Rethinking Workplace Learning and Development

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

About me, Global health, Interviews, Published articles, The Geneva Learning Foundation

The following is excerpted from Watkins, K.E. and Marsick, V.J., 2023. Chapter 4. Learning informally at work: Reframing learning and development. In Rethinking Workplace Learning and Development. Edward Elgar Publishing.

This chapter’s final example illustrates the way in which organically arising IIL (informal and incidental learning) is paired with opportunities to build knowledge through a combination of structured education and informal learning by peers working in frequently complex circumstances.

Reda Sadki, president of The Geneva Learning Foundation (TGLF), rethought L&D for immunization workers in many roles in low- and middle-income countries (LMICs).

Adapting to technology available to participants from the countries that joined this effort, Sadki designed a mix of experiences that broke out of the limits of “training” as it was often designed.

He addressed, the inability to scale up to reach large audiences; difficulty to transfer what is learned; inability to accommodate different learners’ starting places; the need to teach learners to solve complex problems; and the inability to develop sufficient expertise in a timely way. (Marsick et al., 2021, p. 15)

This led his organization, to invite front-line staff from all levels of immunization systems in low- and middle-income countries (LMICs) to create and share new learning in response to the social and behavioral challenges they faced.

Sadki designed L&D for “in-depth engagement on priority topics,” insights into “the raw, unfiltered perspectives of frontline staff,” and peer dialogue that “gives a voice to front-line workers” (The Geneva Learning Foundation, 2022).

Subscribe to continue reading

Subscribe to get access to the rest of this post and other subscriber-only content.

What learning science underpins peer learning for Global Health?

What learning science underpins peer learning for Global Health?

Events, Global health

Watch Reda Sadki’s presentation at the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH) Symposium on 19 October 2023

Most significant learning that contributes to improved performance takes place outside of formal training.

It occurs through informal and incidental forms of learning between peers.

Effective use of peer learning requires realizing how much we can learn from each other (peer learning), experiencing the power of defying distance to solve problems together (remote learning), and feeling a growing sense of belonging to a community (social learning), emergent across country borders and health system levels (networked learning).

At the ASTMH annual meeting Symposium organized by Julie Jacobson, two TGLF Alumnae, María Monzón from Argentina and Ruth Allotey from Ghana, will be sharing their analyses and reflections of how they turned peer learning into action, results, and impact.

In his presentation, Reda Sadki, president of The Geneva Learning Foundation (TGLF), will explore:

  1. What do we need to understand about digital learning?
  2. Networked learning: rethinking learning architecture in the Digital Age
  3. Social learning: peer learning is about making human connections
  4. Practical examples of TGLF peer learning systems for WHO, Wellcome, UNICEF, and Bridges to Development that connect learning to change, results, and impact.
  5. Emergent peer learning systems driven by local practitioner and community needs and priorities.

Join this Peer Learning symposium on Day 2 of the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH).

TechNet conference how to to open access to global health conferences-small

What did we learn from the Movement for Immunization Agenda 2030 (IA2030) in its first two years?

Global health, Innovation, The Geneva Learning Foundation

At a World Health Organization conference in Panama, The Geneva Learning Foundation is hosting an Innovations Café today.

The session’s title is “Connected learning to accelerate local impact at global scale: Year 1 of the Movement for Immunization Agenda 2030 (IA2030)”.

What is the Movement for Immunization Agenda 2030 (IA2030)?

Immunization Agenda 2030 (IA2030) is the world’s strategy, adopted by the World Health Assembly in 2020, to achieve the global goals for immunization.

In March 2022, The Geneva Learning Foundation (TGLF) launched a call to form a movement in support of IA2030.

By June 2023, over 16,000 health workers were participating.

More than 80% work in districts and health facilities and over half are government workers.

70% work in fragile contexts such as armed conflict, remote areas, urban poverty, and other challenges.

This ground-up commitment has the potential to complement the top-down work of the IA2030 global partners, if this community of practitioners is recognized, empowered, and listened to by global health agencies and donors.

In today’s session, you will hear first-hand from IA2030 Movement Members.

How has participation in this Movement helped them to better serve the immunization and primary health care needs of the local communities they serve?

In Year 1 of this Movement, we demonstrated the feasibility of establishing a global peer learning platform for immunization practitioners, with the creation of a movement of more than 10,000 health workers in support of IA2030 goals. Learn more about Year 1 outcomes.

In Year 2, as the Movement continued to grow rapidly in over 100 countries, we generated evidence of practitioner demand and public health impact, captured in academic papers and multiple detailed case studies. Request your invitation to the IA2030 Movement’s Knowledge-to-Action Hub to get access to research outputs.

Learn more about how new digital learning approach can open access to international global health conferences otherwise restricted to the select few.

Health performance management in complex adaptive systems

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

Global health, Learning, Research

We need a conceptual framework that situates health performance management within complex adaptive systems.

This is a summary of an important paper by Tom Newton-Lewis et al. It describes such a conceptual framework that identifies the factors that determine the appropriate balance between directive and enabling approaches to health performance management in complex systems.

Existing health performance management approaches in many low- and middle-income country health systems are largely directive, aiming to control behaviour using targets, performance monitoring, incentives, and answerability to hierarchies.

Health systems are complex and adaptive: performance outcomes arise from interactions between many interconnected system actors and their ability to adapt to pressures for change.

In my view, thiscpaper mends an important broken link in theories of change that try to consider learning beyond training.

The complex, dynamic, multilevel nature of health systems makes outcomes difficult to control, so directive approaches to performance management need to be balanced with enabling approaches that foster collective responsibility and empower teams to self-organise and use data for shared sensemaking and decision-making.

Directive approaches may be more effective where workers are primarily extrinsically motivated, in less complex systems where there is higher certainty over how outcomes should be achieved, where there are sufficient resources and decision space, and where informal relationships do not subvert formal management levers.

Enabling approaches may be more effective in contexts of higher complexity and uncertainty and where there are higher levels of trust, teamwork, and intrinsic motivation, as well as appropriate leadership.

Directive and enabling approaches are not ‘either-or’: designers of health performance management systems must strive for an appropriate balance between them.

The greater the dissonance between designing a health performance management system and the real context in which it is implemented, the more likely it is to trigger perverse, unintended consequences.

Interventions must be carefully calibrated to the context of the health system, the culture of its organisations, and the motivations of its individuals.

By considering each factor and their interdependencies, actors can minimise perverse unintended consequences while attaining a contextually appropriate balance between directive or enabling approaches in complex adaptive systems.

The complexity of the framework and the interdependencies it describes reinforce that there is no ‘one-size-fits-all’ blueprint for health performance management.

For higher-order learning and whole-system improvement to occur, practical and tacit knowledge needs to flow among complex adaptive systems’ actors and organisations, thus leveraging the power of networks and social connections (eg, learning exchanges and communities of practice).

Reference

Newton-Lewis, T., Munar, W., Chanturidze, T., 2021. Performance management in complex adaptive systems: a conceptual framework for health systems. BMJ Glob Health 6, e005582. https://doi.org/10.1136/bmjgh-2021-005582l

Collective Intelligence Cambridge Digital Education Futures Initiative

The COVID-19 Peer Hub as an example of Collective Intelligence (CI) in practice

Global health, The Geneva Learning Foundation

A new article by colleagues at the Cambridge Digital Education Futures Initiative (DEFI) illustrates academic understanding of Collective Intelligence (CI) through the COVID-19 Peer Hub, a peer learning initiative organized by over 6,000 frontline health workers in Africa, Asia, and Latin America, with support from The Geneva Learning Foundation (TGLF), in response to the initial shock of the pandemic on immunization services that placed 80 million children at risk of missing lifesaving vaccines. Learn more about the COVID-19 Peer Hub…

From the abstract:

Collective Intelligence (CI) is important for groups that seek to address shared problems.

CI in human groups can be mediated by educational technologies.

The current paper presents a framework to support design thinking in relation to CI educational technologies.

Our Collective Intelligence framework is grounded in an organismic-contextualist developmental perspective that orients enquiry to the design of increasingly complex and integrated CI systems that support coordinated group problem solving behaviour.

We focus on pedagogies and infrastructure and we argue that project-based learning provides a sound basis for CI education, allowing for different forms of CI behaviour to be integrated, including swarm behaviour, stigmergy, and collaborative behaviour.

We highlight CI technologies already being used in educational environments while also pointing to opportunities and needs for further creative designs to support the development of CI capabilities across the lifespan.

We argue that Collective Intelligence education grounded in dialogue and the application of CI methods across a range of project-based learning challenges can provide a common bridge for diverse transitions into public and private sector jobs and a shared learning experience that supports cooperative public-private partnerships, which can further reinforce advanced human capabilities in system design.

Article excerpt:

As an example of Collective Intelligence in practice, in 2020–2021, more than 6000 health workers joined The Geneva Learning Foundation (TGLF) COVID-19 Peer Hub.

Participants shared more than 1200 ideas or practices for managing the pandemic in their contexts within 10 days. Relevant peer ideas and practices were then referenced as participants produced individual, context-specific action plans that were then reviewed by peers before finalisation and implementation.

Mapping of action plan citations (C3L 2022) demonstrate patterns of peer learning, between countries, organisations and system levels.

In parallel, TGLF synthesises data generated by peer learners in formats legitimised by the global health knowledge system (e.g. Moore et al. 2022).

The biggest challenge to CI in this context remains one of legitimacy: how can collective intelligence compete with the perceived gold standard of academic publication within this expert-led culture?

We argue that as CI education is further developed and extends across the lifespan from school learning environment to work and organisational environments, CI technologies and practices will be further developed, evaluated, and refined and will gain legitimacy as part of broader societal capabilities in CI that are cultivated and reinforced on an ongoing basis.

References cited in this excerpt:

Kovanovic, V. et al. (2022) The power of learning networks for global health: The Geneva Learning Foundation COVID-19 Peer Hub Project Evaluation Report. Centre for Change and Complexity in Learning.

Moore, Katie, Barbara Muzzulini, Tamara Roldán, Juliet Bedford, and Heidi Larson. 2022. Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.6965355

Full article: Hogan, M.J., Barton, A., Twiner, A., James, C., Ahmed, F., Casebourne, I., Steed, I., Hamilton, P., Shi, S., Zhao, Y., Harney, O.M., Wegerif, R., 2023. Education for collective intelligence. Irish Educational Studies 1–30. https://doi.org/10.1080/03323315.2023.2250309

Teach to Reach

Teach to Reach: peer learning at scale

The Geneva Learning Foundation

Teach to Reach are fast-paced, dynamic digital events connecting local and global practitioners to each other in a new, potentially transformative shared dialogue. 

Teach to Reach and other TGLF special events rally thousands, serving as powerful moments of inspiration, providing the amazing sensation of being connected with thousands of fellow, like-minded people and the impetus to transform this feeling into shared purpose and action. 

Meet, network, and learn with colleagues from all over the world 

Successive editions of TGLF’s flagship event series, “Teach to Reach: Connect”, enabled a cumulative total of 27,000 health professionals to share experiences, test approaches, and identify solutions with international experts listening and learning with them. 

To learn more about the Geneva Learning Foundation (TGLF), download our brochure, listen to our podcast, view our latest livestreams, subscribe to our insights, and follow us on Instagram, LinkedIn, Facebook, Twitter, and YouTube. Or introduce yourself to our Partnerships team.

Honoring health professionals as leaders of change

Honoring health professionals as leaders of change

Global health

We honor everyone who is joining the Special Event “From community to planet: Health professionals on the frontlines of climate change”: health staff from immunization and other areas of health – environmental health and One Health, but also those who fight neglected tropical diseases (NTDs), HIV, and other ailments. We also honor allies, including human rights advocates, those working to decolonize global health, fighting for gender and racial equity as well as economic justice.

Since 2016, the Geneva Learning Foundation (TGLF) has supported a global peer learning network and platform, built by and for immunization staff from all over the world. This is because we believe that practitioner-led peer education is a powerful philosophy for change in the Digital Age. 

In 2020, when the COVID-19 pandemic, at least 80 million children under one were placed at risk of vaccine-preventable diseases such as diphtheria, measles and polio as COVID-19 disrupted immunization service as worldwide. Over 6,000 immunization staff om TGLF’s immunization network worked together to build the COVID-19 Peer Hub, collaborating on early-learning recovery plans and then preparing strategies to engage communities ahead of the introduction of the COVID-19 vaccines.

In March 2022, this network and platform helped launch the Movement for Immunization Agenda 2030 (IA2030), transforming the world’s strategy into local action. IA2030 Movement Leaders are accelerating progress by learning from each other, sharing successes, lessons learned, and challenges, forging together new ways of thinking, learning, and doing to meet the complex challenges ahead. Learn more about the Movement… What is the Movement for Immunization Agenda 2030 (IA2030)?

We honor these IA2030 Leaders, primarily government workers from districts and facilities, who were the first to respond to the Call to Action of the Special Event “From community to planet: Health professionals on the frontlines of climate change”.

What does immunization have to do with climate change? Read this blog post.

Learning from Front-line Health Workers in the Climate Change Era

Learning from Frontline Health Workers in the Climate Change Era

Global health, Writing

By Julie Jacobson, Alan Brooks, Charlotte Mbuh, and Reda Sadki

The escalating threats of climate change cast long shadows over global health, including increases in disease epidemics, profound impacts on mental health, disruptions to health infrastructure, and alterations in the severity and geographical distribution of diseases.

Mitigating the impact of such shadows on communities will test the resilience of health infrastructure in low- and middle-income countries (LMICs) and especially challenge frontline health workers. The need for effective and cost-efficient public health interventions, such as immunization, will evolve and grow.

Health workers, approximately 70% of which are women, that provide immunization and other health services will be trusted local resources to the communities they serve, further amplifying their centrality in resilient health systems.

Listening to and building upon the experiences and insights of frontline health workers as they live with and increasingly work to address the manifestations of climate change on health is pivotal to the collective, global response today and in the years to come.

We imagine a future of health workers connected to each other, learning directly from the successes and challenges of others by choosing to engage in digital, peer-supported, peer-learning networks regardless of the remoteness or location of their communities. Success will lie in a nimbleness and ability to quickly see new emerging patterns and respond to evolving needs of individuals and communities.

Such a future shines a light on the importance of new ways of thinking about global health, leadership, who should have a “voice”, starting from a position of equity not hierarchy, and the value that peers ascribe to each other. The hyperlocal impact of climate change on health cannot be mitigated only through global pronouncements and national policies. It requires local knowledge and understanding.

Recognizing this unique position of health workers, Bridges to Development and The Geneva Learning Foundation, two Swiss non-profits, are supporting this first-ever, large peer-learning event for frontline health workers to share their experiences and insights on climate change and health.

More than 1,100 health workers have already shared their observations of changes in climate and health affecting the communities they serve in over 60 countries. They will be sharing their stories and insights at the Special Event: From community to planet: Health professionals on the frontlines of climate change, but you can already read short summaries from Guatemala; India and Mongolia; Bénin, Gambia, and Kenya.

Starting from a Call to Action shared through the Movement for Immunization Agenda (IA2030), the call has “gone viral” through local communities and districts: over 4,500 people – most of them government workers involved in primary health care services in LMICs – registered to participate and contribute.

Almost every health worker responding says that they are very worried about climate change, and that, for them, it is already a grave threat to the health of the communities they serve.

Taken together, their observations, while imperfect, paint a daunting picture. This picture, consistent with global statistics and other data, helps to bring to life global pronouncements of the dire implications of climate change for health in LMICs.

Amid this immense and dire challenge lies an opportunity to shift from a rigid, academically-dominated approach to a decentralized, democratized recognition and learning about the health impacts of climate change. This shift underscores the importance of amplifying insights from those who are bearing the brunt of the consequences of climate change, and recognizing the special role of health service workers as bridges between their communities and those working elsewhere to address similar challenges.

This perspective requires those of us working at the global level to critically evaluate and challenge our biases and assumptions. The notion that only climate or health specialists can offer meaningful insights or credible solutions should be questioned. The understanding of climate change’s impact on epidemiology of disease, mental health and other manifestations – and the strategies employed to mitigate them – can be substantially enriched and sharpened by welcoming the voices of those on the frontlines. By doing so, we can foster a more comprehensive, inclusive, equitable and effective response to the challenges posed by climate change.

The thousands of members of the Movement for the Immunization Agenda 2030 (IA2030) and others who have initiated this global dialogue around climate and health may be forging a new path, showing the feasibility and value of the global health community listening to and supporting the potential of frontline health workers to shine the brightest of lights into the shadow cast worldwide by climate change.

This editorial is a contribution to the Special Event: From community to planet: Health professionals on the frontlines of climate change.

About the authors

Julie Jacobson and Alan Brooks are co-founders and managing partners of Bridges to Development. Jacobson was the president of the American Society for Tropical Medicine and Hygiene (ASTMH) in 2020-2021. Bridges to Development, a nonprofit founded in 2018 based in Europe and the US, strives to build on the world’s significant progress to date towards a stronger and more resilient future.

Reda Sadki and Charlotte Mbuh lead the Geneva Learning Foundation (TGLF). The Geneva Learning Foundation (TGLF) is a non-profit implementing its vision to catalyze transformation through large scale peer and mentoring networks led by frontline actors facing critical threats to our societies. Learn more: https://doi.org/10.5281/zenodo.7316466.

Illustration: The Geneva Learning Foundation Collection © 2023. All rights reserved.

Interplay between climate and health

What does immunization have to do with climate change?

Global health, Thinking aloud

With climate-driven shifts in disease patterns and emerging health threats, the need for a robust immunization infrastructure is more obvious than ever. As the demand for both existing and novel vaccines rises in response to an expanding disease burden and new health threats, immunization staff will inevitably play a key role.

Immunization staff, trusted health advisors to communities, already stand as sometimes-overburdened but always critical actors in resilient health systems.

These professionals, entrusted with administering vaccines, contribute to preventing disease outbreaks and maintaining population health. Furthermore, their direct engagement with local communities, their intimate understanding of community health concerns, and their role as trusted advisors position them to recognize and respond to emerging health needs.

The role of immunization and other primary health care (PHC) staff as health educators becomes increasingly pertinent in a changing climate. By leveraging their experience in working with communities to understand and accept health interventions, immunization staff can help those they serve to make sense of the complex relationships between climate and health – and develop appropriate responses.

Through digital networks, we see health professionals connected to each other, learning from each other’s successes, lessons learned, and challenges. We imagine that these networks, if properly nurtured and sustained, will become increasingly important as health workers face the interconnected consequences of climate change on health within the local communities where they work for health. This also require new ways of thinking and new leadership, in addition to a new kind of digital health infrastructure to support turning learning into action.

As we step into a world facing escalating health threats from a changing climate, the crucial role of immunization staff in protecting communities will become more pronounced.

Existing approaches – even the ones that so impressively moved the needle of vaccination coverage and health in the past – may now need to be reconsidered and adapted to face new challenges and new threats that we know are coming.

By supporting the will and commitment of immunization staff who are concerned about the consequences of climate on health, and then expanding to include other health professionals, we may find that immunization can serve as a pathfinder to strengthen health systems and promote health equity. We may even find practical, meaningful ways for frontline health professionals and communities to forge together a new leadership for global health.

Learn more about the Geneva Learning Foundation’s special event: From community to planet: Health professionals on the frontlines of climate change.

Analog gates or digital bridges.png

Digital bridges cannot cross analog gates

Global health, Thinking aloud

I’ve been doing a lot of thinking recently about an interesting question, as I’ve observed myself and colleagues starting to travel again: “Why are we again funding high-cost, low-volume face-to-face conferences that yield, at best, uncertain outcomes?”

I am surprised to have to ask this question. I was hoping for a different outcome, in which the experience of the COVID-19 pandemic led to a lasting change in how we bridge physical and digital spaces for a better future. We were brutally forced to work differently due to the COVID-19 pandemic’s restrictions on freedom of movement. Nevertheless, we discovered that it is possible to connect, meet, collaborate, and learn without sinking budgets into air travel and accommodation. At least some of work-related travel was due to habit and convention, not necessity. Yes, there were limitations, especially due to the emergency nature of the pivot to online. But the debate is open whether the limitations we experienced being forced to work online are more or less severe than those of the offline medium.

In global health, traditional face-to-face meetings, workshops, and conferences have been part and parcel of professional life for decades. They served their intended purpose, helping staff connect formally and informally, providing the connective tissue to learn, share, and coordinate. They have been – and remain – deeply ingrained in the culture of global health. Why should this modus operandi be reconsidered?

As someone who is often required to attend face-to-face conferences, despite being a vocal advocate for more efficient, inclusive models, here is how I understand both sides of the dichotomy that this scenario presents.

Traditional face-to-face meetings, workshops, and conferences offer a unique charm. They allow the select few to reconnect with colleagues, stay updated on institutional developments, and keep fingers on the pulse of the latest changes in our fields. Information can be shared informally, which is far more difficult to do online. (This is not inherent to the online medium, but due to the technologies we have developed that assume, support, and structure formal communication.) If you were invited or selected to be at the meeting, that indicates to those in the room that you are a valid stakeholder.

There is a considerable downside. These events are exclusionary by definition. Not everyone’s costs can be covered. Selection is often based on hierarchy. Often, only the most senior get to go. When less senior practitioners are included, tokenism is difficult to avoid. Then, there is the high cost. It is primarily expenditure on travel and hotels, not event quality. There is also the cost to the environment. Think of the carbon footprint. They are disruptive to everyday work, as attendance requires absence. Strangely, their impact is seldom measured, evaluated, or questioned.

The same donor who will unquestionably plunk down $150,000 for the plane tickets and hotels rooms of 100 people might require the evidence of a randomized controlled trial (RCT) before investing in a new digital learning approach that might include 1,000 or 10,000 people for the same cost and produce far more significant outcomes than a meeting report.

So why are face-to-face events still being funded, at high cost and questionable return, when global health is supposed to be evidence-based and focused on impact?

Ironically, as Girija Sankar made the case recently in The Lancet, the very conferences designed to push the boundaries of research and collaboration in global health often act as “gates,” creating a divide between insiders and those on the outside. These gatherings are often arranged by the gatekeepers of global health, the credentialed leaders who control funding and policy. Their decisions shape the future of health at a global level, conferring agency upon a select few while inadvertently excluding many others.

It is undeniably satisfying – and deeply so – to connect with colleagues over the course of several days, sharing conversation, meals, coffees. It is not only about listening and learning. It is about being human together, despite the constraints and urgencies of the work. So, if you are in a position to fund such an event for yourself or for your colleagues, why would you say no, given the obvious benefits and zero incentive to deny your colleagues what they are used to getting?

The value of such events is in part premised on their exclusivity. Letting everyone in could dilute their value. Furthermore, digital experience remains awful: a Zoom call is undeniably inferior to the experiential richness and pleasure of a meeting in a shared physical space.

Unfortunately, as long as such wonderful moments are reserved for the few – due to the nature of the medium, despite the best intents –, such communion stops at the conference walls – and excludes everyone outside them.

The Geneva Learning Foundation’s Teach to Reach program presents a stark contrast to this traditional model. Our online, digital, and networked peer learning events are dynamic, inclusive, connecting local practitioners from everywhere. With no upper limit on participants, these digital events rally thousands from all corners of the globe, providing an unparalleled platform for shared learning and action.

The upcoming Teach to Reach 8 event on 16 June 2023 is a testament to this, with over 16,000 anglophones and francophones already registered to join. Most notably, the majority of participants are government health workers working on the frontlines in Africa and Asia. Teach to Reach is led by an “organizing committee” composed of 282 Teach to Reach Alumni from 35 countries who are founding Members of the Global Council of Learning Leaders for Immunization in November 2020.

Some global-level colleagues who have rejoined the mission travel, conference, and workshop circuit share that they struggle to understand Teach to Reach. It is just too different from what they are used to. They have to painstakingly listen to staff with lousy connectivity who share local experiences, problems, and challenges that seem quaint, compared to the abstract global-level strategies they usually engage peers who are almost exactly like themselves. Such sameness is reassuring. Comparatively, Teach to Reach is too chaotic and noisy. So many voices, speaking from so many different pespectives. Too time-consuming. Too confusing. Too different from what “we” are used to. Too messy. 

Yet, the real world is messy. We know that the probability of finding a solution locally increases with the number and diversity of inputs available. At Teach to Reach, thousands share their experience, using a robust, proven peer learning model. The global experts who do attend do so as “guides on the side” rather than “sages on the stage”.

The unstated, underlying assumption of many so-called capacity-building initiatives is that the locals do not know. Therefore, “we” must teach them. There is no way to call this anything other than a colonial assumption. Recognizing the value and significance of local expertise and experience may have been less important in the past, when countries successfully carried out effective top-down strategies that moved the needle of vaccination coverage across the world. Today’s more complex immunization challenges require problem-solving approaches that recognize that context is central. What you know, because you are there every day, side-by-side with families and communities that you serve, turns out to be more important than generalities.

For example, the Foundation’s research has shown that reaching zero-dose or underimmunized children calls for local creativity to tailor and adapt strategies, rather than apply a cookie-cutter guideline. Should we be searching for generalizations that can be turned into norms and standards, when every zero-dose context is different? What if the opportunity were to hone in on the ‘how’ of local action, to better understand what makes the difference at the last mile of service delivery?

Should we assume that it is local staff who need to develop their capacity and change, when behavior change is probably necessary for everyone, at all levels?

Change is hard, but it is definitely happening. The last two editions of Teach to Reach have been in partnership with UNICEF and since 2022 with support from Wellcome. Ephrem T. Lemango and Kate O’Brien, who lead immunization at UNICEF and WHO respectively, prefaced the latest Teach to Reach report, writing: “Uniquely, the Geneva Learning Foundation’s platform and its Teach to Reach events provide a way to link such people together, so that they can share experiences about what works and equally important, what doesn’t work, while learning from each other. Learning happens best when people seek answers to their specific daily challenges. Teach to Reach is proof that immunization professionals are hungry to learn, and hungry to share.”

Furthermore, they note that “it is humbling to hear how committed people are to sharing experiences in the hope that they will benefit someone else, how the inadequacies of internet connections fail to deter people participating, and how so many are using precious digital data to take part. The digital space allows everyone to participate, irrespective of national boundaries or positions in an immunization hierarchy.”

Girija Sankar also reminds us that gatekeeping is not only for the leaders. It is also an opportunity for each of us to consider our roles and responsibilities. When deciding on invites, we should ask ourselves, “Is the limitation due to budget constraints or based on our perception of who has the most valuable input or the most funding to contribute?” It is also a call to action for those of us who have access to closed-door meetings or sit on advisory boards. We must pause and reflect on our roles and use our authority to pave the way for those who might not traditionally have a voice in these important discussions.

So, while I, and many others, have to travel to face-to-face conferences to stay “in the loop”, it is essential to recognize the limitations of these gatherings and work towards more inclusive and efficient models. The need to shift our mindset is more pressing than ever in the field of global health. In our quest for a healthier world, let’s ensure that the gates of knowledge and decision-making are open to all. Let’s embrace models like Teach to Reach, breaking down barriers and creating an inclusive platform for dialogue, learning, and action.

Imagine if the World Health Organization’s unspent mission travel budget in 2020 – around $400 million – had been invested in digital infrastructure to support continuous learning to explore and support new kinds of collaboration between different levels of the health system.