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Category: Global health

  • A global health framework for Artificial Intelligence as co-worker to support networked learning and local action

    A global health framework for Artificial Intelligence as co-worker to support networked learning and local action

    The theme of International Education Day 2025, “AI and education: Preserving human agency in a world of automation,” invites critical examination of how artificial intelligence might enhance rather than replace human capabilities in learning and leadership. Global health education offers a compelling context for exploring this question, as mounting challenges from climate change to persistent inequities demand new approaches to building collective capability.

    The promise of connected communities

    Recent experiences like the Teach to Reach initiative demonstrate the potential of structured peer learning networks. The platform has connected over 60,000 health workers, primarily government workers from districts and facilities across 82 countries, including those serving in conflict zones, remote rural areas, and urban settlements. For example, their exchanges about climate change impacts on community health point the way toward more distributed forms of knowledge creation in global health. 

    Analysis of these networks suggests possibilities for integrating artificial intelligence not merely as tools but as active partners in learning and action. However, realizing this potential requires careful attention to how AI capabilities might enhance rather than disrupt the human connections that drive current success.

    Artificial Intelligence (AI) partnership could provide crucial support for tackling mounting challenges. More importantly, they could help pioneer new approaches to learning and action that genuinely serve community needs while advancing our understanding of how human and machine intelligence might work together in service of global health.

    Understanding Artificial Intelligence (AI) as partner, not tool

    The distinction between AI tools and AI partners merits careful examination. Early AI applications in global health primarily automate existing processes – analyzing data, delivering content, or providing recommendations. While valuable, this tool-based approach maintains clear separation between human and machine capabilities.

    AI partnership suggests a different relationship, where artificial intelligence participates actively in learning networks alongside human practitioners. This could mean AI systems that:

    • Engage in dialogue with health workers about local observations
    • Help validate emerging insights through pattern analysis
    • Support adaptation of solutions across contexts
    • Facilitate connections between practitioners facing similar challenges

    The key difference lies in moving from algorithmic recommendations to collaborative intelligence that combines human wisdom with machine capabilities.

    A framework for AI partnership in global health

    Analysis of current peer learning networks suggests several dimensions where AI partnership could enhance collective capabilities:

    • Knowledge creation: Current peer learning networks enable health workers to share observations and experiences across borders. AI partners could enrich this process by engaging in dialogue about patterns and connections, while preserving the central role of human judgment in validating insights.
    • Learning process: Teach to Reach demonstrates how structured peer learning accelerates knowledge sharing and adaptation. AI could participate in these networks by contributing additional perspectives, supporting rapid synthesis of experiences, and helping identify promising practices.
    • Local leadership: Health workers develop and implement solutions based on deep understanding of community needs. AI partnership could enhance decision-making by exploring options, modeling potential outcomes, and validating approaches while maintaining human agency.
    • Network formation: Digital platforms currently enable lateral connections between health workers across regions. AI could actively facilitate network development by identifying valuable connections and supporting knowledge flow across boundaries.
    • Implementation support: Peer review and structured feedback drive current learning-to-action cycles. AI partners could engage in ongoing dialogue about implementation challenges while preserving the essential role of human judgment in local contexts.
    • Evidence generation: Networks document experiences and outcomes through structured processes. AI collaboration could help develop and test hypotheses about effective practices while maintaining focus on locally-relevant evidence.

    Applications across three global health challenges

    This framework suggests new possibilities for addressing persistent challenges.

    1. Immunization systems

    Current global immunization goals face significant obstacles in reaching zero-dose children and strengthening routine services. AI partnership could enhance efforts by:

    • Supporting microplanning by mediating dialogue about local barriers
    • Facilitating rapid learning about successful engagement strategies
    • Enabling coordinated action across health system levels
    • Modeling potential impacts of different intervention approaches

    2. Neglected Tropical Diseases (NTDs)

    The fight against NTDs suffers from critical information gaps and weak coordination at local levels. Many communities, including health workers, lack basic knowledge about these diseases. AI partnership could help address these gaps through:

    • Facilitating knowledge flow between affected communities
    • Supporting coordination of control efforts
    • Enabling rapid validation of successful approaches
    • Strengthening surveillance and response networks

    3. Climate change and health

    Health workers’ observations of climate impacts on community health provide crucial early warning of emerging threats. AI partnership could enhance response capability by:

    • Engaging in dialogue about changing disease patterns
    • Supporting rapid sharing of adaptation strategies
    • Facilitating coordinated action across regions
    • Modeling potential impacts of interventions

    Pandemic preparedness beyond early warning

    The experience of digital health networks during recent disease outbreaks reveals both the power of distributed response capabilities and the potential for enhancement through AI partnership. When COVID-19 emerged, networks of health workers demonstrated remarkable ability to rapidly share insights and adapt practices. For example, the Geneva Learning Foundation’s COVID-19 Peer Hub connected over 6,000 frontline health professionals who collectively generated and implemented recovery strategies at rates seven times faster than isolated efforts.

    This networked response capability suggests new possibilities for pandemic preparedness that combines human and machine intelligence. Heightened preparedness could emerge from the interaction between health workers, communities, and AI partners engaged in continuous learning and adaptation.

    Current pandemic preparedness emphasizes early detection through formal surveillance. However, health workers in local communities often observe concerning patterns before these register in official systems.

    AI partnership could enhance this distributed sensing capability while maintaining its grounding in local realities. Rather than simply analyzing reports, AI systems could engage in ongoing dialogue with health workers about their observations, helping to:

    • Explore possible patterns and connections
    • Test hypotheses about emerging threats
    • Model potential trajectories
    • Identify similar experiences across regions

    The key lies in combining human judgment about local significance with AI capabilities for pattern recognition across larger scales.

    The focus remains on accelerating locally-led learning rather than imposing standardized solutions.

    Perhaps most importantly, AI partnership could enhance the collective intelligence that emerges when practitioners work together to implement solutions. Current networks enable health workers to share implementation experiences and adapt strategies to local contexts. Adding AI capabilities could support this through:

    • Ongoing dialogue about implementation challenges
    • Analysis of patterns in successful adaptation
    • Support for rapid testing of modifications
    • Facilitation of cross-context learning

    Success requires maintaining human agency in implementation while leveraging machine capabilities to strengthen collective problem-solving.

    This networked vision of pandemic preparedness, enhanced through AI partnership, represents a fundamental shift from current approaches. Rather than attempting to predict and control outbreaks through centralized systems, it suggests building distributed capabilities for continuous learning and adaptation. The experience of existing health worker networks provides a foundation for this transformation, while artificial intelligence offers new possibilities for strengthening collective response capabilities.

    Investment for innovation

    Realizing this vision requires strategic investment in:

    • Network development: Supporting growth of peer learning platforms that accelerate local action while maintaining focus on human connection.
    • AI partnership innovation: Developing systems designed to participate in learning networks while preserving human agency.
    • Implementation research: Studying how AI partnership affects collective capabilities and health outcomes.
    • Capacity strengthening: Building health worker capabilities to effectively collaborate with AI while maintaining critical judgment.

    Looking forward

    The transformation of global health learning requires moving beyond both conventional practices of technical assistance and simple automation. Experience with peer learning networks demonstrates what becomes possible when health workers connect to share knowledge and drive change.

    Adding artificial intelligence as partners in these networks – rather than replacements for human connection – could enhance collective capabilities to protect community health. However, success requires careful attention to maintaining human agency while leveraging technology to strengthen rather than supplant local leadership.

    7 key principles for AI partnership

    1. Maintain human agency in decision-making
    2. Support rather than replace local leadership
    3. Enhance collective intelligence
    4. Enable rapid learning and adaptation
    5. Preserve context sensitivity
    6. Facilitate knowledge flow across boundaries
    7. Build sustainable learning systems

    Listen to an AI-generated podcast about this article

    🤖 This podcast was generated by AI, discussing Reda Sadki’s 24 January 2025 article “A global health framework for Artificial Intelligence as co-worker to support networked learning and local action”. While the conversation is AI-generated, the framework and examples discussed are based on the published article.

    Framework: AI partnership for learning and local action in global health

    DimensionCurrent StateAI as ToolsAI as PartnersPotential Impact
    Knowledge creationHealth workers share observations and experiences through peer networksAI analyzes patterns in shared dataAI engages in dialogue with health workers, asking questions, suggesting connections, validating insightsNew forms of collective intelligence combining human and machine capabilities
    Learning processStructured peer learning through digital platforms and networksAI delivers content and analyzes performanceAI participates in peer learning networks, contributes insights, supports adaptationAccelerated learning through human-AI collaboration
    Local leadershipHealth workers develop and implement solutions for community challengesAI provides recommendations based on data analysisAI works alongside local leaders to explore options, model scenarios, validate approachesEnhanced decision-making combining local wisdom with AI capabilities
    Network formationLateral connections between health workers across regionsAI matches similar profiles or challengesAI actively facilitates network development, identifies valuable connectionsMore effective knowledge networks leveraging both human and machine intelligence
    Implementation supportPeer review and structured feedback on action plansAI checks plans against best practicesAI engages in iterative dialogue about implementation challenges and solutionsImproved implementation through combined human-AI problem-solving
    Evidence generationDocumentation of experiences and outcomes through structured processesAI analyzes implementation dataAI collaborates with health workers to develop and test hypotheses about what worksNew approaches to generating practice-based evidence

    Image: The Geneva Learning Foundation Collection © 2024

  • Why an open-source manifesto for global health?

    Why an open-source manifesto for global health?

    Lire la version française: Pourquoi un manifeste open-source pour la santé globale?

    The global immunization community is now focused on “the big catch-up”, dealing with recovery of immunization services from the consequences of the COVID-19 pandemic, as countries – and immunization staff on the frontlines – work toward the goals of Immunization Agenda 2030 (IA2030).

    At the Seventy-Fourth World Health Assembly, the Director General of the World Health Organization had called for “a broad social movement for immunization that will ensure that immunization remains high on global and regional health agendas and help to generate a groundswell of support or social movement for immunization”.

    A Movement is larger than any one individual or organization. The Geneva Learning Foundation is one of many working to support this Movement. In March 2022, we launched a call for immunization staff at all levels of the health system to connect across boundaries of geography and hierarchy – to commit to working together to achieve the goals of Immunization Agenda 2030 (IA2030).

    In 2022, over 10,000 health professionals, primarily government workers from districts and facilities, joined this movement and shared ideas and practices, analyzed root causes of their local immunization challenges, and developed and implemented corrective actions to tackle them, together. Learn more…

    Today, we share an open-source Manifesto for how health services could develop in ways that we think would make them more effective, recognizing health workers and communities – and the expertise and experience they hold because they are “there every day” – at the centre of public health systems.

    No vision or strategy can or should be developed as a pronouncement by a single organization of how things should be.

    • This Manifesto is an open-source draft because, in today’s complex world, we tackle challenges that no one country or organization can possibly overcome alone.
    • For such a manifesto to be meaningful requires the participation, and contribution of those on the frontlines of global health, in dialogue with global, regional, and country leaders.

    This is why we are inviting you – along with more than 10,000 members of the Movement for Immunization Agenda 2030 (IA2030 – to bring to life and shape this Manifesto.

    Version 1.0 of the manifesto was first shared in a special issue of The Double Loop, the Geneva Learning Foundation’s insights newsletter. Learn more…

  • Rising together: promoting inclusivity and collaboration in global health 

    Rising together: promoting inclusivity and collaboration in global health 

    The ways of knowing of health professionals who work on the front lines are distinct because no one else is there every day. Yet they are typically absent from the global table, even though the significance of local knowledge and action is increasingly recognized. In the quest to achieve global health goals, what value should professionals within global health agencies ascribe to local experience? How do we cultivate a more inclusive and collaborative environment? And why should we bother?

    A recent roundtable discussion, attended by technical officers and senior leaders, provided an occasion to present and explain how the Geneva Learning Foundation’s Immunization Agenda 2030 (IA2030) platform and network could be used to support “consultative engagement” between global and local leaders. This platform and network is reaching over 50,000 health professionals, helping them build connections with each other – defying boundaries of geography and health system levels – to transform learning into action. 

    One global observer expressed concern that all this learning, sharing, and action might be “a bunch of hot air”. This can, at best, be interpreted as doubt towards the value of lived experience, and, at worst, as a brutal dismissal of the will and commitment expressed by thousands of health professionals working, more often than not, in difficult circumstances.

    How should we understand and respond to such skepticism?

    Between March and September 2022, 10,000 health professionals working on the frontlines of immunization made a personal, moral commitment to making a difference in their communities, above and beyond their professional roles. Together, they decided to make their country’s commitment to IA2030 a personal and professional commitment – because they wanted to. This cannot be insignificant.

    In the first year of our IA2030 programme, we observed remarkable gains from such peer learning in the confidence and self-esteem of participants. It has already led to a year of intense sharing of experience, leading to over one thousand health professions taking corrective actions to tackle the root causes of their local challenges, using their own local resources and capacities, and sharing challenges, successes, and lessons learned. Such higher-order learning in the affective domain has already been shown to support deepening competencies needed to tackle complex problems.

    To overcome current immunization challenges, it may be useful to first recognize the value of diverse perspectives, acknowledging that each individual’s lived experience can provide unique insights and knowledge. Building meaningful, respectful connections to those on the frontlines creates new possibilities for how this can be combined with the world’s collective knowledge: the norms, standards, and other guidelines that global agencies produce. By doing so, we can create a more inclusive culture, ensuring not only that every voice is heard and valued, but that these voices combine to figure out the “how” of solving global health challenges that play out at the local level.

    Moreover, we must avoid perpetuating self-fulfilling prophecies that could undermine the motivation and participation. Heat generated by the voices and collective commitment of thousands of local health workers mobilizing and learning together to take action will evaporate into thin air if the global community fails to listen, respond and support them. A less cynical, more inclusive approach might help us raise the upswell of support in favor of immunization. It is essential that we encourage active involvement and recognize the dedication of those who strive to make a difference in the communities they serve. By fostering a supportive environment when we sit at a global roundtable, we can help dispel skepticism and promote the engagement of health professionals at all levels.

    Lastly, it is important to challenge any biases or preconceived notions that may hinder our ability to appreciate the knowledge held by others. As we continue to advocate for local action and recognize the significance of local actors, we must be mindful of potential biases that could inadvertently devalue the contributions of those we seek to support. By being aware of these biases, we can work towards a more equitable global health community where everyone’s knowledge and experience are valued.

    Promoting inclusivity and collaboration in global health agencies is critical to achieving our shared objectives. By recognizing the value of local perspectives, challenging biases, and promoting active engagement, we can create a more supportive environment for health professionals around the world and ensure that their collective efforts are recognized and supported.

    It is important to consider such rejection in the context of the growing emphasis on local action and the recognition of local actors within the global community. As we work towards a more inclusive and collaborative environment, we must ensure that we genuinely appreciate and support local efforts.

  • Credible knowers

    Credible knowers

    “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 lowest form of evidence. We are learning, as one of many organizations contributing to Immunization Agenda 2030 (IA2030), to reconsider this assumption.

    An ongoing ‘consultative engagement’ in which a group of global experts has been listening and learning with health professionals working in districts and facilities provides a practical example that changing how we know can lead to significant change in what we do – and what results and outcomes may come of it.

    On 12 December 2022, the Geneva Learning Foundation (TGLF) hosted a special event with the Immunization Agenda 2030 Working Group on Immunization for Primary Healthcare and Universal Health Coverage, which includes representatives from leading global agencies that support immunization efforts worldwide. 

    Over 4,000 people participated. Most were health workers from districts and health facilities in Asia, Africa, and Latin America. In the run-up to the event, they shared 139 context-specific experiences about their daily work – challenges, lessons learned, and successes – in integrating immunization as part of primary health care practices. The live event opened with such stories and then transitioned into a formal presentation of the framework. This helped everyone make sense of both the “why” and the “how” of the new framework.

    However, this was not the first time that the global group was in listening mode. In fact, the new framework was the capstone in a year-long ‘consultative engagement’ that had begun at Teach to Reach 4 on 10 December 2021, attended by 5,906 health professionals who deliver vaccines in districts and facilities. (Teach to Reach is the Foundation’s networking event series, during which participants meet to share experience and global experts listen and learn. You can view the sessions on primary health care here and here.)

    Global health organizations often issue new frameworks and guidance, sometimes accompanied by funding for capacity development. However, dissemination often relies upon conventional high-cost, low-volume approaches, such as face-to-face training or information transmission through digital channels, even though fairly definitive evidence suggests severe limitations to their effectiveness.

    To address these challenges, the Geneva Learning Foundation and its partners are launching the IA2030 Movement Knowledge to Action Hub, a platform for sharing local expertise and experience across geographical and health system level boundaries. The goal is to research and implement new ways to convert this knowledge into action, results and, ultimately, impact.

    The Double Loop, a monthly insights newsletter edited by Ian Steed and Charlotte Mbuh, is one component of this Hub. The newsletter asked questions to all 4,000 participants of the December 2022 event, 30 days and 90 days later, to gather feedback on the new framework.

    Here are the questions we asked three months on:

    1. Since you discovered the Framework for Action: Immunization for Primary Health Care, have you referred to this framework at least once? If you have not used it, can you tell us why? How could this Framework be improved to be more useful to you?
    2. If you have referred to this Framework, tell us what did you do with the information in the Framework? How did your colleagues respond to the Framework?
    3. How did this Framework make a difference in solving a real-world problem you are facing? How did things turn out? Explain what you are doing differently to integrate health services, empower people and communities, and lead multisectoral policy and action.

    Within days, we received hundreds of answers:

    • Some health professionals apologized, often citing field work, emergency response, and other pressing priorities. This can help better understand the strengths and weaknesses of learning culture (the capacity for change), which the Foundation’s Insights Unit has been researching in the field of immunization since 2020.  
    • Others praised the framework in generic terms (“It’s a great framework”), but did not share any specific examples of actual review, use, or application. Some speak to sometimes peculiar practices of accountability in immunization, where top-down hierarchies remain the norm and provide incentive to always provide positive accounts and responses, whatever the reality may be.
    • A few respondents candidly explained that the Framework does not fit their local needs, as it was primarily designed for national planners. This begs the question of how such local adaptation and tailoring might happen.
    • Finally, we discovered credible, specific narratives of actual use, including adaptation at the local levels. These provide fascinating examples of how a global guidance, developed through a year-long consultative engagement, is actually being translated into practice.

    Our Insights Unit is analyzing these narratives, as this exercise is helping us learn how to scale the IA2030 Movement Knowledge to Action Hub to involve the more than 10,000 health professionals who joined the Movement in its first year.

    The Double Loop regularly shares feedback from its readers as “insights on sights”. You can already read a sample of responses about the framework.

    On 31 March 2023, our team will meet with the IA2030 Working Group to share and discuss the insights gathered through this process.

    The Working Group has also changed through this process. In January 2023, it invited its first sub-national member, Dr. María Monzón from Argentina, who brings her own professional experience and expertise from running a primary health care center. She will also serve as the voice of over 10,000 Movement Leaders, immunization staff from 99 countries and all levels of the health system, who met and have been intensively collaborating for over a year in the Foundation’s IA2030 programme. 

    Surprisingly, one global immunization technical expert shared his concern that thousands of professionals learning from each other to strengthen their resolve and action might amount to “just a bunch of hot air”. This will only be the case if the global immunization community fails to respond and support, even as it proclaims a genuine willingness to recognize local voices as credible knowers. In another blog post, I’ll share some thoughts on what it might take to rise together.

  • What is a “rubric” and why use rubrics in global health education?

    What is a “rubric” and why use rubrics in global health education?

    Rubrics are well-established, evidence-based tools in education, but largely unknown in global health.

    At the Geneva Learning Foundation (TGLF), the rubric is a key tool that we use – as part of a comprehensive package of interventions – to transform high-cost, low-volume training dependent on the limited availability of global experts into scalable peer learning to improve access, quality, and outcomes.

    The more prosaic definition of the rubric – reduced from any pedagogical questioning – is “a type of scoring guide that assesses and articulates specific components and expectations for an assignment” (Source).

    The rubric is a practical solution to a number of complex issues that prevent effective teaching and learning in global health.

    Developing a rubric provides a practical method for turning complex content and expertise into a learning process in which learners will learn primarily from each other.

    Hence, making sense of a rubric requires recognizing and appreciating the value of peer learning.

    This may be difficult to understand for those working in global health, due to a legacy of scientifically and morally wrong norms for learning and teaching primarily through face-to-face training.

    The first norm is that global experts teach staff in countries who are presumed to not know.

    The second is that the expert who knows (their subject) also necessarily knows how to teach, discounting or dismissing the science of pedagogy.

    Experts consistently believe that they can just “wing it” because they have the requisite technical knowledge.

    This ingrained belief also rests on the third mistaken assumption: that teaching is the job of transmitting information to those who lack it.

    (Paradoxically, the proliferation of online information modules and webinars has strengthened this norm, rather than weakened it).

    Indeed, although almost everyone agrees in principle that peer learning is “great”, there remains deep skepticism about its value.

    Unfortunately, learner preferences do not correlate with outcomes.

    Given the choice, learners prefer sitting passively to listen to a great lecture from a globally-renowned figure, rather than the drudgery of working in a group of peers whose level of expertise is unknown and who may or may not be engaged in the activities.

    (Yet, when assessed formally, the group that works together will out-perform the group that was lectured.) For subject matter experts, there can even be an existential question: if peers can learn without me, the expert, then am I still needed? What is my value to learners? What is my role?

    Developing a rubric provides a way to resolve such tensions and augment rather than diminish the significance of expertise.

    This requires, for the subject matter expert, a willingness to rethink and reframe their role from sage on the stage to guide on the side.

    Rubric development requires:

    1. expert input and review to think through what set of instructions and considerations will guide learners in developing useful knowledge they can use; and
    2. expertise to select the specific resources (such as guidance documents, case studies, etc.) that will help the learner as they develop this new knowledge.

    In this approach, an information module, a webinar, a guidance document, or any other piece of knowledge becomes a potential resource for learning that can be referenced into a rubric, with specific indications to when and how it may be used to support learning.

    In a peer learning context, a rubric is also a tool for reflection, stirring metacognition (thinking about thinking) that helps build critical thinking “muscles”.

    Our rubrics combine didactic instructions (“do this, do that”), reflective and exploratory questions, and as many considerations as necessary to guide the development of high-quality knowledge.

    These instructions are organized into versatile, specific criterion that can be as simple as “Calculate sample size” (where there will be only one correct answer), focus on practicalities (“Formulate your three top recommendations to your national manager”), or allow for exploration (“Reflect on the strategic value of your vaccination coverage survey for your country’s national immunization programme”).

    Yes, we use a scoring guide on a 0-4 scale, where the 4 out of 4 for each criterion summarizes what excellent work looks like.

    This often initially confuses both learners and subject matter experts, who assume that peers (whose prior expertise has not been evaluated) are being asked to grade each other.

    It turns out that, with a well-designed rubric, a neophyte can provide useful, constructive feedback to a seasoned expert – and vice versa.

    Both are using the same quality standard, so they are not sharing their personal opinion but applying that standard by using their critical thinking capabilities to do so.

    Before using the rubric to review the work of peers, each learner has had to use it to develop their own work.

    This ensures a kind of parity between peers: whatever the differences in experience and expertise, countries, or specializations, everyone has first practiced using the rubric for their own needs.

    In such a context, the key is not the rating, but the explanation that the peer reviewer will provide to explain it, with the requirements that she provides constructive, practical suggestions for how the author can improve their work.

    In some cases, learners are surprised to receive contradictory feedback: two reviewers give opposite ratings – one very high, and the other very low – together with conflicting explanations for these ratings.

    In such cases, it is an opportunity for learners to review the rubric, again, while critically examining the feedbacks received, in order to adjudicate between them.

    Ultimately, rubric-based feedback allows for significantly more learner agency in making the determination of what to do with the feedback received – as the next task is to translate this feedback into practical revisions to improve their work.

    This is, in and of itself, conducive to significant learning.

    Learn more about rubrics as part of effective teaching and learning from Bill Cope and Mary Kalantzis, two education pioneers who taught me to use them.

    Image: Mondrian’s classroom. The Geneva Learning Foundation Collection © 2024

  • Pandemic preparedness through connected transnational digital networks of local actors

    Pandemic preparedness through connected transnational digital networks of local actors

    What is the link between pandemic preparedness, digital networks, and local action? In the Geneva Learning Foundation’s approach to effective humanitarian learning, knowledge acquisition and competency development are both necessary but insufficient. This is why, in July 2019, we built the first Impact Accelerator, to support local practitioners beyond learning outcomes all the way to achieving actual health outcomes.

    What we now call the Full Learning Cycle has become a mature package of interventions that covers the full spectrum from knowledge acquisition to implementation and continuous improvement. This package has produced the same effects in every area of work where we have been able to test it: self-motivated groups manifesting remarkable, emergent leadership, connected laterally to each other in each country and between countries, with a remarkable ability to quickly learn and adapt in the face of the unknown. Such networks have obvious relevant for pandemic preparedness.

    In 2020, we got to test this package during the COVID-19 pandemic, co-creating the COVID-19 Peer Hub with over 6,000 frontline health professionals, and building together the Ideas Engine to rapidly share ideas and practices to problem-solve and take action quickly in the face of dramatic consequences of the new virus on immunization services (largely due to fear, risk, and misinformation). By January 2021, over a third of Peer Hub members had successfully implemented their immunization service recovery project, far faster than colleagues who faced the same problems but worked alone, without a global support network. Once connected to each other, these country teams then organized inter-country peer learning to help them figure out “what works” for COVID-19 vaccine introduction and scale-up.

    Such a holistic approach is about mobilizing and connecting country-based impact networks for pandemic preparedness that reach and involve practitioners at the local levels, as well as national MoH leaders and planners – quite different from conventional approaches (whether online or face-to-face) to building capacity and preparedness.

    TGLF’s global health network and platform reach significant numbers of practitioners at all levels of the health system. It is not only the number of people who participate (47,000 as I write this) but also the depth of engagement and diversity of contexts that they work in. Globally, 21.2% face armed conflict; 24.5% work with refugees or internally-displaced populations; 61.6% work in remote rural; 47% with the urban poor; 35.7% support the needs of nomadic/migrant populations. This is across 110 countries, with over 70 percent in “high burden” countries. Many have deep experience in responding to epidemic outbreaks of all kinds. Health professionals who join come from all levels of the health system, but most are (logically) from health facilities and districts, the bottom of the health pyramid.

    Through the network and platform, they build lateral connections, forging bonds not only of knowledge but also of trust. They do this not because they are from the same profession, but primarily (we believe) because they face similar challenges and see the benefit of sharing their experience in support of each other. Engagement is voluntary (ie people opt in and contribute because they want to), with no per diem or other extrinsic incentives offered. The concern for both epidemic outbreak and pandemic preparedness is shared.

    Individuals develop and implement corrective actions to tackle the root causes of the challenges they are taking on, drawing on both peer learning and the best available global guidelines. For the IA2030 Movement, our largest initiative so far, participants are simultaneously implementing 1,024 projects in 99 countries, learning from each other what works, sharing successes, lessons learned, and challenges. Here are four examples of what collective action through digital networks looks like :

    • In Ghana, TGLF’s alumni (including national and regional MoH EPI directors) decided to organize online sessions country-wide to share the latest information about COVID-19 with local staff, starting in April 2020. They had learned how to use digital tools to find the best available global knowledge and to combine it with their local expertise and experience to inform collective action.
    • In Burkina Faso, the national EPI manager entrusted the first “masked” vaccination campaign to the TGLF alumni team, which has organized itself country-wide, with over half of alumni working in conflict-affected areas. He told me no one else had the network and the capacity for change to figure out quickly how to get this right.
    • In the Democratic Republic of Congo, the TGLF alumni team is increasingly being asked by national EPI to contribute to various activities, due to their effectiveness in connecting and coordinating. The alumni network is country-wide and includes many from very remote areas. When Monkeypox was reported in Europe and North America, we were already seeing a steady stream of information through the DRC and other country networks.

    We believe that this continuous learning and action is actually the definition of pandemic preparedness. Trying to imagine preparedness and response to new pandemics using old, failed methods of training and capacity building – whether face-to-face or online – is both dangerous and irrational.

    Image: Remote villages illuminated by rays of light, with mountains beyond mountains in the background. The Geneva Learning Foundation Collection.

  • Reinventing the path from knowledge to action in global health

    Reinventing the path from knowledge to action in global health

    At the Geneva Learning Foundation (TGLF), we have just begun to share a publication like no other. It is titled Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers.

    You can access the full report here in French and in English. Short summaries are also available in three special issues of The Double Loop, the Foundation’s free Insights newsletter, now available in both English and French. The report, prefaced by Heidi Larson who leads the Vaccine Confidence Project, includes DOI to facilitate citation in academic research. (The Foundation uses a repository established and maintained by the Geneva-based CERN for this purpose.)

    However, knowing that academic papers have (arguably) an average of three readers, we have a different aspiration for dissemination.

    As a global community, we recognize the significance of local action to achieve the global goals.

    The report documents vaccine confidence practices just weeks before the introduction of COVID-19 vaccines. It is grounded in the experience of 734 practitioners from local communities, districts, regions, and national teams, who developed case studies documenting a situation in which they were able to successfully lead individuals and groups toward better understanding and acceptance of the benefits of vaccines and vaccination.

    Immunization staff from all levels of the health system became citizen scientists, active knowledge-makers drawing on their personal experience of a situation in which they successfully overcame the barriers to vaccine acceptance in the community.

    Experiential learning offers a unique opportunity to discover unfiltered experiences and insights from thousands of people whose daily lives revolve around delivering immunization services. But what happens once experience has been shared? What is to be done with what we learn?

    Sharing this report, we have found, has triggered remarkable dialogue and led to the co-creation of a steadily growing collection of new practices actually used to build vaccine confidence (as opposed to the many theoretical frameworks on the topic), submitted through our new Insights system. New stories and their analysis are being shared back with local practitioners and with TGLF’s Insights partners, fostering continuous learning that is an action imperative of a strong learning culture. (For Insights, we work with Bridges to Development, the Centre for Change and Complexity in Learning (C3L), and the International Vaccine Access Center at Johns Hopkins.)

    In the coming weeks, we will be inviting 10,000 leaders of the Movement for Immunization Agenda 2030 to share this report to their colleagues, teams, and organizations (in both ministries of health and civil society organizations). They will be sharing back their own insights on how the findings can be used to improve demand for vaccines – and colleagues who listen to their presentation of the report will also be able to share back what they learn, connecting with each other through our Insights system.

    Then, the Foundation’s Impact Accelerator will track if and how insights from this report are linked to reported positive outcomes, and we should be able to document this, at least in some cases. This will not only foster double-loop learning but also explicitly link learning to implementation and results.

    In this way, local practitioners will be putting to use global knowledge grounded in their local experiences, for their own needs. We believe that this provides a complementary, more organic mechanism than current top-down processes for developing normative guidance driven by global assumptions and priorities.

    As Kate O’Brien, WHO’s Director of Immunization, said during a recent Insights Live session: “The global role on immunization is actually to bring together everything that is known by people at the grassroots level. That’s where the action is. Global guidance is basically one means to share knowledge and expertise that’s coming from the grassroots level around the world with others who may not have had that experience yet.”

    What we are doing with this report is part of a larger initiative to build the IA2030 Movement Knowledge to Action Hub. New knowledge produced by local practitioners will be available as both static and living documents that local and global practitioners can add their inputs to, at any time. This Hub will be launched at Teach to Reach 7 on 14 October 2022, with over 13,000 local practitioners registered for this event.

    Image: Many paths to moving mountains. The Geneva Learning Foundation Collection.

  • Renaissance

    Renaissance

    For decades, learning in global health has depended on a conventional model premised on the scarcity of available knowledge and an emphasis on establishing mechanisms to transmit that knowledge from the center (capital city, headquarters) to the periphery (field, village, training room).

    With the Internet, scarcity disappeared. But the economy of high-cost, low-volume training has persisted, with little or no accountability. Worse, transmissive training – replicating the least-effective practices from physical spaces – began to proliferate online in video-based training and webinars.

    That economy need to be rebuilt in a digital-first age. It requires a new, long-term infrastructure.

    The platforms that could do this are the ones that deeply care about the people they reach, with teams who understand that trust in boundless digital spaces must be earned. It has to come from the heart.

    The quality of content also matters, but it is not sufficient.

    The quality of conversation in the network – as well as the quality of the ‘pipes’ that connect those in it – matter more.

    So does the quality of the relationships, both between the team and its members, but – perhaps even more so – between its members. 

    There are a number of digital platforms that are trying to connect health workers. In aggregate, it is going to work. 

    The fledgling efforts have been about how to reach people. The next phase is going to be about rebuilding the knowledge and learning engine that can drive not just performance and results, but also renew meaning and purpose.

    This rebuilding will be based on trust. And on transferring ownership from those who initiated these platforms to those who need them.

    Trust does not happen because a platform is easy to use. It does not happen because great content is being offered. It is not about getting the “user” to click the “register here” or “join now” calls to action. 

    We have seen what happens when social media customers are advertisers rather than content creators. 

    What is the business model for digital health education?

    Competition in digital health education can foster a Renaissance for global public health.

    We need platforms to succeed if we do not want to remain in the Dark Ages.

  • A round table for Immunization Agenda 2030: The leap from “bottom-up” consultation to multidimensional dialogue

    A round table for Immunization Agenda 2030: The leap from “bottom-up” consultation to multidimensional dialogue

    They connected from health facilities, districts, and national teams all over the world. 4,769 immunization professionals from the largest network of immunization managers in the world joined this week’s Special Event for Immunization Agenda 2030 (IA2030), the new strategy for immunization, with 59 global and regional partners who accepted the invitation to listen, learn, and share their feedback. (The Special Event is now being re-run every four hours, and you can join the next session here.)

    “My ‘Eureka moment’ was when the presenter emphasized that many outbreaks are happening throughout the globe and it is the people in the room who can steer things in a better direction”, shared a participant. “This gave me motivation and confidence that by unifying on a platform and by discussing the challenges, we can reach a solution.”

    Two of the top global people accountable for executing this new strategy, WHO’s Ann Lindstrand and UNICEF’s Robin Nandy, were in attendance. “With such commitment”, said Robin Nandy, “I am confident that we can achieve the goals of IA2030. Let us be mindful of the importance of convenient and high quality services delivered by a well informed workforce, which you all embody.”

    Hearing “invaluable insights”, Ann Lindstrand recalled that “IA2030 was developed with thousands of immunization stakeholders like you. It reflects exactly what you are telling today. I am encouraged to hear your analyses and ideas to face our common challenges.”

    Indeed, in developing Immunization Agenda 2030 intended to be “adaptive and flexible”, global partners employed a “bottom-up co-creation process”, described as “close engagement of countries to ensure that the vision, strategic priorities and goals are aligned with country needs.”

    There is, however, a risk of confirmation bias. Staff from countries do their best to carry out what they have been asked to do. In the conventional top-down hierarchical system, global recommendations are adopted by ministries of health that then command staff to execute them. If the system remains overly rigid, staff who want to keep their jobs are likely to confirm and comfort the assumptions of the higher-ups whose vision they have been tasked to implement, no matter the depth of the chasm between these assumptions and reality.

    During the Teach to Reach Accelerator conference in January 2021, Kate O’Brien, the director of WHO’s Immunization Department, pointed out that the term “bottom-up initiative” does not call into question existing hierarchies: “I don’t like the sort of hierarchy, about this is the bottom and this is the top, it has a certain sort of power element to me. […] I think leadership is about sitting around a table with a group of people, and drawing the best ideas from everybody who’s sitting around that table, wherever they come from.”

    Of course, immunization programmes have a strong technical dimension that require standardization. There are critical elements required for safe and effective vaccination. For example, WHO now organizes weekly didactic Q&A webinars (with Project ECHO, a fascinating organization of doctors exploring new ways to learn, and TechNet-21, a pioneering digital platform for immunization) that do the job of transmitting information to people involved in COVID-19 vaccine introduction. However, we know that information is necessary but insufficient to lead to the effective localization and application of standards. 

    As Kate O’Brien explained, “we need people to feel like they have the authority and are empowered to lead change in their community, in their programme, at the most local level, understanding what the goal is and what the targets are, taking those critical things that really cannot be compromised and adapting all around that.”

    The IA2030 framework is, according to its global custodians, “designed to be tailored by countries to their local context, and to be revised throughout the decade as new needs and challenges emerge.” In line with this vision, global partners are hoping to foster a “groundswell of support” or even a “social movement”, to ensure that immunization remains high on global and regional health agendas in support of countries.

    Alicia Juarrero, whose research focuses upon complex systems’ models of neural processes involved in proto-moral, moral and ethical cognition, emotions and behaviors, has made the compelling point that requires us to restructure what she calls the “space of possibility”. Continuous dialogue enabled by digital technologies can cut across hierarchies and borders to help create such a space. This represents a logical and constructive shift from “bottom-up” toward what Ian Steed has called multidimensional dialogue.

    Such a dialogue is likely to be different from what global partner staff are used to. It may be interesting, yet feel somehow illegitimate, if only because challenging the status quo may not be in their job description. Some may question its relevance. “This is just not how we do things in immunization,” is how one partner rebuked us in private. Others may even feel threatened, choosing to ignore or dismiss it, even if their organization’s mission is to support countries and people who deliver vaccines. Certainly, what is emergent is far from perfect and requires continued improvement to be truly inclusive of all voices and stakeholders needed to achieve the immunization goals. Nevertheless, participants in this week’s global round table collectively expressed the feeling of empowerment that stems from being connected in a global community for action. Combined with active presence and strong support of organizational leaders, it is moments like these that can spark new consciousness and could foster the birth of a movement.

    Image: Rainbow above the clouds. Personal collection.

  • Two false dichotomies: quality vs. quantity and peer vs. global expertise

    Two false dichotomies: quality vs. quantity and peer vs. global expertise

    The national EPI manager of the Expanded Programme for Immunization (EPI) of the Democratic Republic of the Congo (DRC), just addressed the COVID-19 Peer Hub Teams from DRC and Ivory Coast, saluting both teams for their effort to prepare and strengthen COVID-19 vaccine introduction. I am honored to have been invited and pleased to see how this initiative is not only country-led but truly owned and led by its participants.

    She has joined the Inter-Country Peer Exchange (reserved for COVID-19 Peer Hub Members) organized by the Peer Hub’s DRC Team to share rapid learning from COVID-19 vaccine introduction.

    In the room are immunization professionals, primarily those working for the Ministries of Health, directly involved in vaccine introduction from both countries and from all levels of the health system.

    Other COVID-19 Peer Hub country teams are organizing similar inter-country exchanges, in response to their own needs, building on what they have learned as Scholars about the value of digital networks to strengthen and accelerate their response to the pandemic, from recovery to vaccine introduction.

    Today’s exchange is reserved for COVID-19 Peer Hub Members from the two countries, following a public meeting on 27 March 2021. (Short recaps in French and in English are available below. The full recording of the inaugural 27 March 2021 exchange is available on The Geneva Learning Foundation’s social media channels.)

    The Inter-Country Peer Exchange is only possible because, in response to the pandemic in 2020, we co-designed the Peer Hub and rapidly doubled the size of what was already the largest platform for immunization managers. We combined the best of both worlds: the best available global technical expertise with the field-based expertise of thousands of participants.

    In this way, we do not need to choose between false dichotomies that seek to oppose quality to quantity or peer versus global expertise.

    COVID-19 vaccine introduction: Recaps below in English and French about the first COVID-19 Peer Hub Inter-Country Peer Exchange between the Peer Hub teams from the Democratic Republic of the Congo (DRC) and Ivory Coast