more on issues of legitimacy, representation and effects on democracy. Gómez focuses more on the lack of theoretical and empirical evidence for CSOs’ influence across all stages of the policy process. 

Doyle and Patel (2008) challenge the assumption that CSOs automatically enhance representation and democracy in global health governance.

  • They argue that talk of ‘partnership’ obscures logistical and political obstacles to Southern CSO participation.
  • The authors also question the real agenda of many global health governance agencies and Western donor countries in the use of CSOs to deliver health interventions directly, bypassing government agencies where possible.
  • They suggest this CSO-led approach and the bypassing of government agencies has had a number of negative effects that either undermines claims of CSOs to be enhancing democracy or undermines the potential effectiveness of global health interventions.

Gómez (2018) similarly critiques the lack of evidence for CSOs’ assumed comparative advantage in health program delivery.

  • His review finds the literature “narrowly focused on the agenda-setting and policy implementation stages, failing to account for all stages of the policymaking process and civil society’s role in it.”
  • He argues that “very little effort has been made to test and develop theoretical and analytical policymaking frameworks, clearly and consistently defining and conceptualizing civil society’s role and influence in global health policymaking, provide methodological specificity and diversity, while emphasizing the importance of causal mechanisms.”

Doyle and Patel conclude that failure by advocates to respond to the sceptical arguments put forward here may weaken the legitimacy of CSO involvement in GHIs [global health initiatives].

They call for research to clarify how different CSOs operate in different contexts to help to identify those variables that promote or impede the success of health interventions in different settings globally.

Gómez, on the other hand, concludes by “encouraging scholars to address these lacuna in the literature and to explore the utility of political science theory and alternative policymaking models to better define and explain the complexity of civil society’s role and influence in global health policymaking processes.”

Together, these articles make a compelling case for more critical examination of the role of CSOs in global health, and for moving beyond broad assumptions to more nuanced, context-specific and empirically-grounded analysis. They provide a valuable counterpoint to the often unquestioning enthusiasm for CSO engagement in much of the global health field.

Dominant Assumption  Evidence Challenging Assumption 
CSOs enhance representation and democracy in global health governance  Questionable existence of a coherent “global civil society” (Doyle & Patel)
Lack of accountability and representation of populations claimed to be represented (Doyle & Patel)
Elevating CSOs can undermine democracy and state legitimacy in developing countries (Doyle & Patel) 
CSOs have a comparative advantage in delivering health interventions  Lack of evidence for comparative advantage (Gómez)
Short-term donor funding creates perverse incentives and unsustainable interventions (Doyle & Patel)
“Marketization” leads to duplication, inefficiencies, and focus on easy to measure outputs vs impact (Doyle & Patel)
Bypassing and competing with public health systems is detrimental (Doyle & Patel) 
CSOs play a significant role across all stages of the global health policy process  Literature narrowly focused on agenda-setting and implementation stages (Gómez)
Lack of theoretical and empirical analysis of CSO roles and influence across all policy stages (Gómez) 
Partnership rhetoric reflects genuine collaboration and equality between Northern and Southern CSOs  “Talk of ‘partnership” obscures logistical and political obstacles” to Southern CSO participation (Doyle & Patel)
Unequal power relations and Northern dominance in CSO partnerships (Doyle & Patel) 
CSO involvement improves the effectiveness of global health interventions  Lack of evidence for impact of CSO involvement on health outcomes (Gómez)
Focus on short-term, easily measurable outputs vs long-term impact and sustainability (Doyle & Patel)
Negative effects on health systems and government capacity (Doyle & Patel) 

References

Doyle, C., Patel, P., 2008. Civil society organisations and global health initiatives: Problems of legitimacy. Social Science & Medicine 66, 1928–1938. https://doi.org/10.1016/j.socscimed.2007.12.029

Gómez, E.J., 2018. Civil society in global health policymaking: a critical review. Global Health 14, 73. https://doi.org/10.1186/s12992-018-0393-2

Visual storytelling for health

Visual storytelling for health

Events, Global health

Do you work for health? Your are invited to a visual storytelling workshop with health care workers from 44 countries. The Geneva Learning Foundation’s first Fellow of Photography, Chris de Bode, will lead this workshop.

544 health care workers from 44 countries have already confirmed their participation. 80% of participants are sub-national staff working in fragile contexts. Most work for their country’s ministry of health.

Chris deBode spent decades on assignments, traveling around the globe for various NGOs, magazines, and newspapers.

Now, he has partnered with the Geneva Learning Foundation (TGLF) to share his experience with health practitioners who are there every day, as they learn to tell their own visual stories about immunization, the impacts of climate change on health, and other issues that matter for the communities they serve.

“Technical knowledge is not decisive in making your picture”, says Chris. “The person behind the camera makes the difference. You are the source of your image.”

The workshop is reserved for health professionals who contributed photos to the 2022 and 2023 Immunization Agenda 2030 (IA2030) Movement’s International Photo Exhibitions for World Immunization Week. However, it will also be livestreamed for everyone who has not previously been able to participate.

In 2022 and 2023, over 2,000 photos were shared by immunization staff from all over the world.

On 18 March 2024, health professionals from the following countries will be participating: Afghanistan, Angola, Bangladesh, Belgium, Benin, Burkina Faso, Burundi, Cameroon, Canada, Central African Republic, Chad, Comoros, Congo, Costa Rica, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, France, Gabon, Gambia, Germany, Ghana, Guinea, Guinea-Bissau, Haiti, India, Indonesia, Kenya, Lebanon, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Morocco, Niger, Nigeria, Pakistan, Saudi Arabia, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sri Lanka, Sudan, Tanzania, Togo, Tunisia, Turkey, Uganda, United States, Zambia, Zimbabwe.

Photo by Chris deBode: Eleven-year-old Wilberforce runs along an unpaved road near his home in Gulu, Northen Uganda where he lives with his parents and 6 siblings. He says: “I want to be the fastest. I want my parents, my school and country to be proud of me. Every day I run. I dream of coming home with the biggest trophy.”

Watch the inauguration of the First International Photography Exhibition for Immunization Agenda 2030

Watch the Special Event: World Immunization Week 2023

Watch the Special Event: World Immunization Week 2022

Mental Health and Psychosocial Support in Ukraine Coping, Help-seeking and Health Systems Strengthening in Times of War

Mental health and psychosocial support in Ukraine: insights from an interdisciplinary review

Global health

A new interdisciplinary review from the ARQ National Psychotrauma Centre and VU Amsterdam provides an in-depth analysis of the mental health impacts, cultural and historical factors shaping coping and help-seeking, the evolving humanitarian response, and recommendations for strengthening mental health and psychosocial support (MHPSS) in Ukraine.

The report is an interdisciplinary literature review supplemented by key informant interviews.  It synthesizes academic publications, gray literature, media reports and policy documents in English, Ukrainian and Russian. The review team included Ukrainian practitioners and regional experts to identify additional Ukrainian-language sources.

The review found that the war has led to high levels of acute psychological distress, increased risk of the development of future mental health problems, exacerbation of chronic mental health conditions, psychosocial problems, and an increase in substance use. Exposure to war-related trauma and violence, coupled with the loss of social support systems, poses lifelong risks for a range of mental health issues. Internally displaced persons (IDPs) are particularly vulnerable, with previous research showing that “32% of IDPs in Ukraine experienced post-traumatic stress disorder (PTSD) and 22% had depression.”  

Children’s mental health is a critical concern, with “three out of four parents report[ing] signs of psychological trauma in their children” such as “impaired memory, inattention, and learning difficulties.” Over 1.2 million children are internally displaced, with approximately 91,000 separated from family care. These are “the most vulnerable children […] living outside their families, residential institutions for children without parental care or boarding schools, unaccompanied and separated children, and children with disabilities.” Displacement disrupts education, social networks and routines. Adolescents struggle most to adapt and connect with new peers. Older children are taking on caregiver roles for younger siblings. The review identifies a lack of policies and programs specifically targeting child and adolescent mental health as a key gap.

Ukraine’s complex history has shaped current attitudes and practices around mental health. The review notes that “Ukraine’s historical memory is fragmented, with evaluations of events varying significantly among different population groups,” compounded by “Russia’s historic and contemporary efforts to rewrite Ukrainian history.” Soviet-era legacies of stigma, institutionalization, and the misuse of psychiatry have bred mistrust of formal mental health services, according to the review. Instead, “help seeking behaviour tends to be directed toward spiritual leaders (clergy) and practices.” Religious beliefs and leaders play an important role in mental health coping and support.

High levels of societal stigma toward mental illness persist, rooted in cultural norms that view psychological distress as a personal weakness or moral failing. Many Ukrainians hide their struggles and avoid seeking professional help due to fears of being perceived as ‘weak,’ receiving a diagnosis that could jeopardize employment, or being involuntarily hospitalized. “Ukrainians still perceive psychiatrists as being highly likely to disclose information about mental health and psychosocial disorders with employers, and therefore, even a single visit to a psychiatric hospital may destroy the future […] There is a particular tendency to hide suicidal thoughts due to high levels of fear of involuntary hospitalisation”, says the report.

Since 2014, conflict-affected areas in Eastern Ukraine have seen an influx of MHPSS services through humanitarian efforts, while recent national reforms have aimed to decentralize and deinstitutionalize mental healthcare. However, the current crisis has disrupted these reform efforts while dramatically increasing MHPSS needs. This presents both challenges and opportunities to “build on available resources” and integrate “successes of the emergency response into building more sustainable mental health care systems.”

The review highlights the stark regional disparities in MHPSS needs and capacities due to variations in conflict exposure, displacement patterns, infrastructure damage, and pre-existing resources. Areas affected by armed conflict face acute challenges, including widespread mine contamination, community distrust, and decimated health services. Meanwhile, safer areas in Western Ukraine are straining to meet the needs of large displaced populations. However, they also have more MHPSS responders and opportunities for longer-term interventions.

To address these complex challenges, the authors stress the importance of cross-sectoral coordination, building on local capacities and cultural resources, and strengthening partnerships between government, civil society, and faith-based organizations. Rigorous research on MHPSS interventions in conflict-affected Ukraine can inform evidence-based responses in the country and globally. 

The review provides a roadmap for strengthening Ukraine’s MHPSS response through a focus on sustainable, locally-grounded, and trauma-informed approaches. While the needs are vast, there are also opportunities to transform mental healthcare and build resilience.

Reference: Iryna Frankova, Megan Leigh Bahmad, Ganna Goloktionova, Orest Suvalo, Kateryna Khyzhniak, 2024. Mental Health and Psychosocial Support in Ukraine: Coping, Help-seeking and Health Systems Strengthening in Times of War. ARQ National Psychotrauma Centre and VU Amsterdam, Amsterdam, Netherlands.

Image: The Geneva Learning Foundation Collection © 2024

IWD2024 Women inspiring women

Women’s voices from the frontlines of health and humanitarian action

Global health

English version | Version française

GENEVA, Switzerland, 8 March 2024 – The Geneva Learning Foundation (TGLF) is sharing a collection of stories titled “Women inspiring women”, shared by 177 women on the frontlines of health and humanitarian action.

Download: The Geneva Learning Foundation. (2024). Women inspiring women: International Women’s Day 2024 (1.0). https://doi.org/10.5281/zenodo.10783218

The collection is a vibrant tapestry of women’s voices from the frontlines of health and humanitarian action, woven together to showcase the resilience, passion, and leadership of women who are making a difference in the face of war, disease, and climate change.

TGLF reached out to women in its global network of more than 60,000 health workers, inviting them to share their heartfelt advice and vision for the future with young women and girls.

Health workers in this network, men and women, are on the frontlines of adversity: they work in remote rural areas or with the urban poor. Many support the needs of nomadic and migrant populations, refugees, and internally-displaced populations (IDPs). 

Imagine being able to sit down with a community health worker in Nigeria, a nurse in India, or a doctor in Brazil, and listen to their stories of triumph and struggle. “Women Inspiring Women” makes that possible, bringing together voices that are rarely heard on the global stage.

The responses are raw, honest, and deeply moving.

From remote villages to urban slums, women work to build a better future for their communities.

What makes this collection truly unique is its authenticity and diversity. 

“In a world of war, disease, and a worsening climate, literacy is vital for the next generation of women and girls to make better choices concerning health, marriage, and income. Literacy is key in transforming households out of poverty, no matter who they are or where they are born.” – Hauwa Abbas, Public health specialist (MPH), Nigeria

Through their words, these women offer invaluable guidance to the next generation of female leaders. They share the lessons they’ve learned, the challenges they’ve faced, and the hopes they hold for a world where every girl can live a healthy, fulfilling life, no matter where she is born.

“Serving humanity as a health or humanitarian worker is one of the most rewarding careers one can engage in. Though it requires a lot of hard work more importantly and what is usually not thought about is the heart work it involves. The ability to empathize with the sick and those in humanitarian needs is a key ingredient for success.” – Ngozi Kennedy MB ChB, MPH, Public health specialist, Ethiopia

“This collection is a celebration of the incredible resilience and leadership of women health workers and humanitarians worldwide,” said TGLF Executive Director Reda Sadki. “It’s a testament to the power of storytelling to inspire change and unite us in our shared vision for a better future.”

“Insist on making generational impact as a woman against ALL odds! Don’t give up, don’t give in, don’t give way! Persistence wears out resistance! This is my success story today as I battled many challenges to establish rotavirus surveillance in my country as well as rotavirus vaccine introduction advocacy which has finally culminated in the vaccine introduction in Nigeria.” – Professor Beckie Tagbo, Doctor, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria

In the lead up to International Women’s Day, TGLF has been sharing sneak peeks of the stories and quotes on its social media platforms. Follow along on LinkedIn, Twitter/X, Facebook, Instagram and Telegram to get a glimpse of the inspiration that awaits.

“Women Inspiring Women” is more than just a collection of stories. It’s a rallying cry for gender equality, a celebration of women’s leadership, and a reminder of the incredible impact one voice can have. Get ready to be inspired, moved, and empowered by the voices of women health workers and humanitarians worldwide.

Join us in amplifying the voices of these extraordinary women and creating a world where every girl can thrive.

“Resilience and determination in the face of difficulties will be essential – it is vital not to be deterred or discouraged when faced with setbacks of adversity, which are an inevitability in these spheres. Health or humanitarian work is all about people. There may be days where you question your decision and that is where determination keeps you going.” – Genise Pascal-Ferrer Iglesias, Coordinator of Imaging Services, Goodwill, Dominica

“Empowered women empower women. Ever since you were born, I kept you with me in all my philanthropic activities. […] I wish you all the blessings, happiness and success in life. Someday, you will write a similar letter to your own daughter saying, ‘Empowered women empower women’.” – Dr Faiza Rabbani, Public health specialist (MPH), Lahore District, Punjab Province, Pakistan

Download “Women inspiring women” via this link https://doi.org/10.5281/zenodo.10783218

About the Geneva Learning Foundation

Learn more about The Geneva Learning Foundation: https://doi.org/10.5281/zenodo.7316466

Created by a group of learning innovators and scientists with the mission to discover new ways to lead change, TGLF’s team combines over 70 years of experience with both country-based (field) work and country, region, and global partners.

  • Our small, fully remote agile team already supports over 60,000 health practitioners leading change in 137 countries.
  • We reach the front lines: 21% face armed conflict; 25% work with refugees or internally-displaced populations; 62% work in remote rural areas; 47% with the urban poor; 36% support the needs of nomadic/migrant populations.

TGLF’s unique package:

  1. Helps local actors take action with communities to tackle local challenges, and
  2. provides the tools to build a global network, platform, and community of health workers that can scale up local impact for global health.

In 2019, research showed that TGLF’s approach can accelerate locally-led implementation of innovative strategies by 7X, and works especially well in fragile contexts.

Photo: The Geneva Learning Foundation Collection © 2024