Learn health, but beware of the behaviorist trap

Reda SadkiGlobal health, Theory

The global health community has long grappled with the challenge of providing effective, scalable training to health workers, particularly in resource-constrained settings. In recent years, digital learning platforms have emerged as a potential solution, promising to deliver accessible, engaging, and impactful training at scale. Imagine a digital platform intended to train health workers at scale. Their theory of change rests on a few key assumptions: On the surface, this seems sensible. Mobile optimization recognizes health workers’ technological realities. Multimedia content seems more engaging than pure text. Assessments appear to verify learning. Incentives promise to drive uptake. Scale feels synonymous with success. While well-intentioned, such a platform risks falling into the trap of a behaviorist learning agenda. This is an approach that, despite its prevalence, is a pedagogical dead-end with limited potential for driving meaningful, sustained improvements in health worker performance and health outcomes. It is a paradigm that views learners …

Why health leaders who are critical thinkers choose rote learning for others-small

Why health leaders who are critical thinkers choose rote learning for others

Reda SadkiGlobal health

Many health leaders are highly analytical, adaptive learners who thrive on solving complex problems in dynamic, real-world contexts. Their expertise is grounded in years of field experience, where they have honed their ability to rapidly generate insights, test ideas, and innovate solutions in collaboration with diverse stakeholders. In January 2021, as countries were beginning to introduce new COVID-19 vaccines, Kate O’Brien, who leads WHO’s immunization efforts, connected global learning to local action: “For COVID-19 vaccines […] there are just too many lessons that are being learned, especially according to different vaccine platforms, different communities of prioritization that need to be vaccinated. So [everyone]  has got to be able to scale, has got to be able to deal with complexity, has got to be able to do personal, local innovation to actually overcome the challenges.” In an Insights Live session with the Geneva Learning Foundation in 2022, she made a compelling …

Petra Klepac Climate change, malaria and neglected tropical diseases-a scoping review

Klepac and colleagues‘ scoping review of climate change, malaria and neglected tropical diseases: what about the epistemic significance of health worker knowledge?

Reda SadkiGlobal health

By Luchuo E. Bain and Reda Sadki The scoping review by Klepac et al. provides a comprehensive overview of codified academic knowledge about the complex interplay between climate change and a wide range of infectious diseases, including malaria and 20 neglected tropical diseases (NTDs). The review synthesized findings from 511 papers published between 2010 and 2023, revealing that the vast majority of studies focused on malaria, dengue, chikungunya, and leishmaniasis, while other NTDs were relatively understudied. The geographical distribution of studies also varied, with malaria studies concentrated in Africa, Brazil, China, and India, and dengue and chikungunya studies more prevalent in Australia, China, India, Europe, and the USA. One of the most striking findings of the review is the potential for climate change to have profound and varied effects on the distribution and transmission of malaria and NTDs, with impacts likely to vary by disease, location, and time. However, the …

Examples of double-loop learning in global health

Five examples of double-loop learning in global health

Reda SadkiWriting

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 …

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

Reda SadkiGlobal 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 …

What is double loop learning in global health

What is double-loop learning in global health?

Reda SadkiGlobal 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.” 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 …

Why lack of continuous learning is the Achilles heel of immunization

Why lack of continuous learning is the Achilles heel of immunization 

Reda SadkiGlobal health, Theory

Continuous learning is lacking in immunization. This lack may be an underestimated barrier to the “Big Catch-Up” and reaching zero-dose children This was a key finding presented at Gavi’s Zero-Dose Learning Hub (ZDLH) webinar “Equity in Action: Local Strategies for Reaching Zero-Dose Children and Communities” on 24 January 2024. The finding is based on analysis large-scale measurements conducted by the Geneva Learning Foundation in 2020 and 2022, with more than 10,000 immunization staff from all levels of the health system, job categories, and contexts, responding from over 90 countries. Year n Continuous learning Dialogue & Inquiry Team learning Embedded Systems Empowered People System Connection Strategic Leadership 2020 3830 3.61 4.68 – 4.81 4.68 5.10 4.83 2022 6185 3.76 4.71 4.86 4.93 4.72 5.23 4.93 TGLF global measurements (2020 and 2022) of learning culture in immunization, using the Dimensions of Learning Organization Questionnaire (DLOQ) What does this finding actually mean? In immunization, the …

Protect Invest Together

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

Reda SadkiGlobal 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 …

Analog gates or digital bridges.png

Digital bridges cannot cross analog gates

Reda SadkiGlobal 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 …

Credible knowers

Credible knowers

Reda SadkiGlobal health, The Geneva Learning Foundation, Thinking aloud

“Some individuals are acknowledged as credible knowers within global health, while the knowledge held by others may be given less credibility.” – (Himani Bhakuni and Seye Abimbola in The Lancet, 2021) “Immunization Agenda 2030” or “IA2030” is a strategy that was unanimously adopted at the World Health Assembly in 2020. The global community that funds and supports vaccination globally is now exploring what it needs to do differently to transform the Agenda’s goal of saving 50 million lives by the end of the decade into reality. Last year, over 10,000 national and sub-national health staff from 99 countries pledged to achieve this goal when they joined the Geneva Learning Foundation’s first IA2030 learning and action research programme. Discover what we learned in Year 1… Learn more about the Foundation’s platform and network… What is the Movement for Immunization Agenda 2030 (IA2030)? In global health, personal experience is assumed to be anecdotal, the …